Many recent immigrants in Philadelphia, who are signed up for health insurance through the ACA, now face special hurdles in using that new coverage.
Tens of thousands of Philadelphians are now signed up for health insurance through the Affordable Care Act. That includes many recent immigrants who, in some cases, may now face special hurdles in actually using the new coverage.
Initial excitement and confusion
Thoai Nguyen, director of the Southeast Asian Mutual Assistance Associations Coalition in Philadelphia, or SEAMAAC, said that for many new Americans, the initial enrollment period signaled access to insurance for the very first time.
“The excitement of possibly getting coverage… it started a whole healthy way of talking about health,” he said, pointing to the high uninsured and underinsured rates among the communities SEAMAAC serves.
Immigrants typically have to wait five years to qualify for federal benefits, but not so for ACA subsidies.
Nguyen’s agency helped hundreds sign up for coverage, but it wasn’t always easy. Many didn’t realize they were eligible, he said, while others worried, incorrectly, that drawing down a federal subsidy to buy coverage would reduce their tax refund.
Nancy Nguyen, director of the nearby Philadelphia branch of BPSOS, an agency mainly serving Philadelphia’s Vietnamese community, said initially there was a lot of confusion and “fear to get on because people weren’t sure why they had to divulge so much information” to the government.
But she said once people began to hear about someone they knew getting affordable insurance through the ACA, it overcame their fears.
“Literally our phones just started blowing up,” said Nguyen. “People just started coming to our office and we had to self-inform.”
Language was, and remains, a huge barrier, according to area health workers. Navigating health insurance can be hard for anyone, but on top of that, the application was only available in English and Spanish.
Enter Shekhar Bastola and a handful of other SEAMAAC workers who speak Mandarin, Karen and other Burmese dialects. The group spent a lot of time going through the enrollment process with people using the language enrollees know best.
Monchi Tamang, 59, came to Philadelphia three years ago, after two decades in a refugee camp in Nepal. She speaks no English, but heard about the ACA from a relative.
“I feel like I need insurance because sometimes we may have some kind of emergency and we may get sick,” she said. “When we go to the hospital without insurance, it’s going to cost a lot of money.”
On her own, Tamang was stuck. The marketplace’s phone interpreters couldn’t really help her sort through plan options because it lacked visual aids. Luckily for Tamang, she met Bastola, a Bhutanese outreach worker who spoke her native language at SEAMAAC.
Through multiple visits, Bastola and other staffers guided legal immigrants through the process.
Priscilla Huang, with the Asian and Pacific Islander American Health Forum, Her group, part of a broader ACA collaborative, found that even when the marketplaces offered materials in Asian languages, the documents were rife with errors, including made up words in some languages for “premium.” Common metaphors sometimes didn’t translate:
“We did hear stories about consumers, for example, of a Chinese speaker who walked into a clinic, and said, ‘where is the marketplace?’ She was driving around, looking for this marketplace,” said Huang.
Beyond languageCultural issues also complicated matters. Asian names often confounded government websites, leading to frequent errors. The marketplace relied heavily on credit reports to verify identification, but many people hadn’t built up enough of a credit history to be in the system.
And at the most basic level, Huang says American concepts like copays, referrals and preventive visits mystified a lot of people.
“For many Asian American and immigrant consumers, health insurance is a completely new concept,” said Huang. “In many ways I liken it to a lifestyle change because the countries they come from, this system doesn’t exist.”This is why many groups are as busy today as they were during open enrollment, with the focus shifting to helping people access care.
The work continues
Wah Wah Kyaw, a Karen outreach worker at SEAMAAC, and others are now following up with people they helped enroll, to see if they know how to use their coverage. They’re also meeting with people one-on-one to troubleshoot problems.
“They don’t know how to choose the doctor, they don’t know how to use the insurance card,” Kyaw said.
Ran Liu, a Chinese outreach worker, said many are still confused.”I have a lot of phone calls every day,” she said, adding that she and others went through an education process themselves, learning about how different primary care referral networks and copay systems worked.
That day, she met with Lin Guo, who had come in with a letter in English that she recently received from the marketplace. Liu dials up the federal marketplace help line, interprets the conversation, and gets clarification.Turns out the problem was easily resolved. Guo, a restaurant worker, is relieved and says she’s mostly happy with her plan, which costs her less than a dollar a month.
As for Monchi Tamang, the Nepali refugee, she met with Shekhar Bastola, the Bhutanese outreach worker, because she’s been snared by one of the more common problems for immigrants.
“There was a mistake in my name and my husband’s name on the insurance card, so I just came in to make that correction here,” she said.
Shekhar tells her it’ll take a week before her new card arrives. He also reviews how to pay premiums and set up a doctor’s visit.
Thoai Nguyen, SEAMAAC’s director, says moving forward, new community presentations are in the works, with topics that include how to ask for an interpreter and how to interact with a doctor.
He and others worry how ready the health system is for a new wave of insured people who lack English proficiency and don’t know how everything works.
“If that means that after getting coverage, perhaps even some hand holding to go to that first appointment, it’s very important for us to do that,” he said.