WASHINGTON -- Explaining the Affordable Care Act is hard enough. Try explaining it to someone who comes from a country where health insurance itself is a foreign concept.
Then try telling them how the insurance "marketplace" works.
Vietnamese speakers looking to comply with the Affordable Care Act were given materials that translated marketplace as something like "stock market for health insurance."
To Chinese ears, the marketplace would have sounded more like a physical supermarket, and speakers of Tagalog got a translation of deductible that could have led them to believe it was a reduction in cost -- not the amount paid out-of-pocket for services.
"There are a number of communities that are deeply affected by the challenges of language access," said Kathy Ko Chin, president of the Asian and Pacific Islander American Health Forum.
Language is just one of the challenges faced by community groups that have been working to boost enrollment ahead of Monday's deadline to enroll for health insurance through the federal marketplace.
Translation challenges and a lack of widely available materials in many foreign languages have strained the capacity of the groups that try to take the state's non-English speakers through the complicated process of signing up - and understanding American health care.
"At the beginning, the word ‘marketplace' being translated - like in Vietnamese - it sounded like it was a grocery store, that you go to a store and shop for health insurance," said Yen Nguyen, acting CEO for Asian Pacific Community in Action. The nonprofit promotes health and wellbeing of Asian and Pacific Islander families in Maricopa County.
"It was very funny because in reality it's just an online website that you go into for health insurance, not an actual grocery store," Nguyen said.
Vietnamese speakers were not alone, said Ko Chin, who co-chairs an umbrella organization called AIM for Equity that wrote to the Department of Health and Human Services to report questionable translations in health care materials. It said some translations weren't even translations: For materials in Tagalog, a language of the Philippines, some words were just made up.
Foreign languages spoken in Arizona range from Tagalog to Albanian to Navajo. And speakers of those languages were more likely to be uninsured in 2012, before Obamacare took effect, according to Census Bureau estimates.
Compounding the problem is the fact that the government marketplace website is only available in English and Spanish.
But even Spanish speakers, who comprise nearly three-quarters of the non-English-speaking adults in Arizona, were confused by translated materials explaining Obamacare, enrollment advocates said.
During its original rollout, the description of the health insurance marketplace as an "exchange" was misleading to Latinos, said Cheryl O'Donnell, Arizona's state director of Enroll America.
"When you talk about an exchange, you're talking about, ‘I give you something in exchange for something,' and it's very concrete in that way," O'Donnell said.
"Whereas a marketplace, everybody's familiar with a marketplace," she said. "They know that if they go somewhere, they have to purchase something, but they have a variety of choices in order to make the purchase that they want."
Beyond translation issues, many non-English speakers come from countries and communities without health insurance programs. In some cases, insurance itself is a novelty.
"If you've never lived in a country that has health insurance and you live now in this country that has health insurance … what is insurance, first of all? What's health insurance?" Ko Chin said.
"You tell me I'm paying something every month; what do I get for it? And then, even when I go to the doctor, I still have to pay something?" she said. "You start putting all these pieces together, and it doesn't make sense."
But many were able to get past the fractured translations and foreign concepts and get enrolled. Those early enrollees are already beginning to receive their health plan packets - all in English, Ko Chin said.
"So those people go right back to their...APCA-like organization and say, ‘What is this? You have to explain this,'" she said.
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