OAKLAND — Set on a gritty corner of Oakland’s International Boulevard, the nonprofit Street Level Health Project offers free checkups to patients who speak a total of 22 languages, from recent Mongolian immigrants seeking a doctor to Burmese refugees in need of a basic dental exam.
It also provides a window into one of the challenges for state officials who are trying to implement the Affordable Care Act, President Barack Obama’s sweeping health care overhaul.
Understanding the law is a challenge even for governors, state lawmakers and agency officials, but delivering its message to non-English speakers who can benefit from it is shaping up as a special complication. That is especially true in states with large and diverse immigrant populations.
For Zaya Jaden, a 35-year-old from Mongolia, getting free care for her sister’s persistent migraine was a much higher priority than considering how the expansion of the nation’s social safety net through the Affordable Care Act might benefit her.
The sisters crammed into the clinic’s waiting room, sandwiched between families chatting in the indigenous Guatemalan language Mam, and discussed whether enrolling in Medicaid under the Affordable Care Act would work for the family’s finances.
“It was a good idea that Obama had, but I don’t know if it will work for me,” said Jaden, who gets private insurance for her family through her job as a laundress at an Oakland hotel and currently makes too much money to qualify for Medicaid. “If I make less than what I make to try to qualify for the government program, how could I pay my rent?”
Jaden’s ambivalence demonstrates the cultural and language hurdles that California and several other states are facing as they build exchanges — or health insurance marketplaces — and try to expand coverage to ethnic and hard-to-reach populations.
California has the largest minority population of any state, about 22.3 million people. That’s followed by Texas with 13.7 million, New York with 8.1 million, Florida with 7.9 million and Illinois with 4.7 million.
“So far it’s fallen to us, and we don’t know what (the state’s) capacity will be to go beyond Spanish,” said Stephanie Altman of Health and Disability Advocates.