Lost in Translation

The Census Bureau reported last year that in 2017 83.9% of Hispanics had health insurance coverage in the United States, split about 53.5% in private coverage and 39.5% in government coverage. For midsize and large employers that employ many Hispanics, what do the health insurance enrollment efforts look like, especially for those who speak little English?

I can only speak to ones I’ve worked with, and it usually depends on the structure of their workforce. I worked with one that had many locations instead of a couple of big corporate campuses. So, when there are numerous locations, a lot of time they will, quite naturally, try to rely on supervisors or leadership on site at each location. With that client, one year they wanted to increase enrollment, and we gave a scenario breaking things down mathematically with an illustration as to what it would look like financially if they took the premium from their paycheck versus paying the fine on the ACA. We showed them that, if they paid the premium, it would be the same as the fine but they would have the value of healthcare coverage. It had an impact, and they did get a bit of an increase in enrollment. For larger organizations, it’s particularly important to have people on site who are empowered to speak effectively and positively about their benefits. I recommend that benefits communication be part of the training and onboarding for those positions. They have to understand the role benefits plays in the financial health of an organization. This doesn’t happen a lot and should happen a lot more.

What evidence have you seen in your work that indicates a language barrier causes Hispanic workers to forego employer-sponsored insurance?

Something to understand here is that, for many of these employees, employee-sponsored benefits are their only option because of their legal status. Many are working, getting a paycheck, paying taxes and don’t have access to the public options. They aren’t making a decision of whether to take employer-sponsored or look elsewhere; it is that or nothing, and we see evidence of that all the time. If we are talking about barriers, language is just one of many for Spanish speakers. There is also the cost and misinformation given about the plans. Also, this is a community that is very accustomed to living with physical risk. When you talk to them about the fact that they might get sick, they are accustomed to taking big risks with their well-being or just being in a risky situation. There is also just the perception among people who came here to work as adults that they will just have the short end of the stick and that benefits are designed and intended for people raised here in this country.

Are there other systemic differences in other countries that would make a difference in how they use benefits?

In Latin America, they can get can more hardcore pain killers and antibiotics from the local pharmacies, sometimes without prescriptions. They chat with the pharmacist, get a diagnosis and medication, and assume their problem is solved. Here, they have to make an appointment with a doctor and pay them and then go to the pharmacy, so it’s like they are paying twice. They think ours is a roundabout, expensive and inefficient way of getting medications. It can be hard to persuade people that it’s a better way.

Are these some of the reasons why it can be challenging to get Spanish-speaking employees to even opt into benefits packages?

Trying to explain a benefits package to Spanish-speaking employees is like trying to sell a car to someone who loves using public transportation. They aren’t happy about spending an hour in a room learning about a product they don’t want to buy, and they aren’t interested in having more money taken out of their paycheck. They don’t understand why their employer cares where they go for healthcare. They think their employer should only care about whether they show up for work, do a good job and are punching in and out on time.

A 2019 Pew report says Hispanic adults still trail white and black Americans in home broadband use: about 61% of Hispanics use it as opposed to 79% of Caucasians and 66% of African Americans. That suggests online research of health benefits is not a good educational method. Is there a better way?

There is no other way to say it than that is absolutely the worst education method for this community. When talking with one client recently, they were finding that this population doesn’t want to enroll online. Lots of Spanish speakers don’t even have email, and they don’t want it. It may be a little different for younger people who have spent most of their lives here. Older Spanish-speaking people are intimidated by technology. Sometimes they will use it to download music or FaceTime with families in their home countries. But online research is not happening. Absolutely not. And there are very few exceptions in my experience. And even if they do want to use it, the information they have access to online is very spotty. Most resources aren’t available, and if they are translated, it’s probably not done very well. Even those who try to do online research, what they find is all over the map in terms of how clear and understandable it is. For instance, the term for “back” in navigation, Google translates into the body part for back: espalda. And zip, like ZIP code, comes out as the zipper on your pants.

Is this why you recommend professional translation when interpreting benefits documents?

You aren’t going to hand over a document to any employee and ask them to produce your benefits booklet just because they speak English. Yet employers do it in Spanish or other languages all the time. They think, if they can speak this language, they can produce a document that will reflect our company. But doing it for the lowest cost is risking translating benefit terms which are very industry-specific. It’s easy to translate terms incorrectly. Even if you do have a professional translator, you have to make sure the terminology is appropriate and clear. My agency has a dataset of terms to know what is clearest. It’s a software translation management, system so when you put information into the system, it defaults to particular terms.

You also recommend providing benefits information to English and Spanish speakers separately, correct?

Lots of times when there are enrollment meetings with employees, there is an HR manager or a broker talking to a group of mixed-language speakers with an interpreter there. It’s better than nothing, but it’s really an ineffective strategy because it’s making the process twice as long and boring for everyone. It’s more effective to split them up and have two different presentations. If you have someone speaking to them in Spanish, it may help to draw out questions they need to hear, like why their employer is offering insurance to them. English speakers already understand this.

What about using people in the office like supervisors or receptionists to help explain benefits?

Sometimes these people can give disastrous information. I was on a conference call one time where a Spanish-speaking employee was supposed to explain the package to other employees. He stood up, and the first thing he said was, “This isn’t obligatory, and you don’t have to participate.” That was his big introduction—exactly what you don’t want him saying. There is also often confusion between what workers compensation and health insurance cover. When someone gets injured on the job and doesn’t know where the best place is to go, instead of coming to HR, they get information from co-workers who unwittingly misguide them. Dumping this kind of thing on operations employees who have a million other things to do isn’t the best approach. When it comes to bilingual supervisors, you can coach and support them so they understand how critical a financial investment this is for the employer. They shouldn’t answer questions they can’t answer. They can send employees to a helpline or videos, if there are some online, encourage the employees to participate, but they shouldn’t have to get into explaining the nitty-gritty of the plans.

Are there other cultural issues that can complicate uptake of insurance among Spanish-speaking employees?

A lot of the time employers are competing with the local community clinic. Community clinics are great organizations that provide nonprofit, basic family care. They are valuable and serve a real function but are mostly intended to help people who don’t have insurance or can’t pay their co-pays or premiums. The clinics are there to serve the lowest-income folks in a community.

Why do Spanish-speaking employees tend to go to community clinics?

If the clinics are located in an area where there are lots of Spanish-speaking folks, most of the staff speaks it there. They are also often promoted or interviewed in local Spanish media, so they may have heard about it on local television. They feel comfortable there, and it is low-cost, so they may have gotten vaccines for their children, an annual checkup or some kind of service or screening in their language for a reasonable price. The confusion comes in when people have an option: should they take their employer-sponsored insurance or rely on community clinics? That depends on the person, their income and the plan they are offering, but they should be able to make an informed decision. They should know that if they ever need a specialist it can be really challenging to see one at a clinic.

Do Spanish-speaking employees tend to look to each other’s experiences to determine if they will take insurance?

Bad news travels fast. Before the Affordable Care Act, when maternity benefits didn’t have to be covered, at one organization, a man put his wife on his insurance because she was pregnant. He found out later that the delivery wasn’t going to be covered. He told everyone the insurance wasn’t worth anything. Participation dropped off because one person had a bad experience. They figured, “Why would we have money taken out of our paychecks if Pedro did and it was worthless?” These immigrants tend to be skeptical and watch their backs. They have had a tough time where they were living before or they wouldn’t have come here. They tend to be very cautious, and when something doesn’t look like what it was supposed to be, sometimes they will go to their HR manager to ask about it, and sometimes they won’t. They may not say anything and just throw in the towel.