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Senate health talks focus on illegal immigrants

Negotiators discuss rules to bar coverage

‘What we are trying to prevent is anyone who is here illegally from getting any federal benefit,’ said Senator Kent Conrad of North Dakota. ‘What we are trying to prevent is anyone who is here illegally from getting any federal benefit,’ said Senator Kent Conrad of North Dakota.
By Erica Werner and Ricardo Alonso-Zaldivar
Associated Press / September 12, 2009

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WASHINGTON - Senate negotiators closing in on a comprehensive health care bill have whittled away all but the most contentious issues and one of those loomed large yesterday: coverage for illegal immigrants.

The negotiators thought they had settled the issue, but that was before Representative Joe Wilson of South Carolina shouted “You lie!’’ at President Obama when the president said in his speech to Congress that illegal immigrants wouldn’t be covered under his health plan.

That led the senators to revisit the issue to make sure they have provisions in place to enforce prohibitions against illegal residents getting federally subsidized coverage.

“What we are trying to prevent is anyone who is here illegally from getting any federal benefit,’’ said Senator Kent Conrad of North Dakota, a member of the “Gang of Six’’ of three Democratic and three Republican members of the Senate Finance Committee.

The White House says that Obama does not want illegal immigrants to be able to buy insurance through the new purchasing exchange he proposes. White House press secretary Robert Gibbs said yesterday that the administration will work with lawmakers on language to enforce that.

The House health bill expressly prohibits federal subsidies for illegal immigrants, but critics note that there are no enforcement mechanisms or language on how to verify whether someone is in this country legally.

“Without a verification requirement it’s essentially like posting a 55-mile-per-hour speed limit and not having any highway patrol on the road,’’ said Ira Mehlman, spokesman for the Federation for American Immigration Reform.

Democrats in two House committees defeated amendments that would have required verification of legal status, saying such measures create barriers to legal residents getting the health coverage they need.

The Senate negotiators are facing a deadline early next week to produce a bipartisan deal. If they don’t succeed, committee Chairman Max Baucus plans to go it alone with a Democratic bill.

Baucus’s plan largely mirrors what Obama laid out in his speech Wednesday night: expansion of coverage to most of the nearly 50 million uninsured, new requirements for individuals to obtain insurance, new prohibitions against insurance company practices such as denying coverage based on personal health history, and creation of the new exchange where consumers could shop among different health plans.

A successful effort could form the basis for legislation that could appeal to a majority in the Senate since the Finance Committee has a moderate makeup that resembles the Senate as a whole.

This weekend will be critical as aides and lawmakers hammer out language not just on illegal immigration, but also a handful of other thorny issues including abortion, how much states must pay for an expansion of Medicaid, and medical malpractice.

Finance Committee members are looking at the possibility of special courts in which a judge with medical expertise would hear malpractice cases, Conrad said. The theory is that medical judges wouldn’t be as easily swayed by emotion as are lay juries. Other possibilities include the option of arbitration, as well as some liability protection for doctors who follow “best practice’’ clinical standards in treating their patients.

Many economists are skeptical that malpractice insurance premiums paid by doctors - or even the practice of defensive medicine to avoid litigation - are major reasons for soaring health care costs. But the issue looms large politically because many conservatives in both parties are convinced that doctors routinely order up tests their patients don’t need because they are afraid of getting sued.

Obama’s overture in his speech could give him a way to peel off some Republican votes, as well as shore up support from moderates in his own party. The president said that while he doesn’t see malpractice changes as a “silver bullet,’’ he has talked to enough doctors to suspect that fear of litigation contributes to unnecessary costs.

He directed the Department of Health and Human Services to provide funding for pilot programs to test some alternatives to litigation. Administration officials said Obama’s order will encourage states to experiment with programs that reduce litigation and promote patient safety. Preventable medical errors are estimated to cause 44,000 to 98,000 deaths a year.

Doctors’ groups, which lost the battle for national limits on jury awards for pain and suffering, now see a possibility for other ways to reduce malpractice lawsuits.

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