Access to medical care is one of the civil rights of every citizen. In multiethnic societies such as the United States, many people, especially immigrants with limited English proficiency (LEP), cannot receive proper medical care. There are several reasons why they are unable to have proper medical treatment. It could be because they are in the country illegally or they shy away from contact with people, including healthcare providers because they cannot speak English properly. Another reason is that they are subjected to discrimination.
Other people assume that they cannot access healthcare because they do not have health insurance, while others forego medical treatment due to poverty. The size of the vulnerable population in the United States continues to grow. The fact that the budget constraint is a constant burden to government agencies, hospitals and physicians cannot be discounted.
However, there are existing laws in the United States that enforces dispensing proper medical care to all people without discrimination.
Title VI of the Civil Rights Act of 1964
This section of the Civil Rights Act expressly states that discrimination based on national origin, color or race is prohibited. The rule specifically pertains to agencies and organizations that receive federal financial assistance and federal funds to provide benefits, aids or services.
Title VI of the Civil Rights Act of 1964 is very specific in the application of its regulations. It prohibits discrimination that may be intentional or to methods, criteria or procedures that may look neutral but have a level of discrimination that can affect people because of their nationality, color or race.
It is vital that all these practices and policies instituted by agencies and organizations receiving federal funding should be stopped, unless the recipient organization or agency can prove that some of their policies are necessary to reach their nondiscriminatory goal. However, this practice cannot be allowed if there are other means to reach their objective without excluding a large number of minorities.
People who have limited English language skills should be given equal chances to access federally funded programs. The practices and programs of federally funded agencies or organizations should not deny access to their programs if the persons with limited skills in the English language are qualified to them.
If LEP individuals are eligible for human services, healthcare services and Medicaid, it is against the law to deny them assistance because of their nationality, color or race. Enforcing Title VI as well as other civil right laws such as the Americans with Disabilities Act (ADA) and the Health Insurance Portability and Accountability Act (HIPAA) is the Office for Civil Rights (OCR), which is under the U. S. Department of Health and Human Services (DHHS).
Title VI covers several programs and institutions, such as:
- Public assistance programs
- Day care centers
- Family health centers and clinics
- Extended care facilities
- Nursing homes
- Senior citizen centers
- Medicaid and Medicare
- Adoption agencies
- Mental health centers
- Alcohol and drug treatment centers
It is essential for LEPs and people belonging to minority groups to understand the discriminatory acts that are prohibited under Title VI. These discriminatory acts limit their chances to gain access to services on an equal footing. For all federally funded recipients, they are prohibited from doing the following:
- Deny benefits, financial aid and services that are provided as a component of human or health service programs
- Render a different benefit, financial aid or service or give them in a different way to minority groups
- Allow the separate treatment or segregate individuals from minority groups when providing any type of benefit, financial aid or service
Obligations of Healthcare Facilities Under Title VI
In order for federally funded healthcare organizations and facilities to comply with the provisions under Title VI, they are required to:
- Provide free written and oral language assistance to their LEP patients. Discrimination because of their limited capacity to speak English is discrimination against their national origin according to the U.S. Supreme Court. They are entitled to access healthcare services equally like their English-speaking counterparts. Likewise, the facilities should notify patients that they have the right to the services provided by the facility.
- Provide free written and oral language assistance to patients with impaired communication abilities. The facility should provide Braille, large print or audio assistance.
- The facility must post materials and signs in the languages predominantly spoken in their service area. They should also have other documents and consent forms available in different languages.
Healthcare organizations and institutions can lose their state or federal funding if they fail to comply with the provisions of Title VI of the Civil Rights Act of 1964. Aside from losing their funding, healthcare facilities that fail to comply may face closure, charges of medical malpractice and lawsuits from patients.
Section 1557 of the Affordable Care Act
The new provisions of Section 1557 of the Affordable Care Act (ACA) include the protection of individuals against discrimination based in sex stereotyping and gender identity. According to the Department of Health and Human Services, the protection of certain people against discrimination due to sex stereotypes and gender identity extends to every gender identity – people with non-binary gender (genderqueer), transgender, bisexual, gay and lesbian.
The final ruling on the prohibition of discrimination under Section 1557 took effect on May 18, 2016. It bans discrimination in healthcare and health coverage of individuals based on their age, national origin, color, race, sex and disability. The new ruling comprises federal policies and nondiscrimination laws that already exist as well as new provisions, such as:
- Extension of the protections against discrimination based on sex for health coverage and healthcare as well as discrimination against gender identity according to sex discrimination’s definition.
- Systemizing long-existing guidance regarding access for people with limited proficiency in the English language. It includes the provision of free, timely and accurate services for language assistance.
- Avoiding discrimination based on disability by combining existing law requiring sensible modifications on information technology, access to buildings and effective communication.
- Disallowing discriminatory designs of health insurance benefits, such as limiting or denying typical healthcare coverage and inclusion of specific healthcare coverage to protect transgenders.
Section 1557 covers medical insurers and healthcare providers. Insurers should not discriminate due to gender identity. All insurers participating in the Marketplace cannot create benefit plans or marketing practices that can discriminate against consumers due to their disability, age, sex, nationality, color or race. They are not allowed to refuse to renew or issue, limit, cancel or deny insurance policies according to the discriminatory bases. Healthcare providers should treat all individuals consistently according to the gender they specified. Section 1557 is applicable to every healthcare activities and programs.
The Americans with Disabilities Act (ADA)
In its broad definition, the Americans with Disabilities Act disallows discrimination against individuals with disabilities in the fields of telecommunications, local and state government services, public accommodations and employment.
It also provides that healthcare facilities and private and public hospitals should provide services to persons with disability in the same manner that they provide healthcare services to normal individuals.
This means that they are required to alter their procedures and policies and provide auxiliary services and aids for effective communication. This may include the removal of existing physical barriers that may impede disabled individuals from smoothly accessing the facility. The ADA issues accessibility standards for alterations of existing facilities and accessibility features for new buildings.
Covered in Title III of the Americans with Disabilities Act are private providers of mental and physical health care regardless of their size and their location, even if the clinic or facility is located in a private home.
Title II of the ADA covers healthcare facilities and hospitals operated by the local or state government.
The ADA also requires easy access for individuals with disability to healthcare institutions offering healthcare conferences, education and training sessions to the public.
Provisions Under Title II and Title III
ADA requires the modification of standard procedures, practices and policies in order for individuals with disabilities to access medical services. This could include providing interpreters during medical examinations, sign language interpreters for people with hearing difficulties, assistance to mobility-challenged individuals and providing accessible entrances.
The Act requires facilities to admit service animals unless it can jeopardize the safety of the facility or require it to make major adjustments to its operation.
Aside from professional interpreters, healthcare providers should have Braille text, large print, readers and written notes for effective communication. The healthcare provider should train its staff on how to effectively communicate with patients and individuals with visual, speech and hearing impairments.
Patients in nursing homes and hospitals who are hard of hearing or deaf should be able to access programs with closed captions. Captioning is also required for information available in slide or video shows.
Facilities are required to remove structural communication barriers by installing visual doorbells, flashing alarm systems, permanent signs, elevator controls in Braille, raised characters, assistive listening systems and telephones with volume control.
These three laws ensure that healthcare services to individuals regardless of their nationality, age, color, race, disability and sex orientation are accessible.
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