ULG's Language Services Blog

The Affordable Care Act and Language Access


There’s been a lot of talk about healthcare lately.

With a new administration in the White House and “Obamacare” tenuously hanging in the balance, the future of the Affordable Care Act (ACA) is uncertain.

But until there is a repeal of the ACA, it remains the law of the land. The bill was passed in 2010 and represents a sweeping change in the way Americans receive healthcare. In the language world, the legislation also meant an impressive overhaul when it comes to healthcare translations and interpreting.

The language requirements set forth in the ACA give non-native speakers the opportunity to receive better healthcare. At the same time, the legislation allows medical providers a chance to instill confidence in their patients while showing a willingness to foster cross-cultural connections.

While it’s still alive and well, let’s look at some of the language requirements put forth by section 1557 of the ACA.

Competent Vs. Qualified Interpreters

In the past, federal requirements only mention the use of “competent” linguists in hospitals and clinics, but the Affordable Care Act takes the guideline a step further. Section 1557 of the bill requires that federally funded healthcare organizations hire “qualified” interpreters.

The important thing here is that the law provides standards hospitals and clinics can refer to when gauging the qualifications of medical interpreters. Under Section 1557, a “qualified” interpreter is someone who:

  • Abides by interpreter ethics and confidentiality
  • Has proficiency in English and at least one other spoken language
  • Has the ability to effectively and accurately use the necessary terminology required by a certain interpreting situation

The ACA also makes the distinction between untrained and qualified bilingual medical staff. Too often, healthcare professionals are called on to interpret because they speak more than one language, but their bilingual abilities are usually subpar compared to professional linguists.

According to the law, a “qualified” bilingual staff member is someone who has:

  • Demonstrated a proficiency in speaking English and at least one other language and has a knowledge of the necessary terminology the situation requires
  • Is able to effectively and accurately communicate with LEP patients in their primary language(s)

Using under-trained or unqualified medical staff has been shown to cause poor patient outcomes for LEP (Limited English Proficiency) individuals. But these doctors and nurses are still too often utilized when interpretation services are needed.

Access and Information

Under Section 1557, healthcare providers must provide notice to LEP patients that they do provide interpreting services. These notices need to be posted in the 15 most prevalent languages in the nation.

Although “Language Access Plans” are not required by healthcare providers, it is one way for the federal government to gauge whether or not an entity is in compliance with the ACA language rules. When applying for federal funds, healthcare providers must be able to demonstrate adherence to the guidelines outlined in Section 1557.

Providers are required to provide interpreting and translation services to LEP patients under the Affordable Care Act, both free of charge, and cannot require a patient to be responsible for providing his or her own interpreter.

VRI Requirements

The final revisions to Section 1557 included requirements for the quality of video remote interpreting services. The law states that “A public entity that chooses to provide qualified interpreters via VRI services shall ensure that it provides:

  • Real-time, full-motion video and audio over a dedicated high-speed, wide bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry or grainy images, or irregular pauses in communication;
  • A sharply delineated image that is large enough to display the interpreter's face, arms, hands, and fingers, and the participating individual’s face, arms, hands, and fingers, regardless of his or her body position;
  • A clear, audible transmission of voices; and
  • Adequate training to users of the technology and other involved individuals so that they may quickly and efficiently set up and operate the VRI.”

An Uncertain Future

Since his campaign, President Donald Trump has criticized the ACA, promising constituents he would repeal the bill if elected to office. So far there have been rumblings, but the administration has failed to successfully put forward a new plan.

Until a new proposal is brought forward and passed by the House and Senate, the Affordable Care Act will still dictate language access for federally funded healthcare organizations.