by Lisa Aliferis

Covered California may have had strong overall enrollment, but people who do not speak English as a first language are underrepresented in the state’s health insurance marketplace, according to an analysis from Berkeley’s Greenlining Institute.

The report relied on Covered California data which showed that 20 percent of enrollees do not speak English as a primary language. That’s compared to 44 percent of Californians overall.

“We know California is a diverse state ethnically and linguistically,” said Jordan Medina, a health policy fellow with Greenlining and lead author of the study. “Moving forward if the Affordable Care Act is going to work in California, we have to make sure those populations are represented in the health insurance marketplace.”

As part of its analysis Greenlining interviewed certified enrollment counselors working to help people sign up for insurance through Covered California. While online sign up was available in English and Spanish, people who spoke other languages had written material available only. Counselors reported that they ran out of materials in at least some languages.

Counselors said they preferred helping people sign up by using the online portal, but since it was only available in English and Spanish, it slowed them down. A counselor with an agency that worked with Japanese Americans told Greenlining, “We tried to use the website, because that’s what Covered California suggested we do, but the line-by-line translation with elderly Japanese Americans made the process extremely tedious.”

Greenlining called on Covered California to make the online sign up available in the 13 most common languages spoken in California.

Covered California spokesperson Anne Gonzales said the agency is looking into this, “but there is no firm date on when that functionality will be added, or which languages will be added.”

Problems with both the Spanish language marketing campaign and the Spanish language website were widely reported earlier this year, and Greenlining mentioned these issues. Gonzales pointed to a Spanish language working group at Covered California which “recalibrated and focused resources” on making improvements in these areas. She said Covered California is currently reviewing its resources for Asian language translations as well, including Mandarin, Korean, Vietnamese and Hmong.

Curiously, one of the major issues Greenlining pointed out has already been addressed by the Covered California board. In the first open enrollment period, certified enrollment counselors were paid $58 for every person they enrolled into a plan. But counselors told Greenlining that fee did not compensate them for the level of work required.

Gonzales said that Covered California is “moving away from that business model.” During the first open enrollment, there was a division between outreach/education and enrollment. Covered California grantees doing educational events could not also sign people up for insurance.

That’s changing now. Covered California is instituting a “navigator” model and will award a total of $16.9 million in grants to organizations which will handle “outreach, education and enrollment.”

Greenlining also called on Covered California to move forward on hiring a diversity officer.

“At the end of the day, this helps with accountability,” Medina said. “If you have someone whose sole responsibility it is to make sure that all materials — whether that be on the web or printed materials — if there’s one person in charge of that, it makes it really easy for community groups to partner with Covered California to make sure it’s done in an equitable way.”

Greenlining credited Covered California, saying that the state “led the nation in implementing the Affordable Care Act,” but Medina also observed that the rollout was always expected to be a multi-year effort. “As we move farther into implementation, Covered California is going to have to really pay attention to hard to reach groups,” he said. “That’s particularly crucial to outreach to Californians who don’t speak English well.”