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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.”

Carmen Heredia Rodriguez, Kaiser Health News

Carmen Heredia Rodriguez, Kaiser Health News

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Business

NPRC Scores First Advocacy Victory: David Shaw Finally Gets His Wish to ‘Go Home’

POST NEWS GROUP — The National Probate Reform Coalition (NPRC), formed by the Post Newspaper Group in January following years of reporting on alleged abuses within the probate court system, helped Beverly secure the return of her husband, along with the couple’s property and assets.

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Beverly and David Shaw were separated by a hospital after Beverly took David there to treat his dehydration. The hospital determined Beverly was not caring for David property and placed him under their guardianship. Courtesy photo.

For nearly four years, Beverly Shaw fought to bring her husband home.

She watched as David Shaw moved through three nursing homes, became increasingly sedated and repeatedly expressed his desire to return to his wife. Last week, that finally happened.

The National Probate Reform Coalition (NPRC), formed by the Post Newspaper Group in January following years of reporting on alleged abuses within the probate court system, helped Beverly secure the return of her husband, along with the couple’s property and assets.

For NPRC, the Shaw case represents its first major advocacy victory. For David, it means something much simpler: He finally got to go home.

In a letter to the court, Beverly raised serious concerns about her husband’s care at Riverview at the Park Nursing Home.

She alleged that David was frequently heavily sedated and questioned whether his medications were properly documented. She said an aide told her medications were sometimes administered without proper charting, although she acknowledged she had not independently verified that information.

Shaw also said she was unable to obtain David’s medical records and questioned medications he was receiving despite previous medical instructions following his 2023 stroke.

“I believe David has been subjected to abuse, neglect, and unnecessary chemical restraint,” Shaw wrote.

The allegations are Shaw’s account and have not been independently established. But they raise questions central to NPRC’s mission: Who is watching when a vulnerable person becomes subject to guardianship? Who is accountable when family members say they are ignored? And who makes sure the person under guardianship, not the professionals surrounding them, remains the priority?

“Please let me go home”

Perhaps the most compelling part of Shaw’s case was David’s own voice. Shaw told the court she possesses recordings in which David repeatedly expressed his desire to return home.

After 45 years of marriage and four years apart, Beverly argued that David deserved the opportunity to spend his remaining years at home with his wife, receiving individualized care.

NPRC responded with a “Request for Compassion” letter-writing campaign to Judge Thomas Inman, Associate Circuit judge for Ste. Genevieve County, Missouri. The coalition also helped Shaw pursue appropriate legal filings and engaged with her attorney to press for action.

The court ultimately returned David to Beverly’s custody and restored the couple’s property and assets.

“What we have here is the power of coalition,” said Alee Carrino, an NPRC planning committee member. “We applied pressure from all sides, and it worked.”

The victory comes during NPRC’s eighth month of organizing for probate reform. The coalition advocates for greater judicial and governmental oversight, court ombudsmen, mandatory mediation, transparency in probate billing and stronger protections for elders and disabled people.

The Shaw case sends a powerful message: Guardianship is supposed to protect vulnerable people, not permanently separate them from those who love and care for them.

David Shaw asked to go home. His wife fought to bring him home. NPRC supported her every step of the way, and this time, the system listened.

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Commentary

ESSAY: California Can Close Its Colorectal Cancer Gap

POST NEWS GROUP — The numbers are stark. From 2014 through 2018, the age-adjusted colorectal cancer incidence rate was 40.2 cases per 100,000 Black Californians, compared with 35.8 among non-Hispanic White Californians. The mortality rate was 25.3 deaths per 100,000 among Black Californians and 17.7 among White Californians—a 43% difference.

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Dr. Gracie Ann Dinkins, left, and Sydney Y.K. Brown, MA

Every breakthrough in cancer care carries a promise: earlier detection, better treatment and longer life. California has helped deliver that promise through world-class cancer centers, a statewide cancer registry and major public-health investments. Yet colorectal cancer still exposes a painful divide: Black Californians are more likely to develop the disease and far more likely to die from it than their White neighbors.

The numbers are stark. From 2014 through 2018, the age-adjusted colorectal cancer incidence rate was 40.2 cases per 100,000 Black Californians, compared with 35.8 among non-Hispanic White Californians. The mortality rate was 25.3 deaths per 100,000 among Black Californians and 17.7 among White Californians—a 43% difference. 

A later state analysis showed that the incidence gap remained in 2021, at 39.0 versus 35.0 cases per 100,000.

These differences should not be treated as an inevitable consequence of biology. The more revealing explanation lies in what happens—or fails to happen—across the cancer-care continuum: prevention, screening, diagnostic follow-up, treatment and surveillance after treatment.

Colorectal cancer is one of the few cancers that screening can sometimes prevent. Colonoscopy can find and remove precancerous polyps, while stool-based tests can identify people who need further evaluation. The U.S. Preventive Services Task Force recommends screening for average-risk adults from ages 45 through 75, with several acceptable options. But a screening test saves no one if it is never offered, never completed or not followed by a timely colonoscopy after an abnormal result.

California’s cancer-burden report shows both the urgency of the problem and a troubling data gap. Nearly six in 10 colorectal cancers were diagnosed at a regional or distant stage among both Black and White patients from 2009 through 2018. The racial difference in stage was not statistically significant. Yet, the registry report did not include screening information, so it could not show who was offered a test, who completed it or who received the necessary colonoscopy afterward. It also did not assess whether survivors completed recommended follow-up. California can count cancers and deaths, but it cannot yet see every missed opportunity that produced them.

The disparities become clearer after diagnosis. A California Cancer Registry study of nearly 27,000 people with stage I through III colorectal cancer found that Black patients had 39% higher odds of receiving less than guideline-recommended treatment and 78% higher odds of waiting more than 60 days for treatment than White patients. Neighborhood socioeconomic disadvantage explained part of the substandard treatment, but racial differences persisted even after researchers accounted for where patients lived.

Survival reflects the accumulation of these missed opportunities. Among Californians diagnosed from 2009 through 2013, five-year relative survival was 58.8% for Black patients and 65.1% for White patients. After researchers adjusted for age, insurance, neighborhood income, stage, chronic illness and other factors, the survival difference was no longer statistically significant. That does not make the gap less serious. It identifies much of it as potentially preventable: when access, timing and health conditions are unequal, survival will be unequal too.

California already has proof that a better system can work. Kaiser Permanente Northern California built an organized program that identified eligible patients, mailed annual home stool tests to those overdue, offered colonoscopy as an alternative, and tracked abnormal results through follow-up. Screening among Black members rose from about 40% in 2009 to 80% in 2019. Over the same period, their colorectal cancer death rate fell from 54.2 to 20.9 per 100,000, essentially eliminating the Black-White mortality gap within that health system.

The lesson is not that every Californian must join one health plan. It is that equity requires organized care rather than reliance on chance encounters. Mailed screening outreach, patient navigation and guaranteed follow-up colonoscopy should become standard across Medi-Cal, county health systems and community clinics. Health systems should publicly report screening completion; time from a positive stool test to colonoscopy; time from diagnosis to treatment; receipt of guideline-concordant therapy; and completion of post-treatment surveillance—each stratified by race, insurance, and neighborhood.

Transportation, paid time off, bowel-preparation costs, childcare and distrust are not side issues; they determine whether patients can complete care. Community organizations, churches, clinicians and public hospitals should help design outreach from the beginning, not merely deliver messages created elsewhere. Survivors should leave treatment with a clear surveillance plan, navigation support and reminders that do not disappear when active therapy ends.

Closing California’s colorectal cancer gap is achievable. The state has the tests, specialists, data systems and proof of concept. What it needs is the will to connect them. Success should be measured not only by how many cancers we treat, but by how many we prevent, how quickly we act and whether every Californian has an equal opportunity to survive.

About the Authors 

Gracie Ann E. Dinkins, MD, FACS, is a Clinical Assistant Professor of Surgery and Surgery Clerkship Director at the Charles R. Drew University College of Medicine, Department of Surgery. Her mission is to help realize the CDU vision: Excellent health and wellness for all in a world without health disparities.

Sydney Y. K. Brown, MA, is a medical student at the Charles R. Drew University College of Medicine whose work focuses on clinical research, community engagement, and health equity. She is committed to advancing equitable access to high-quality care and improving health outcomes in underserved communities.

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Community

As Part of Your Back-to- School Checklist, Vaccinate

POST NEWS GROUP — Vaccines protect your household and also limit the spread of diseases such as measles and polio. The higher the vaccination rate in a community, the greater the protection for everyone – especially the most vulnerable.

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IStock.

Berkeley Public Health recommends families catch up on immunizations before the new school year begins 

Parents, check that your children return to school up to date on vaccinations. If necessary, schedule a visit with your family’s doctor or with the City of Berkeley’s Immunization Clinic to catch up.

Vaccines protect your household and also limit the spread of diseases such as measles and polio. The higher the vaccination rate in a community, the greater the protection for everyone – especially the most vulnerable. 

Families are encouraged to:

If your child doesn’t have a health care provider, you may be able to access free vaccinations through the City of Berkeley’s Immunization Clinic. Make an appointment by calling (510) 981-5350, emailing phmailbox@berkeleyca.gov, or booking online.

See what shots are required for pre-kindergarten or TK-12th grade, and check that your kids have all their recommended vaccines.

FREE VACCINE CLINICS AUG. 4-13

Children without health insurance or whose insurance doesn’t cover vaccines can get them for free:

City of Berkeley Immunization Clinic
West Berkeley Family Wellness Center
1900 Sixth St.

Hours: Tuesdays–Thursdays, 9 a.m.–3 p.m. 
Closed 12 p.m.–1 p.m.

Make an appointment between Aug. 4–6 or Aug. 1113 for back-to-school vaccine clinics:

Children 18 years and under are eligible for free City vaccines if they are:

  • Medicaid-eligible
  • Uninsured
  • Underinsured (insurance does not cover vaccines)
  • American Indian or Alaska Native

If you are unsure whether you or your child is up to date, the City of Berkeley Vaccination Clinic can help review records and provide recommended vaccines.

FAMILY WELLNESS RESOURCES

Vaccines are just one of the many public health services you can access at the West Berkeley Family Wellness Center. The center is home to the Women, Infants, and Children program, nutrition support, case management services, and a variety of family support services, plus free classes throughout the year.

Vaccinations aren’t just for kids. Throughout adult life, everyone should keep up with their vaccination needs. See recommended vaccines for adults

Get a healthy start to the school year. Check your child’s vaccinations. Make an appointment with your doctor or get free vaccines at the City clinic.

VACCINE INFORMATION AND FAMILY RESOURCES

Get trusted information about the City of Berkeley by bookmarking berkeleyca.govsubscribing to our newsletter, and following us on Bluesky and Instagram.

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