English Proficiency Can Impact Care Disparities, Coverage Rates

Limited English proficiency (LEP) can significantly stunt a patient’s ability to communicate with doctors and receive care, which results in broader care disparities along racial and ethnic lines, according to a KFF issue brief.

Most individuals with LEP are Hispanic, and nearly a quarter live in California. Spanish, Chinese, and Vietnamese are the top three most common languages for individuals with LEP. The prevalence of Spanish far outweighs its counterparts, with 63 percent of LEP individuals speaking this language.

Despite the large population of Spanish-speaking individuals in the US with LEP, the share of individuals with LEP is higher among Asian people than Hispanic people. One in three Asian people in the US are not proficient in English.

For the 25.7 million individuals over the age of five who live in the US with LEP, language barriers can lead to uninsurance, access to care challenges, poor health outcomes, and other social barriers.

People with LEP are more likely to have low education and low incomes.

“The lower incomes among people with LEP reflect disproportionate employment in low-wage jobs that often do not offer health coverage, contributing to higher uninsured rates,” the issue brief explained.

Over three in ten adults with LEP (31 percent) are uninsured, compared to 10 percent of English-proficient people, along with 17 percent of LEP children. They are also more likely to have Medicaid coverage than those with English proficiency.

When employer-sponsored health plans are available, individuals with LEP may be unable to afford them. While over two-thirds of English-proficient individuals (67 percent) have private healthcare coverage, 43 percent of individuals with LEP can say the same. Hispanic nonelderly LEP individuals have the highest uninsurance rate (37 percent).

The Affordable Care Act aimed to close gaps in uninsurance. KFF found that disparities did narrow following the law’s implementation.

Uninsurance among LEP dropped by 17 percentage points, while uninsurance declined by seven percentage points for people with English proficiency. Uninsurance dropped from 55 percent to 37 percent among Hispanic individuals with LEP and 27 percent to 10 percent for Asian individuals with LEP. Nonetheless, disparities remained.

Timely access to language assistance, maintenance of Medicaid coverage, and Navigator assistance are a couple of key actions that states can take to improve coverage among individuals with LEP.

Certain trade organizations and regulatory bodies provide support and guidance for linguistic assistance.

For example, CMS has issued guidance on how to help individuals with LEP maintain their Medicaid coverage. HHS has urged states to offer materials in the top 15 languages spoken among their beneficiaries. Navigators and community health centers have been another key support for individuals with LEP in maintaining coverage.

KFF experts warned that the coverage gains that the LEP community has experienced could reverse with the Medicaid unwinding underway. Medicaid programs can help ensure that individuals with LEP remain insured.

“Complex enrollment and renewal processes have historically been barriers to obtaining and maintaining Medicaid coverage.,” the issue brief stated. “Enrollees with LEP are at particular risk for experiencing difficulties, as they may face added challenges understanding and completing tasks or forms due to language barriers, particularly if they are not provided translated materials.”

Separate studies have found that English proficiency can also influence healthcare spending.