Millions of Californians with limited English proficiency now have the right to an interpreter from their commercial health and dental plans -- made possible by a first-in-the-nation law aimed at dismantling the language barriers that get in the way of good medicine.
The new regulation -- implemented New Year's Day after five years of hearings, delays and wranglings among insurance companies, regulators and consumer advocates -- is widely touted as a milestone in reducing mistakes because of miscommunication.
"This is really huge, especially in California where we're getting more and more diverse," said Martin Martinez, policy director for the California Pan-Ethnic Health Network. "Even if you speak English well, it's really hard to understand what your doctor is saying."
As many as 7 million Californians with health-related private insurance lack English fluency and could benefit from the new language service.
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Patients rights advocates applaud the new rules but worry non-English speakers won't be told about the help now available to them. To spread the word, the state is launching a publicity drive in the coming weeks.
"This law has been some time coming," said Anthony Wright, executive director of California Health Access. "Our big concern now is whether people have adequate notice about their rights, and can actually use them."
Doctors' orders will now have to be translated, at least verbally, into Spanish, Mandarin, Hmong, Russian -- any spoken language.
The size and cost of the task -- estimated by insurers to be about $25 million -- make it the biggest regulation effort undertaken by the California Department of Managed Health Care, which regulates HMOs.
The law, Senate Bill 853, was signed in 2003, but shelved as part of a moratorium imposed by Gov. Arnold Schwarzenegger when he took office. It was finally dusted off, but insurers balked at the cost.
"Obviously, we know this is a diverse state and people speak many different languages," said Nicole Kasabian Evans, spokeswoman for the California Association of Health Plans.
The insurers' concern, she said, was about balancing access and affordability. Some insurers plan to contract out the language services.
Some of the infrastructure was already in place because federal law requires health plans to offer interpreters to those enrolled in Medi-Cal or Healthy Families. For years, larger hospitals have had interpreters standing by. Kaiser Permanente, for instance, has 50 at its Northern California facilities and has 3,400 employees with second-language skills.
But many patients did not have guaranteed access to interpreters. For that reason, California's law is broad in its sweep. It requires health, dental and specialty insurers to provide subscribers with translators, at least by telephone, while visiting their doctor, pharmacist or dentist.
"The intent is that better communication leads to better health care. To the extent we can make that possible, we're going to work to do that," said Ben Singer, a spokesman for Anthem Blue Cross, which provides dental and medical insurance to 8 million Californians.
More than 40% of the state's 37 million residents speak a language other than English, according to U.S. Census estimates. A fifth of the population say they do not speak English "very well."
The California Healthcare Interpreting Association in Sacramento is pushing for a certification program to ensure that interpreters used by health plans are well-versed in medical lingo and the languages they translate.