PHOENIX — The California telephone hotline for the state's insurance marketplace includes options to press one for English, and two for Spanish.
But then the options keep going: press three for Cantonese, four for Vietnamese and five for Korean. There are 13 different language options.
These multilingual greetings are just one of the ways California is trying to help non-English speakers as they enroll in the new health care options that opened this week.
After all, figuring out insurance is daunting enough even if you speak English perfectly, said Iyan John of the Asian & Pacific Islander American Health Forum.
His organization has been working with U.S. Health and Human Services to make federal Affordable Care Act resources more accessible to the millions of people nationwide who are eligible to enroll, but are not proficient in English.
“Those individuals that speak different languages need to have the same opportunities as those who speak English really well,” John said.
And census data shows that non-English speakers are far more likely to be uninsured than the general population.
California has a private health endowment that is putting tens of millions of dollars toward ethnic media to educate that audience about expanded Medicaid.
And because the state is running its own insurance exchange, it got significant federal funds to do outreach.
But this isnt the case everywhere.
“California had more money available to do the targeted type of outreach that is not going to happen in many of the other states,” John said.
States like Arizona that are using the federally run marketplace, for example, couldn’t qualify for many of the federal grants California got.
That means limited funds for outreach in English, let alone other languages.
Arizona community groups did get federal funds to hire so-called navigators — many of them bilingual — to help with enrollment. But the grant was only enough to hire about 100 of these workers, when there are roughly 1 million uninsured in the state.
“I have a feeling it is going to be very challenging,” said Yen Nguyen, a navigator who also directs a Phoenix organization dedicated to helping Asians, Pacific Islanders and refugees get health services.
Nguyen speaks Vietnamese, making her one of the few navigators in the state who speaks an Asian language.
“They probably will be relying on our agency,” Nguyen said. “Which we don't have a lot of volunteers.”
And Nguyen has already found that there is a lot of confusion in the Vietnamese community about what the Affordable Care Act does, much less how to enroll.
Many of those problems stem from language barriers.
“So far, ‘marketplace,’” Nguyen said. “You know it is very hard to translate.”
Nguyen said not everyone in the immigrant community has understood the term.
“A lot of people thought it was where you go, you know, like a store, where you go and you shop, not realizing it was online.”
She said she heard from people in the community they had seen it literally translated as ‘grocery store’ in Vietnamese.
“So we keep having to remind them, this is a website, you need to use your computer,” Nguyen said.
Of course the biggest group of non-English speakers shopping in the new online marketplaces are those who speak Spanish.
In Arizona, 40 percent of the uninsured identify as Spanish speakers, according to a Fronteras Desk analysis of census data.
Nationally, there are about four million Spanish speakers who will be eligible to buy insurance on the new marketplaces, according to federal estimates. These include legal immigrants and naturalized citizens.
The federal government’s website had planned to have a Spanish-language application available Oct. 1, but it has been delayed a few weeks.
Earlier this week, Livbier Pearson, a bilingual navigator who works for Phoenix-based Keogh Health Connection, sat down with an uninsured client, Mariaelena Frisby.
Frisby, who is 60, told Pearson in Spanish that she had come to find out what insurance she qualifies for.
Though Frisby specifically requested to have her appointment with a Spanish-speaking staff person, her English is actually quite good.
But she said she prefers her native Spanish for topics like health insurance.
“It’s easier, you know,” she said in English. “If it’s in your own language, it is always easier.”
She said part of her goal today is to bring back information about the new health care options to her Spanish-speaking friends and relatives.
“They don’t even know what is going on,” Frisby said. “They dont know.”
Which means, there will be a lot of work to be done in the next several months to get this population enrolled.