Since the Affordable Care Act (ACA) became law six years ago, more than 20 million people have enrolled and received coverage. From the numbers alone, one thing is clear: the efforts of policymakers, advocates and navigators show their work is paying off. The number of uninsured in this country has dropped to a historic low, in no small part thanks to the tax credits, subsidies, and expanded Medicaid that make coverage for low- and middle-income families more affordable than ever before.
For the fastest growing racial groups in the country - Asian Americans, Native Hawaiians, and Pacific Islanders (AA and NHPI) - successful enrollment relied on community resources like Action for Health Justice. This national coalition of more than 70 community-based organizations works to outreach, educate and enroll AAs and NHPIs in 22 states and through 56 languages. During the last three Open Enrollment periods, AHJ outreached, educated and enrolled nearly one million AAs and NHPIs. This work has contributed to the yearly drop in AA and NHPI uninsured rates, which was nearly one in seven before the ACA.
Approaching the sixth anniversary of this historic law, success stories abound. In cities and communities across the country, millions of people have affordable options to see a doctor, fill a prescription, and have peace of mind for the health of their families. Thanks to the law's new coverage options, a Tongan American man in Utah was able to move from his employer's expensive health plan into coverage through the Marketplace. With the help of a Navigator, he cut his monthly costs in half and provided his family with the same coverage -- a prospect unthinkable before March 23, 2010. In Mississippi, a self-employed fisherman and his family of five had not been able to afford a doctor's visit in years. Navigators delivered the good news that with a tax credit, the entire family could enroll in a plan they could afford, which began in February. Gone are the days of avoiding the doctor over fear of the bill.
But as anyone who has ever opened a thick "Welcome" packet from a health insurer knows, getting an insurance card is just the first step. Trying to find a primary doctor, search for a specialist, or figure out if your family doctor is in your network - these questions can be a headache for anyone and overwhelming for someone who has never had insurance before. The whole health insurance system can be unfamiliar, and frankly, daunting. Furthermore, if you are one of the 25 million Americans, or one in three AAs and NHPIs who speak a language other than English, this process is even more challenging.
The next push in health care progress must be to ensure that those who have obtained their hard-earned coverage can actually use it. It is often difficult for people who don't speak English very well to find information in their language or answer questions about their coverage--from choosing the right doctor, to finding the closest pharmacy, to understanding how to get a referral for a specialist.
The Centers for Medicare & Medicaid Services is helping connect people to care with handy materials available in three Asian languages - Chinese, Korean, and Vietnamese - to help people understand the coverage they have. Other than these fact sheets, few resources are available in-language, leaving outside groups like AHJ and community-based organizations working directly with the newly insured to fill in the gaps. One group in Oregon helped a newly covered Chinese family find appropriate doctors. The parents were first-generation immigrants, spoke little English, and greatly distrusted doctors they had previously tried to see because of the lack of in-language materials and staff who could help translate. Their child said, "I often translate medical documents and reminders because my parents were not sure whether it was a bill or if it was an important document. I also translated during appointments," because translation services were not covered by their insurance plan. The group worked with the family to figure out the appropriate doctor for the parents, keeping in mind the language barrier. Unfortunately, this is a common story and one that won't go away without concerted efforts to get people from an insurance card to a doctor's office.
An insurance card can be a ticket to better health, but only if the cardholder knows how to use the coverage to find quality, culturally, and linguistically accessible providers. Health care advocates must focus just as intently on continuing enrollment as on supporting in-language materials and interpreters and translators to bridge that gap. Policymakers must continue to develop in-language materials and make them accessible for health programs and centers across the country. On this sixth anniversary of the ACA, getting 20 million people covered is an achievement to celebrate, but getting those millions connected to care is what will truly assure the law's long-lasting impact.