The Role of Limited English Proficiency and Access to Health Insurance and Health Care in the Affordable Care Act Era

Abstract

Purpose: Limited English proficiency adversely impacts people's ability to access health services. This study examines the association between English language proficiency and insurance access and use of a usual care provider after the implementation of the Affordable Care Act (ACA). Methods: Using cross-sectional data from the 2016 Medical Panel Expenditures Survey, we identified 24,099 adults (weighted n =240,035,048) and categorized them by self-reported English-language proficiency. We classified participants according to responses to: “How well do you speak English? Would you say… Very well; well; Not well; Not at all?” (having limited English proficiency: not well; not at all, English proficient: well; very well; and English only: not applicable) and “What language do you speak at home? Would you say… English, Spanish, Other.” Using these two recoded variables, we created a variable with five categories: (1) Spanish speaking, with limited English proficiency, (2) other language speaking, with limited English proficiency, (3) Spanish speaking, English proficient, (4) other language speaking, English proficient, and (5) English only. Health insurance and usual care provider were determined by self-report. Results: Among those <65 years, the percent covered by public insurance (Spanish: 21%, Other languages: 28%, English only 14%), who were uninsured (Spanish: 46%, Other languages: 17%, English only: 8%), and who lacked a usual care provider (Spanish: 45%, Other languages: 35%, English only: 26%) differed by English language proficiency. Among those ≥65 years, fewer people with limited English proficiency relative to English only were dually covered by Medicare and private insurance (Spanish: 12%, Other languages: 15%, English only: 59%), and a higher percent lacked a usual care provider (Spanish: 15%, Other languages: 11%, English only: 7%). Differences persisted with adjustment for covariates. Conclusion: Post the ACA, persons with limited English proficiency remain at a risk of being uninsured relative to those who only speak English.

Examining the role of language competency in genetic testing awareness among adults in the United States

“…Informational resources for individuals with limited English-speaking ability may be less accessible due to a lower likelihood of health insurance and access to a usual care provider (Foiles Sifuentes et al, 2020) and explain the significantly lower odds of genetic testing awareness among non-White respondents with low English proficiency as underrepresented racial and ethnic groups have been found to have lower access to health coverage (Cohen et al, 2018).…”

Disparities in SARS-CoV-2 positivity among pregnant patients with limited English proficiency

“…Latinx populations may be at particular risk of SARS-CoV-2 because of overrepresentation in essential jobs requiring face-to-face interactions, reliance on public transportation, and multi-generational living [ 4 ]. Healthcare access among Latinx LEP communities can be additionally limited by socio-political barriers [ 4 ]; Latinx patients with LEP are more likely to be underinsured than non-Spanish-speaking patients with LEP [ 5 ]. Although data on outcome variation by LEP status is scarce, there is some evidence that Latinx patients with LEP may be at higher risk for poor health than patients with LEP of different racial/ethnic backgrounds [ 6 ].…”

Compact for care: how the Affordable Care Act marketplaces fell short for a vulnerable population in Hawaii

“…Compounding this challenge was the high proportion of COFA households (52.3%) reporting challenges with accessing services due to LEP 29. Other US contexts have demonstrated that those with LEP are much less likely to be insured than other populations, both because of related socioeconomic barriers and the direct impact of difficulty understanding printed materials and communication with insurance providers 5 30…”

“…In the USA, the high costs of care coupled with a large proportion of uninsured individuals contributes to substantial annual risks of catastrophic health expenditures 4. Low-income individuals, migrants and those with limited English proficiency (LEP) are at particular risk 5 6…”