GOP leaders focus on tort reform, health disparities
■ Other priorities include reducing the number of uninsured Americans and passing mental health parity legislation.
By Joel B. Finkelstein — Posted March 1, 2004
Washington -- Republican leaders in the House and Senate have begun to move ahead with their 2004 health care agendas. Already medical liability reform -- a top legislative priority for the American Medical Association -- has become a hot topic.
While Republican lawmakers previously focused on comprehensive medical liability reform, the leadership recently agreed to pursue specialty-specific legislation in the hope of making a dent in the problem this year.
Last month, Sen. Judd Gregg (R, N.H.) introduced a bill that would cap noneconomic damages at $250,000 for lawsuits brought against obstetrician-gynecologists. Punitive damages would be limited to $250,000 or double the noneconomic damages, whichever is greater.
Senate Majority Leader Bill Frist, MD (R, Tenn.), said those cap levels could be up for negotiation, signaling that Republicans are looking for progress on the issue this year.
The AMA supports the new bill as a step forward but will continue to press for tort reform for all physicians. "The AMA will be relentless in its pursuit for reform so that physicians continue to provide care to patients," said AMA President Donald J. Palmisano, MD.
In a meeting with health care reporters, Dr. Frist listed several other health care issues that may get attention this year.
He recently introduced health disparities legislation that would focus more attention and government funds on improving care for minority and poor patients. The bill would provide additional funds for physician training and education.
"There is no excuse for infant mortality to be twice as high in the African-American population as the non-African-American population, or the incidence of asthma four times as high or the chances of dying from asthma seven times as high," he said. "Those health care disparities we're going to hit head on."
Last year, the Senate passed bills designed to help ensure more organ donation and to prohibit genetic discrimination. Dr. Frist said he would encourage the House to vote on those measures this year. He also vowed to work on child obesity, HIV/AIDS and mental health parity legislation this year.
Senate Democrats and a few Republicans also would like to revisit the issue of drug reimportation. But GOP leadership says the Medicare bill was the last word on the issue.
Democrats, meanwhile, are keeping up a steady drumbeat of criticism against the new Medicare reform law. They are also expected to keep up opposition to liability reform. Democrats have their own ideas on health disparities, although there may be more common ground on this issue than other health legislation this year.
Health in the House
House GOP leaders have outlined some basic principles they expect to pursue.
Following the Bush administration's lead, House Republicans propose that the solution to the rise in the number of uninsured Americans is to make the individual market a more viable option for purchasing health insurance. This would be accomplished with the help of individual tax credits, health savings accounts and new market products.
Their philosophy is that moving away from a largely employer-based market will let Americans choose the health insurance products best suited to their needs. Conservative experts argue that the current system insulates consumers from the cost of health services, and that is driving up health care prices and spending.
"You need knowledgeable consumers," said Rep. Bill Thomas (R, Calif.), chair of the House Ways and Means Committee. "Frankly, we have fallen down in that area from the very beginning."
He cited several anecdotes demonstrating the difficulty individuals faced in getting physicians or hospitals to quote a set price for services and procedures. This is evidence of the disconnect between consumer and supplier in the health care market, he said.
While Democrats would like to deal with the uninsured problem by bolstering the chronically underfunded Medicaid program, public health plans should be the insurer of last resort for the under-65 population, Thomas said.