SEATTLE — A visit to a health clinic in Seattle's International District, where patients speak more than 50 different languages, illustrates a challenge Washington faces as it launches its new health insurance exchange as part of the federal Affordable Care Act.
Officials have to overcome a language barrier with many people to get them to participate, a situation many who provide health services are familiar with.
"If the patient doesn't understand and the provider doesn't understand, you have great cause for problems," said Teresita Batayola, CEO of International Community Health Services, which has four clinics around Seattle. Everyone on their medical staff speaks at least one language other than English. "Seattle happens to be very much an international gateway."
The ICHS website is translated into four languages — Chinese, Korean, Vietnamese and Tagalog — and signage around the clinics is offered in multiple languages as well as symbols.
According to U.S. Census figures, nearly half a million Washington residents over age 5 speak a language other than English and say they don't speak English very well. More than 200,000 say Spanish is their primary language, but another 150,000 say they speak an Asian or Pacific Islander language, with Chinese, Korean, Tagalog and Russian the next most popular languages.
In all, people in Washington who don't speak English well speak more than 150 different languages, not including dialects, according to the Census.
State officials estimate about 1 million Washington residents are uninsured, or about one in seven people who live in the state. About a third of them will likely become eligible for free health insurance under Medicaid if the Legislature votes to join the federal expansion program. The rest will be targeted by the state's new health insurance exchange.
Reaching people like the users of the International District clinic — where only about 14 percent of the patients have private insurance — will be a challenge, acknowledged Michael Marchand, spokesman for Washington's health plan finder.
The Affordable Care Act requires that Washington's Health Benefit Exchange build relationships with local groups to help with outreach and assist people who need help signing up for insurance.
The Health Benefit Exchange will be asking groups to apply to be navigators and be paid to help people in their community navigate the exchange.
Chan Lai Ly came into the International District health clinic on Friday for a regular checkup for his diabetes. The 63-year-old exchanged information in both Chinese and Vietnamese with a medical assistant and a physician assistant.
Ly and his wife immigrated to Seattle two years ago from Ho Chi Minh City, Vietnam, to live near their children. When asked what he would do if he wasn't able to get medical help in a language he understood, Ly shrugged his shoulders and said he would "give up."
Marchand expects the navigator grants will go to larger community groups that will subcontract with organizations like International Community Health Services to reach specific populations.
The website for the insurance marketplace will launch in October in both English and Spanish, the most popular language in Washington other than English.
Developers of the website are still working on how they will let non-English speakers know they can get help on the telephone or in person in other languages.
And language barriers are not the only obstacle to getting everyone in Washington to sign up for health insurance.
"Part of the challenge is getting people to embrace change. Change is a difficult thing. There's no way to really sugarcoat it," Marchand said.
Oregon's health insurance exchange will have staff who speak Spanish, Russian and Vietnamese to help explain and market the service that's expected to provide health coverage to thousands of Oregonians.
The exchange will help the uninsured get access to health coverage once the federal health care overhaul requires most Americans to have insurance beginning next year. But the state faces cultural and linguistic challenges in trying to educate limited-English speakers and hard-to-reach populations.
The exchange will be called Cover Oregon. Spokeswoman Lisa Morawski says staff will use an interpretation service to reach people who speak other languages. Cover Oregon also is partnering with insurance agents and community organizations to reach non-English speakers.