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Non-English Speakers Face Health Setback If President Trump Loosens Language Rules

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A federal regulation demands that certain health care organizations provide patients who have limited English skills a written notice of free translation services.

But the Trump administration wants to ease those regulations and also no longer require that directions be given to patients on how they can report discrimination they experience.

The changes could save $3.16 billion over five years for the health care industry, according to the administration.

These changes are part of a broader proposed regulation that would roll back protections banning discrimination based on gender identity. The public comment period closes Aug. 13.

The proposal would not change the government’s requirements that insurers and medical facilities provide foreign language translators and interpreters for non-English speakers.

The government acknowledged in the proposal that the change would lead to fewer people with limited English skills accessing health care and fewer reports of discrimination. But it also questioned the need for these notices, pointing out that in some areas health organizations spend money to accommodate a small contingent of language speakers. For example, notices in Wyoming must account for the 40 Gujarati speakers — a language of India — in the state.

In all, the government said, the impact of doing away with these requirements would be “negligible.”

Others disagree.

“I haven’t seen any reason to believe that this will only have a negligible impact,” said Mara Youdelman, managing attorney for the Washington, D.C., office of the National Health Law Program, a civil rights advocacy group. She said it “will likely result in people just not knowing their rights but not accessing care to which they’re eligible.”

Regulations under Section 1557 of the Affordable Care Act require insurers, hospitals and others to include a “tagline” of free translation services for the 15 languages that are most prevalent in a state. Additionally, it requires a nondiscrimination clause and directions on how to file a complaint with the Department of Health and Human Services Office for Civil Rights.

This information must be posted on websites, in physical spaces and in “significant communications” to the patient. But the ambiguity of that phrase prompted health care organizations to post the required information on numerous pieces of material — such as a separate page about language options sent with each Explanation of Benefits statement from an insurer. Together, these efforts cost organizations billions of dollars.

“No one realized exactly what that definition of ‘significant communication’ — how much would be wrapped up in that,” said Katie Keith, a Georgetown University professor who specializes in the ACA.

An estimated 25.9 million people in the United States in 2017 had limited English proficiency, the Census Bureau reported. Patients facing language barriers have a higher risk of health care complications, such as surgical infections and falls, because they may misunderstand a doctor’s orders, make mistakes preparing for procedures or improperly use medications.

In this latest proposal, however, the federal government questions whether the written notices are needed. The majority of enrollees speak English — census data from 2017 showed that 91.5% of people over age 5 spoke only English at home or spoke the language “very well.” In certain states, the proposal claims, every enrollee receives a notice for translation services in a language that only a few dozen people speak in the area.

Other state and federal laws protect the rights of patients with limited language services, the proposed rule says. It also cites evidence of some enrollees not liking the extra forms and being less inclined to open their mail because of them.

“These complaints make us concerned that the Section 1557 Regulation has resulted in ‘cognitive overload,’” the document stated, “such that individuals experience a diminished ability to process information” because of the additional paperwork.

Anecdotal reports cited by the government also point out that the notices did not significantly increase the number of patients using language services and reporting complaints. However, the proposed rule also estimates at least 90% of hospitals and physicians were not complying with the requirements.

Youdelman admitted she does not have concrete data showing that these taglines translate to increased access to services. However, she added, removing them wholesale without a promise to prevent discrimination in a different way is also counterproductive.

“Eliminating taglines is not the correct solution,” Youdelman said. “There is a way to inform folks while being cost-conscious.”

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Attorney General Bonta, CARB Seek to Defend Rule Limiting Warehouse Pollution in Disadvantaged Los Angeles and Inland Empire Communities

In recent years, the proliferation of e-commerce and rising consumer expectations of rapid shipping have contributed to a boom in warehouse development, particularly in Los Angeles and the Inland Empire. 

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California Attorney General Rob Bonta and the California Air Resources Board (CARB) filed a motion  on Wednesday to intervene in support of South Coast Air Quality Management District’s (Air District) rule requiring warehouses to reduce emissions from heavy sources of on-road pollution that visit those warehouses.

The Air District’s rule regulates these “indirect sources” by requiring owners and operators of some of the largest warehouses in the state to take direct action to mitigate their emissions.   This will reduce air pollution in Los Angeles and the Inland Empire, help California meet state and federal air quality standards, improve the health of our communities, and promote environmental justice.

Last month, the California Trucking Association filed a lawsuit challenging the rule as outside the scope of the Air District’s authority, pre-empted by federal law, and an unlawful tax. In defending the rule, Attorney General Bonta and CARB expect to argue that these claims are meritless and that state and federal law supports the Air District’s authority to adopt the Indirect Source Rule.

“California has long been a pioneer in the fight against climate change – and the Air District’s rule limiting warehouse pollution is no exception,” said Bonta. “The fact is: environmental justice and economic development are not mutually exclusive. There is no binary choice here. The Air District’s Indirect Source Rule will have tremendous benefits for those communities hardest hit by pollution, at a relatively low cost to industry.”

“This is an environmental justice and public health issue,” said CARB Chair Liane M. Randolph. “The communities around these huge warehouse facilities have suffered for years from the effects of businesses and freight haulers who have all but ignored the community impacts of their enterprises. This Indirect Source Rule simply requires them to be much better neighbors. The rule is also part and parcel of local clean air plans developed under Assembly Bill 617 with CARB and South Coast staff, local residents, local businesses and other stakeholders to clean the air in and around these high-traffic routes and locations.”

In recent years, the proliferation of e-commerce and rising consumer expectations of rapid shipping have contributed to a boom in warehouse development, particularly in Los Angeles and the Inland Empire.

The COVID-19 pandemic has accelerated this trend, as consumers have shifted away from in-person retail shopping. Unfortunately, the distribution of warehouse facilities — and resulting pollution — has occurred primarily in low-income communities and communities of color.

Once a new warehouse is built, the facilities and their associated activities, such as truck traffic, can cause a variety of negative impacts affecting public health. For example, diesel trucks visiting warehouses are substantial sources of nitrogen oxide — a primary precursor to smog formation that has been linked to respiratory problems like asthma, bronchitis, and lung irritation — and diesel particulate matter — a contributor to cancer, heart disease, respiratory illnesses, and premature death.

The Air District’s Indirect Source Rule requires existing and new warehouse facilities larger than 100,000 square feet to select from a menu of emissions-reducing activities, such as purchasing zero-emission vehicles, installing air filtration systems in nearby residences, and constructing rooftop solar panels.

A copy of the motion is available here.

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Advice

Commentary: Tips for Staying Safe (Emotionally) as Pandemic Drags On

The ongoing COVID-19 pandemic and the Delta variant have fundamentally changed many of our lives, the way we live and the manner in which we interact with each other, and how we live, work and play together.   

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Many of us are tired, stressed and impatient having to live our lives under this seemingly never-ending pandemic. 

In early spring, many of us were hopeful that COVID-19 was coming to an end.  We began making plans for the summer, from visiting family and friends to attending concerts, plays, planning for vacations and special milestones, and basically “just returning to normal life activities.”  

However, as life would have it, the Delta variant appeared. We were again confronted with the inability to control most aspects of our lives.  In fact, most recently, scientists have purported that we may expect additional variants for years to come.

According to the California Department of Public Health, in February 2021, only 2% of Black Californians were vaccinated. However, as of October 5, 4.2 % of all Black Californians have received at least one dose of vaccine. Representing about 6 % of California’s overall population, we as a community remain behind on our vaccination rate.   

The ongoing COVID-19 pandemic and the Delta variant have fundamentally changed many of our lives, the way we live and the manner in which we interact with each other, and how we live, work and play together.   

This pandemic has reinforced that there are so many aspects of our lives that we cannot control. And anytime we cannot control our lives and/or our environment, we tend to feel helpless which leads to anxiety and possibly depression.  

So, what can a person do, when life does not go as you planned and are impatient for this pandemic to end?  Here are some tips that have been recommended by the experts:

  1. I know this might sound cliché, but recognizing and understanding your feelings, whether you are sad, angry, stressed, or frightened. Accept, do not negate, how you feel.  
  2. The ability to bounce back and adapt to difficult situations is crucial to wellness.  You have to believe in yourself, your ability to be strong and to try your best – relying on various proven self-care methods — to stay positive.
  3. Try having an attitude of gratitude.  Think about just a few little things or events that are going well in your life daily and in the life of your family and friends.
  4. When you feel overwhelmed…. just breathe…Yes, literally, just breathe in through your nose, hold it and exhale through your mouth a few times or meditate by remembering a verse, phrase, poem, or visualizing a tranquil place for just a few seconds. Still yourself.   
  5. Look back on the good times that you have had and treasure those memories.
  6. Plan a reasonably safe event you can look forward to in the near future that will bring you joy or fulfillment. 
  7. Stop thinking negative.  It’s difficult when life feels as if it’s spiraling out of control but find ways to prove that your negative thoughts are either wrong or that the sky will not fall.  Remind yourself that life and circumstances can and do change.  Turn those negative thoughts into positive affirmations.  Have faith and confidence. 
  8. With so many things going on that are out of our control and often make us feel helpless, focus on what you CAN control in your life.  
  1. Take care of yourself. Exercise, even walking 20 minutes a day, eating healthy, sleep on a regular schedule, turn off electronic devises at least one hour before bed, avoid alcohol and substance use, especially before bedtime, connect with community or faith-based organizations, and/or reach out to your local mental health provider, employee assistance program.

Lenore A. Tate, Ph.D., is a licensed psychologist in private practice in Sacramento, California. She specializes in neuropsychology, behavioral health and geriatrics.

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Community

Social Security Benefits Will See Largest Jump in Nearly Forty Years

An average couple’s benefits would increase by $154 to $2,753 per month in 2022.

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Millions of retirees on Social Security will see a 5.9% jump in their benefits next year, the largest cost-of-living adjustment 9 (COLA) in the last 39 years.

The increase comes in the wake of deepening inflation as the economy continues to be impacted by the ongoing COVID-19 pandemic.

The increase will mean about $92 a month for an average retiree, according to estimates by the Social Security Administration.  Increases over the 10 years averaged t 1.65% a year.

An average couple’s benefits would increase by $154 to $2,753 per month in 2022.

This Social Security adjustment will affect 1 in 5 Americans., a total of nearly 70 million people.

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