“Please Hold” ~ Language inaccessibility in Medicare and institutional bias against language minorities

January 5, 2009 (posted by Colin Bailey)

he California Medicare Part D Coalition recently released a report entitled, Please Hold: Medicare Plans Leave Limited English Proficient Beneficiaries Waiting for Access.” Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with permanent kidney failure (called “End-Stage Renal Disease”). Medicare Part D is a voluntary program that provides beneficiaries of Medicare Part A or B with assistance paying for prescription drugs.

Limited English proficiency generally describes someone who has limited ability to read, write, speak, and/or understand English (e.g., US DOT, Federal LEP Working Group, etc.). Because it all too often limits the ability of LEP persons to take full advantage of the opportunities otherwise available to proficient English speakers, LEP status is linked with poverty and social isolation and is a common underlying cause of lack of access to services, including legal services. See Expanding Legal Services: Serving Limited English Proficient Asians and Pacific Islanders (2003). The report shows that limited English proficient (LEP) Medicare beneficiaries are often unable to receive important information from Medicare prescription drug plans, thus leaving them without important medications. In this way, the failure of many government programs to adequately address the needs of their would-be beneficiaries is a systemic and institutional impediment to equal access to services.

Key findings of the Medicare Part D report include:

  • California’s low-income Part D plans are only able to connect limited English proficient dual eligibles to someone speaking their language 69 percent of the time.
  • Non-Spanish speaking LEP beneficiaries have an even harder time getting information from plans, connecting with someone who speaks their language only 57 percent of the time.
  • Plan representatives repeatedly refused to provide services in languages other than English.
  • Multiple callers were told that they had reached an English-only line and needed to call back with an English speaker.
  • Even those beneficiaries who were provided an interpreter were frequently unable to get the information they needed.
  • Written materials were never available in any language other than English or Spanish, and Spanish written materials were not always available.

The report was released by the California Medicare Part D Language Access Coalition, an informal coalition of advocates in legal and community-based organizations serving limited English proficient and low-income communities in California. The effort was led by the National Senior Citizens Law Center, the National Health Law Program, the Greenlining Institute, Asian & Pacific Islander American Health Forum and the Health Consumer Center of Los Angeles.

For more resources on language access (in California), see LSNC’s Language Access Advocate Feed. For additional resources, see the LEP Task Force website at http://www.leptaskforce.org.

Chicago Tribune series on racial segregation

December 29, 2008 (posted by BeenieMum)

In Chicago, America’s most segregated big city, published December 26, 2008, Tribune reporters Azam Ahmed and Darnell Little explore the long-standing segregation between African-Americans and whites in President Elect Obama’s hometown. The article takes a historical look at housing patterns dating back to the late 19th century when blacks were confined to certain geographic areas by law. The article explains that these patterns became institutionalized and persist despite the enactment of civil rights laws not only because of ongoing albeit less overt racism, but because both African-Americans and whites tend to move to neighborhoods where they have connections and for which they feel an affinity. In terms of access to good schools and other resources and property values, these patterns put African-Americans at a distinct economic and social disadvantage. Based on the Tribune’s analysis, 84 percent of the blacks or whites would have to change neighborhoods to true achieve integration. The article is the first in a three-part series.

Site redesign

December 16, 2008 (posted by ElektroMoose)

The REP thanks the Gizmos for the wonderful job they did on the redesign of the REP site. If you’re interested in things tech, take a look at the enterprise search engine they our currently implementing for our LSNC’s offices.

Fair Housing Commission Report posted

December 11, 2008 (posted by BeenieMum)

The final report of the National Commission on Fair Housing and Equal Opportunity, officially released on December 9 at a press conference held in Washington D.C., is now posted on the PRRAC (Poverty & Race Research Action Council) webpage. Coinciding with the 40th anniversary of the passage of the federal Fair Housing Act, the Commission was formed to find ways to address the presently virtually non-existent fair housing enforcement at the federal level, particularly in light of persistent racially segregated housing patterns in most U.S. cities and suburbs and ongoing housing discrimination against people of color, people with disabilities and others. The Commission is co-chaired by former HUD Secretaries Jack Kemp and Henry Cisneros. The Commission’s recommendations include creating an independent fair housing enforcement agency to replace the existing moribund structure at HUD, incorporating fair housing principles into foreclosure relief implementation (e.g., ensuring that neighborhood stabilization funds counter, rather than exacerbate racial segregation), actually ensuring compliance with the obligation of federal housing programs to “affirmatively further fair housing”, and adopting a regional approach to fair housing.

3-year American Community Survey data available for areas and cities at least 20,000 persons in size

December 9, 2008 (posted by ElektroMoose)

Tired of relying on 2000 Census data but hesitant to use ACS data due to its high margins of error? Thankfully the Census Bureau just released 3-year data for cities and places at least 20,000 persons in size. This data has a significantly lower margin of error then the normal 1-year ACS survey data.

“New data released today by the U.S. Census Bureau give more than 2,500 midsized counties, cities and towns nationwide (those with populations between 20,000 and 64,999) their first statistical “portrait” since the 2000 Census on a wide range of key socioeconomic and housing topics.

These are the first American Community Survey (ACS) estimates that combine three years of survey responses (2005-2007) to produce data. The technique makes it possible to release a new set of multiyear estimates annually for smaller geographic areas. The three-year data can produce
estimates for areas with populations as small as 20,000.”

“The 2005-2007 ACS estimates are based on three years of data collected nationwide from about 250,000 addresses per month. In addition, approximately 20,000 group quarters across the United States are surveyed each year, comprising approximately 200,000 residents annually.

The population threshold for which geographic areas have three-year estimates available is 20,000. For nation, states, counties, cities, and towns, the estimated population used to satisfy that threshold is the July
1, 2007, Census Bureau Population Estimates. For other areas, the 2005–2007 ACS three-year estimates of total population are used. For example, since the Census Bureau’s Population Estimates are not available
for school districts, three-year ACS estimates of total population are used to determine if a school district meets the 20,000 population threshold.

As is the case with all surveys, statistics from sample surveys are subject to sampling and nonsampling error.”

Excerpt quoted from Census Bureau Public News Alert issued on December 9, 2008.

Talking about Race in a New Political Era

December 8, 2008 (posted by Colin Bailey)

Framing is a tool long used by advertisers and political consultants to persuade those who would listen and achieve outcomes for their constituents. We, as legal services advocates, should use those same framing techniques, consciously and strategically, to achieve outcomes for our clients. How, you ask?

Today, The National Campaign to Restore Civil Rights, in partnership with New York Lawyers in the Public Interest, sponsored a discussion on the shifting public debate on the role of race in American society and politics. Guest speakers, Eva Paterson (blog), President of the Equal Justice Society (EJS), and Alan Jenkins, Executive Director of The Opportunity Agenda, took up the question of how best do we, as racial justice advocates, keep the dialogue on racial justice alive in the new national political discourse following Barack Obama’s election as the first African-American President of the United States of America?

[For a discussion and samples of the various ways in which race was framed in the 2008 Presidential campaign, see the UCLA Critical Race Studies Program's presentation of "Identity Politics and Political Identities: Race to the White House 2008", especially the section on media materials.]

Keith Kamisugi, EJS’s Director of Communications, provides detailed notes and reviews the take-away lessons from today’s discussion on framing race in his excellent blog entry, titled, “Talking About Race In The Obama Era.”

Alan Jenkin’s lessons for effective framing on race issues are:

1. Lead with shared values instead of dry facts, policies, and rhetoric.
2. Frame issues thematically rather than episodically, showing the systemic barriers to opportunity rather than just the impact to individuals.
3. Present solutions early on.
4. Over-document the negative impact of bias and the benefits of equal opportunity.
5. Appeal to subconscious attitudes about race.
6. Combine participatory and disciplined messaging.
7. Acknowledge our progress and connect history of discrimination to the future.
8. Media matters: use new channels of communication.
9. Connect racial justice messages and solutions to a broader agenda (”break out of your silo”).
10. Repeat, repeat, repeat your message over and over and over again.

Legal Services of Northern California has used these framing techniques in the context of its race-based advocacy through the Race Equity Project. At the NLADA’s recent Annual Conference in Washington, D.C., LSNC Staff Attorneys, Emily Fisher and Colin Bailey, presented lessons learned from the field and current examples of framing in race-based legal advocacy. Take a look at the Power Point slides from Emily and Colin’s presentation “Framing in Race-Based Advocacy.”

If you have comments, suggestions for improvement, or would like to share your use of framing in your work, please use the comment function below. We’re always looking for ways to learn from each other and share the best of what legal services advocacy has to offer.

Presentations on mapping, data, and databases at the 2008 NLADA Annual Conference

November 25, 2008 (posted by ElektroMoose)

We were excited to see a slew of presentations on applied mapping and data analysis in poverty advocacy at the 2008 NLADA Annual Conference. The REP participated in two mapping/data sessions: Using Mapping, Data, and Databases for Advocacy and Program Improvement: An Introduction; Using Mapping, Data, and Databases (II): Developing and Implementing Mapping and Data Capacities.

The presenters for the first session were Eric Schultheis (aka ElectroMoose) from the Race Equity Project, Ann Joyner from the Cedar Grove Institute for Sustainable Communities, and Julie Aguilar Rogado from the Health Rights Hotline. The presenters for the second session were Eric Schultheis, Ann Joyner, and Jason Reece from the Kirwan Institute on the Study of Race and Ethnicity.

Eric Schultheis’s presentation slides are available below in JPEG format as self-extracting ZIP files:

(If you use images or content from these slides please provide the following attribution: The Race Equity Project, Legal Services of Northern California, www.lsnc.net/equity)

“What Happens Now?”

November 10, 2008 (posted by BeenieMum)

This is the question PolicyLink CEO Angela Glover Blackwell put forth in PolicyLink’s EquityBlog on November 5th following Barack Obama’s historic election to the White House. Taking this unique moment in history to remind us that “[a]ll Americans–especially those in low-income communities and communities of color–deserve a chance to participate and prosper[,]” Blackwell offers Four Principles for Equity to guide the Obama Administration and Congress as they prepare to tackle the unprecedented economic challenges we face as a nation: 1) Sustain the deep levels of democratic participation and civic engagement of the presidential campaign; 2) Build an economy that expands opportunity for struggling families and revitalizes distressed communities; 3) Make affordable housing available to all, recognizing its powerful asset-building capacity; and 4) Invest in building strong, healthy communities across the country. View Blackwell’s companion video, find a link to the full Four Principles piece or submit your own recommendations to the Obama Administration and Congress on the EquityBlog by clicking here.

DataPlace does it again

October 30, 2008 (posted by ElektroMoose)

DataPlace unveiled its new Neighborhood Metrics system today. Neighborhood Metrics allows users to “create custom metrics (or indices) by aggregating existing dataset indicators.” Lets say you want to identify neighborhoods of low-income persons at high risk for foreclosure. You could create a metric that “combined high interest loans for both refinance and home purchase, to low-income borrowers in 2006″ and then map the metric. Instead of dealing with multiple layers, DataPlace now allows you to create and display a single easy to understand layer based on the user defined metric. We still haven’t gotten a chance to really explore Neighborhood Metrics but, at least at first glance, it seems to have some real promise.

Stuck with stats in PDF format when you need the stats as an XLS file?

October 20, 2008 (posted by ElektroMoose)

Here’s the situation: you sent out a bunch of FOIA or discovery requests and you get pages of data in PDF format.  After dreaming of federal or state regulations requiring data to be sent in XLS or DBF format,  what will you do? Fear not, we recently found a free web application that will save you from manually copying the data into an Excel spreadsheet.  Zamzar allows you to convert PDFs into a variety of more useful formats. If you need to convert a PDF into XLS follow the following steps: (1) convert the file into a TXT file using Zamzar and (2) import that text file into Excel (you will probably want to select a “fixed width” import if the data in the original PDF was in columns). Viola! It’s that easy. (Although probably not worth mentioning, if you need the data in DBF format for use with GIS software, simply save the XLS file as a DBF in Excel.)