Proposed rule quashes Trump administration’s language access changes

Two years ago, the Trump administration stripped the Affordable Care Act (ACA) of numerous language access provisions, citing their cost as a burden on the economy.

Just a few weeks ago, those provisions were reintroduced along with a handful of other measures that would strengthen language access in the United States’ healthcare system. After two years of advocacy from groups like the National Health Law Program (NHeLP) and the Association of Language Companies (ALC), a proposed rule was published this month, including several language access provisions in Section 1557 of the ACA, covering topics like machine translation, standards for video remote interpreting (VRI), and staff training requirements.

Broadly speaking, Section 1557 prohibits discrimination in the healthcare system on the basis of national origin, race, sex, age, and disability status. Before 2020, it also included several provisions on language access, such as the requirement that individuals with limited English proficiency be notified of their right to meaningful language access services in the healthcare system, such as medical interpreters. 

Mara Youdelman, managing attorney of NHeLP’s Washington, D.C. office, told MultiLingual Media that, although the Trump administration acknowledged the fact that many patients could be negatively impacted by the decision to strip back language access measures, it decided to go through with it regardless.

“The Biden administration came into office pledging to create a more equitable and resilient health care system, and we are glad they recognize the importance of Section 1557 in advancing that work,” Youdelman said in a press release.

Among the provisions that would be restored under the proposed rule are definitions of qualified interpreters, language assistance, limited English proficiency, and others. Additionally, Youdelman told MultiLingual that the proposed rule would require hospitals using VRI to ensure high-quality video and audio that does not lag.

It also adds new requirements, such as a definition of machine translation, and requires that qualified human translators review any machine translations of health information to ensure their accuracy.

“While machine translation may be useful in some day-to-day communication, it is not sufficiently accurate to use when translating health information, especially because of the potential life-or-death consequences,” Youdelman said. “For example, when COVID vaccinations were first being rolled out, machine translation of Virginia’s COVID website into Spanish instructed that people did not need vaccines.”

In addition to the language access provisions, the proposed rule also introduces a host of other provisions to strengthen healthcare accessibility for other marginalized groups. Youdelman said NHeLP hopes to see a finalized version of the rule adopted in early 2023. Members of the public may submit comments on the proposed rule through October 3, 2022, after which the Office for Civil Rights will consider all public comments before finalizing the rule, which will go into effect 60 days after it is officially finalized.

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Andrew Warner
Andrew Warner is a writer from Sacramento. He received his B.A. in linguistics and English from UCLA and is currently working toward an M.A. in applied linguistics at Columbia University. His writing has been published in Language Magazine, Sactown Magazine, and The Takeout.

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