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Enrollment Barriers: Asian Americans and Obamacare

By Vanessa Wang


There are four ways to enroll in health plans under the Affordable Care Act (ACA), also known as Obamacare: online, by mail, on the phone, or in person. The problem is, most of these resources are available only in English and Spanish. This makes enrolling difficult for Asian Americans, Native Hawaiians, and Pacific Islanders (AAs and NHPIs) with limited English proficiency.  Hundreds of thousands in the AA and NHPI community remain uncovered. On September 30, approximately 115,000 people lost their insurance coverage because they could not understand, and therefore failed to respond to, the English and Spanish notices requesting proof on their citizenship status. The Attorneys with the National Immigration Law Center, the law firm Holland & Knight, and several AHJ partners filed formal complaints on September 30, contending that the Affordable Care Act doesn’t follow through with its anti-discrimination provisions.

Action for Health Justice (AHJ), a coalition of over 70 community-based organizations and Federally Qualified Health Centers across 22 states, has successfully reached and enrolled more than 600,000 people through bilingual staff and outreach programs. AHJ was co-founded by four national organizations: Asian and Pacific Islander American Health Forum (APIAHF), Association of Asian Pacific Community Health Organizations, Asian Americans Advancing Justice, and Asian Americans Advancing Justice, Los Angeles. The White House recognized AHJ as a Champion of Change for educating AAs and NHPIs about the new health law.

Priscilla Huang, Senior Director for Impact at APIAHF, says she initiated AHJ in July 2013 because she foresaw Asian American communities facing ACA enrollment barriers and because she considered herself “a liaison and translator between communities and policy makers.” Ms. Huang grew up witnessing her mother “trying to find the right English word” and feels privileged for having gone to law school and “knowing how to say the right word.”

2 During the first enrollment period from October 2013 to March 2014, AHJ partners across the country held weekly conference calls and in-person meetings to share experiences and pinpoint best practices in maximizing enrollment. AHJ held a summit conference in D.C. on September 24, to exchange learned lessons and prepare for the second Open Enrollment. They released a national report, which summarized gaps in resources at state and federal levels during the first Open Enrollment. Huang hopes that this report will “drive state and federal policymakers to improve and enhance Affordable Care Act and Marketplace policies and systems.”

The report identified three major barriers to enrollment: language, immigration status concerns, and low health literacy. Language was identified as the number one barrier. 60% of Asian Americans are foreign-born, the highest of any ethnic group. 32% of Asian Americans have a limited ability to read, write, speak, or understand English. Yet posters, websites, fact sheets, and government presentations aimed at educating people about the ACA are either unavailable in Asian languages or present poor, indecipherable translations. The wait-time for a bilingual assister at the marketplace call center can exceed a week, and the automated recording on the phone provides no Asian language options. To overcome language gaps, AHJ created their own in-language materials and provides enrollment assistance in more than 41 languages, including Tagalog, Urdu, and Samoan. AHJ partners offer in-language, one-on-one appointments to local community members.

Other key barriers Asian Americans face in health plan enrollment include immigration-status concerns and low health literacy. Eligible immigrants applying for health coverage are required to prove their citizenship status, a process that discourages many AAs and NHPIs for fear of deportation, even though the ACA assures that documentation for enrollment would not be used against immigrants. AHJ further reported that immigrant consumers lacked knowledge of Western healthcare systems, including concepts such as deductibles and co-payments. To educate AA and NHPI communities on immigration and healthcare issues, AHJ partners disseminate flyers and offer group presentations at local communities. To maximize outreach, AHJ collaborates with schools, religious groups, small-business organizations, ethnic medias, and government agencies.

3After months of paperwork to enroll in health plans, many eligible immigrant families lost their coverage on September 30 because they failed to provide adequate documentation on their citizenship status. Earlier in August, these families received governmental requests to resubmit verification on their eligibilities, but the families failed to respond because they could not understand the letters written in English or Spanish. The National Immigration Law Center and Holland & Knight filed a Freedom of Information Act request to learn more about the 115,000 people who lost health coverage. Huang and others in AHJ organizations have filed administrative complaints, on the basis that the Department of Health and Human Services violated the anti-discrimination provisions of the Affordable Care Act. These complaints are pending response.

AHJ has committed to at least three years in its mission of outreach, education, and enrollment assistance. It is currently preparing for the second year of Open Enrollment, which begins November 15. To learn more about AHJ’s efforts and to access its national report on enrollment barriers, visit: http://www.apiahf.org/healthcare4me/action-health-justice. To learn more about The Freedom of Information Act request and administrative complaints, visit


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