Oregon law seeks to ensure language access in health care, opponents worry about side effects

Among the slate of legislation passed by the Oregon House of Representatives in 2021, one bill has stood out for those in the language industry.

House bill (HB) 2359 requires health care providers in Oregon to work with interpreters from a health care interpreter registry maintained by the Oregon Health Authority (OHA). Advocates for the law say it will help ensure language access for residents of the northwestern US state who have limited English proficiency (LEP) — some 300,000 people according to the 2018 American Community Survey — while opponents say it will add another layer of bureaucracy to an already unwieldy system, and actually prevent some patients from getting the quality language access they need.

Also known as the Health Care Interpretation Accountability Act, the law seeks to address what were perceived to be loopholes in the provision of language access to LEP persons in Oregon. Proponents said that previous state statute allowed health care providers to hire unqualified interpreters, even when qualified or certified interpreters were available through the OHA. HB 2359 closes this loophole, they say, by requiring health care providers to work with interpreters vetted by the OHA. Proponents claim it will also lead to a safer environment for health care interpreters by providing them with personal protective equipment when working on assignment, as well as requiring health care providers to provide vaccines and/or testing at no cost to the interpreter.

Ensuring access to high-quality language services, with built-in protections for worker and patient safety, would seem at first blush to be an easy initiative to get behind, but the law in its current form does have its detractors.

Speaking on behalf of the Association of Language Companies, William Rivers told MultiLingual that one concern involved funding for language access. “In most states, language services are part of the overhead of operating a health care provider. Because health care providers in general can’t get reimbursed for providing language access, they tend to minimize the cost of language access. This has been the case for some 20 years at least, and it puts tremendous pressure on interpreter rates,” noted Rivers.

Oregon State Representative Andrea Salinas, chief sponsor of the bill, agreed with this concern in part, but felt the benefits outweighed the risks. “One of the concerns we heard from healthcare providers was that they are not always reimbursed for language services by Oregon insurers, requiring the providers, and not the payers, to pay for this service,” said Salinas. She then added that “despite this concern, health care providers were supportive of this legislation because they also believe interpretation services are critical. But they would like to see a fix to the payment system.”

Rep. Andrea Salinas. Photo credit: Gia Goodrich

As for the downward pressure on interpreter rates, Salinas said that her office had heard from “dozens” of interpreters that uncredentialed interpreters were being favored in the assignment of appointments because of the lower rates they charged, and that this law would level the playing field, stabilizing the profession and preventing turnover at language service companies.

River also said that there was need for more and better qualified interpreters, especially in languages of lesser diffusion, so that interpreters could be found no matter the language in question and no matter the urgency of the situation, avoiding situations where speakers of, for example, the indigenous Guatemalan Mam language are forced to wait for a credentialed interpreter when arriving at the ER. “Language access is guaranteed as a right regardless of the language spoken (or signed),” said Rivers. “We need more training programs, innovative ways to certify interpreters in languages other than the bigger languages where developing an occupational certification test is economically and psychometrically feasible.”

Salinas, for her part, noted that the law “requires OHA to provide health care interpreter training and continuing education in accordance with the standards adopted by the Oregon Council on Health Care Interpreters at no or reduced cost in order to bolster the workforce,” and also outlines the instances in which it would be permissible for health care providers to use an interpreter who is not on the registry.

Both sides agree that language access in medical care is a critical human right, and that federal guidelines, mandating this access though they do, often fall short. Where they seem to differ is in how best to ensure and enforce this access, guaranteeing that the 300,000 Oregon residents with limited English proficiency receive the timely, qualified service they need, and that the providers of that service are fairly compensated. As the law moves into its implementation phase the eyes of many will turned on this picturesque state to see how it balances the needs of all its residents.

Michael Reid
Michael Reid, Managing Editor at MultiLingual, is an educator, translator, and language, culture, and diversity consultant who lives in Athens, Greece, with over 20 years of experience. He speaks six languages fluently and another seven to basic competence. He also speaks just enough Klingon to negotiate safe passage through the Neutral Zone.

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