Lawmakers push to unionize, regulate Medi-Cal interpreters
Thousands of Medi-Cal medical interpreters would have the right to join a public employees union and collectively bargain with the state under a legislative push to regulate that profession.
Assembly Speaker John A. Perez is leading the drive, fueled by a major public employees union and sparked in part by federal subsidies for Medi-Cal expansion as part of national health care changes.
Perez's Assembly Bill 1263 would create an oddity in which Medi-Cal interpreters would remain independent contractors but would pay dues to a public employees union for representation. They would be guaranteed at least $60 an hour.
Perhaps the most similar arrangement now involves In-Home Supportive Services workers. They are self-employed but represented by publicemployee unions in negotiations with counties to assist homebound Californians.
The American Federation of State, County and Municipal Employees is pushing Perez's bill and is jockeying for position to represent Medi-Cal interpreters if the measure becomes law.
More than 7 million Californians are limited in English proficiency, and state law already requires Medi-Cal providers to offer interpreting as a customer service. But supporters of AB 1263 complain of inadequate service, standards and oversight.
"Having more trained and professional interpreters will save lives and reduce health care costs by reducing misdiagnoses and giving health professionals the correct information they need," Perez said in a written statement.
Perez's bill would require the State Personnel Board to determine appropriate testing, training and certification of Medi-Cal interpreters. Jobs of existing personnel with two years of experience would not be affected.
The bill would give Medi-Cal interpreters the right to vote for union affiliation as non-public employees ineligible for state pension or other benefits.
The Department of Health Care Services would oversee operation of a new program, CommuniCal, to use certified medical interpreters in serving Medi-Cal recipients.
Ellen Wu, director of the California Pan-Ethnic Health Network, called the issue "absolutely critical" because "not being able to communicate symptoms and experiences with your health care provider will lead to miscommunication, misdiagnosis, mistreatment plans, and less satisfaction in care."
But Jon Coupal, president of the Howard Jarvis Taxpayers Association, said that AB 1263's push to unionize Medi-Cal interpreters reflects the "inordinate political power" of public employee unionsin a Legislature dominated by Democrats.
"It sounds like another typical union power grab," Coupal said. "It becomes far more costly to taxpayers than it needs to be when you create these kinds of classes of contractors who are subject to unionization. It just becomes unwieldy."
AFSCME won a similar campaign in 2010 to unionize about 1,600 interpreters in the state of Washington.
Bill Glasser, owner of Language World Services, a Carmichael-based stable of 100 interpreters, has not read the bill but says that interpreting often is treated as an afterthought. He applauds requiring training, testing or "anything that professionalizes" the service.
But unionizing medical interpreters would perpetuate a system of independent contractors, Glasser said. He would rather see them become supervised employees of health care facilities.
"People need to be monitored and trained and quality assured and managed," he said.
Under Perez's bill, Medi-Cal interpreters would be reimbursed at a base rate "no less than $60 per hour." Rates currently vary but typically are less than that, Glasser said.
Gov. Jerry Brown has taken no position on AB 1263.
Statistics are not readily available on the current number of medical interpreters, but an AFSCME-led coalition estimates that more than 7,000 such jobs will be created over the next decade.
Perez has collected a stack of horror stories from English language learners. Among them:
-- Marin Hernandez, of Los Angeles, said he had a severe stomach ache in 2010 but couldn't get a doctor to understand his symptoms. The doctor assumed he was drunk and told him to go sleep it off, Hernandez said.
-- Ana Pacheco, of Downey, said that doctors couldn't understand her complaint of stomach pain about five years ago. They gave her pain medication, which she took for a year, but it did little good. She finally had her son - 10 years old at the time - translate for her to the doctor. Diagnostic tests discovered a cancerous tumor, she said.
-- Maria Amalia Romero, of Long Beach, said she accidentally sliced through the muscles of a finger with a knife about a decade ago. She went to a hospital emergency room where nobody spoke Spanish. She was ignored for 11 hours before giving up and going home, she said.
Deputy Director Jane Ogle, of the Department of Health Care Services, said there may be some anecdotal complaints but that she is not aware of major systemic flaws in interpreting.
"We have not seen any gaps in service that we have become concerned about," she said.
Of 4.5 million Californians enrolled in a Medi-Cal managed care plan, only two problems reported to the Department of Managed Health Care appeared to be tied to medical interpreting over the past year, records show. Other complaints may have been resolved by providers without state involvement.
AB 1263 would allow interpreting by phone or video but the "preferred mode" would be face-to-face when key treatment decisions are made.
Perez pushed a bill similar to AB 1263 in the final days of last year's session. It passed the Senate on a party-line vote but was tabled before reaching the Assembly floor.
Last year the state Department of Finance, noting that Medi-Cal providers already are required to provide translation, questioned the need for such legislation.
"It is unclear to what extent access to interpretation services are insufficient in the current Medi-Cal program," the Finance Department said in an analysis of last year's bill, Assembly Bill 2392.
Even with federal subsidies, finance officials estimated last year that costs to the state's general fund could total at least $12.5 million annually, perhaps much higher.
Perez's new bill, AB 1263, has not yet been analyzed by state finance officials. His staff estimates state costs of $35 million annually after five years of implementation.
State Sen. Joel Anderson, vice chairman of the Senate Health Committee, said the bill is unnecessary. His Assembly counterpart, Dan Logue of Marysville, said he has not yet taken a position but that cost will be a key consideration.
"I want to look at the bottom line on that," he said.