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.