OAKLAND, Calif. (AP) — Set on a gritty corner of Oakland's International Boulevard, the nonprofit Street Level Health Project offers free checkups to patients who speak a total of 22 languages, from recent Mongolian immigrants seeking a doctor to Burmese refugees in need of a basic dental exam.
It also provides a window into one of the challenges for state officials who are trying to implement the Patient Protection and Affordable Care Act (PPACA).
Understanding the law is a challenge even for governors, state lawmakers and agency officials, but delivering its message to non-English speakers who can benefit from it is shaping up as a special complication. That is especially true in states with large and diverse immigrant populations.
For Zaya Jaden, a 35-year-old from Mongolia, getting free care for her sister's persistent migraine was a much higher priority than considering how the expansion of the nation's social safety net through PPACA might benefit her.
The sisters crammed into the clinic's waiting room, sandwiched between families chatting in the indigenous Guatemalan language Mam, and discussed whether enrolling in Medicaid under the PPACA would work for the family's finances.
"It was a good idea that Obama had, but I don't know if it will work for me," said Jaden, who gets private insurance for her family through her job as a laundress at an Oakland hotel and currently makes too much money to qualify for Medicaid. "If I make less than what I make to try to qualify for the government program, how could I pay my rent?"
Jaden's ambivalence demonstrates the cultural and language hurdles that California and several other states are facing as they build exchanges — or health insurance marketplaces —and try to expand coverage to ethnic and hard-to-reach populations.
California has the largest minority population of any state, about 22.3 million people. That's followed by Texas with 13.7 million, New York with 8.1 million, Florida with 7.9 million and Illinois with 4.7 million.
In Illinois, where nearly 1.2 million residents don't speak English well, the task of translating information about the health care overhaul into other languages has fallen to nonprofit groups and community organizations.
"So far it's fallen to us, and we don't know what (the state's) capacity will be to go beyond Spanish," said Stephanie Altman of Health and Disability Advocates.
The state intends to submit an outreach plan to the federal government this spring. Illinois officials expect federal grant money eventually will be available to help reach non-English speakers, said Mike Claffey, a spokesman for Democratic Gov. Pat Quinn.
The U.S. Census estimates that more than 55 million people speak a language other than English at home. Nearly 63 percent of those are Spanish-speakers, with the highest concentrations in Texas, California and New Mexico. Chinese was the third most commonly spoken language, with large populations in California, New York, Hawaii and Massachusetts.
Five other languages have at least 1 million speakers: Tagalog, French, Vietnamese, German and Korean.
In California, two-thirds of the estimated 2.6 million adults who will be eligible for federal subsidies in the health care exchange will be people of color, while roughly 1 million will speak English less than very well, according to a joint study by the California Pan-Ethnic Health Network and the UCLA Center for Health Policy Research and the University of California, Berkeley Labor Center.
With such diversity in cultures and language, the authors said the success of health care reform "hinges in large part on how well the state conducts culturally and linguistically competent outreach and enrollment efforts."
"If the exchange did no targeted outreach, there could be 110,000 fewer limited-English proficient individuals enrolled," said Cary Sanders, director of policy analysis for CPEHN, an Oakland-based multicultural health advocacy group.
Even the relatively mundane task of developing a brand for California's new health care exchange has prompted some angst.
The exchange's staff tried to come up with a name that signified health insurance and would translate well into Spanish, Chinese, Tagalog, Vietnamese and other languages commonly used in California.
