Perez vs. Coburn

by Katrina Trinko
A dispute between the nominee and the senator is likely to resurface.

Add another issue to what will be a contentious confirmation fight over the nomination of Tom Perez for secretary of labor: his defense of the federal government’s requiring some doctors to provide translators for non-English-speaking patients.

In a scathing 2006 Mother Jones piece, Perez railed against an amendment authored by Oklahoma Republican senator Tom Coburn that would have repealed a Clinton-administration executive order leading to that requirement. Perez accused Coburn of having “exhibited a distressing disregard for the doctor-patient relationship.”

“Coburn, by promoting this amendment, will undermine meaningful communication between doctors and patients,” Perez added, “thus relegating those who do not speak English to a lower rung of our health care system.”

Although both Senate and House Republicans pushed to repeal the executive order, their efforts floundered, and it is still enforced today by federal agencies. In February 2011, Attorney General Eric Holder “reaffirmed” the Obama administration’s commitment to the order.

Nevertheless, a Senate Republican insider says Perez’s push for federally mandated translators is “very likely” to be an issue at his upcoming confirmation hearings.

At stake was whether the federal government should continue to require that doctors in some practices provide translators for patients who speak little to no English. “In the health care sector,” Perez wrote, “physicians, hospitals and other medical providers who receive Medicare and Medicaid reimbursement must provide interpretation and translation services in their patients’ primary languages, thus ensuring that patients with limited English proficiency can have access to health care services equal to that of English speakers.”

If translators weren’t mandated, Perez fretted that it “could literally mean the difference between life and death” for some Americans.

Coburn, an obstetrician, vehemently disagreed with Perez’s take. In 2009, on the day Perez’s appointment to head the Civil Rights Division of the Justice Department was confirmed by the Senate in a 72–22 vote, Coburn blasted Perez’s rhetoric on the Senate floor.

“After all my years of practicing medicine, I take offense at someone stating that I have a ‘distressing disregard’ for the doctor-patient relationship,” Coburn said. “I have treated numerous patients who do not speak English and found ways to communicate with them. Often these patients have family members who speak some English or they find other ways to communicate. There is no reason to burden health-care providers with the expense of having to provide services in languages other than English.”

Furthermore, Coburn charged, Perez was ignoring the real costs imposed on doctors by the mandate. Coburn argued that Perez’s “passion for limited-English-proficiency individuals” was clouding “his judgment as it pertains to health-care treatment and costs and will affect his judgment as the head of the Civil Rights Division.”

Coburn then quoted a 2002 OMB study that said, “We anticipate that the cost of LEP [limited-English-proficiency] assistance, both to government and to the United States economy, could be substantial, particularly if the executive order is implemented in a way that does not provide uniform, consistent guidance to the entities it covers.” He then went on to quote Perez insisting that the implementation of the executive order would have no “fiscal impact on state and federal governments.”

It wasn’t only the OMB that noted the onerous financial burden the rule places on health-care providers. In 2011, the CEO of the American Medical Association, Michael Maves, addressed a letter to Donald Berwick, who was then head of the Center for Medicare and Medicaid Services, expressing concerns:

An AMA survey at the time this guidance was issued revealed that costs of $150 or more for translator services were not uncommon and that the price of these services frequently exceeded the physician’s payment for the visit where they were provided. Yet neither Medicare nor Medicaid compensates physicians for the translators and the physician also cannot bill patients even when they cancel the visit on short notice. With Medicare payments that today are only 3 percent higher on average than in 2001, the cost of these services is a significant hardship that discourages physicians from participating in Medicaid and/or practicing in areas with large minority populations.

In other words, instead of leading to doctors’ providing better treatment to patients with little or no English, the rule was discouraging doctors from setting up shop in areas where patients weren’t likely to speak English.

In 2009, Coburn worried that “Perez fails to understand how the executive order undermines patient care, and I fear this lack of understanding will affect similar policies he will implement if he is confirmed to head the Civil Rights Division.” Substitute “Labor Department” for “Civil Rights Division” and Coburn’s concern still applies today.

Katrina Trinko is an NRO reporter.