Bush reaffirms commitment to tort reform in national address

Much to physicians' satisfaction, President George W. Bush continued his push for medical liability reform, this time mentioning it in his Feb. 2 State of the Union speech.

In his 53-minute address to the nation, Bush asked Congress to move forward on "medical liability reform that will reduce health care costs and make sure patients have the doctors and care they need."

The president's comment encouraged Jay Alexander, MD, a cardiologist from Bannockburn, Ill.

"It was a brief mention, but a very important one because he's keeping it in front of the public," Dr. Alexander said. "It is pretty clear that this is one of the things on his agenda besides Social Security."

Tort reform has been high on the president's to-do list for several years.

He and physicians see reforms, such as a $250,000 cap on noneconomic damages, as a key component in trying to stabilize a medical liability insurance market in which many physicians can't afford the coverage they need.

The House last session twice passed reforms that include the cap, but legislation stalled in the Senate.

American Medical Association President John C. Nelson, MD, MPH, said he applauded Bush for his continued commitment to health care and to enactment of reforms needed to improve the nation's health care system.

The AMA lists 20 states as being in the midst of a medical liability insurance crisis that has physicians retiring early, moving to other states and cutting high-risk services. Consequently, tort reform remains the Association's top legislative priority.

"Without congressional action, the medical liability crisis will surely grow past the 20 states where patient access to care is already suffering," Dr. Nelson said.

Pensacola, Fla., neurosurgeon Troy Tippett practices in one of those crisis states and says liability insurance rates are impacting patient care.

Dr. Tippett's practice no longer takes care of pediatric cases and refers complex spine surgeries to university hospitals. "It means some patients have to drive five to seven hours to get care," he said. "Any light the president shines on the issue is great. He is absolutely correct that we need tort reform."

Insurance access on the agenda

Bush also provided a laundry list of market reforms that he plans to pursue in his second term, including health insurance tax credits, federally regulated association health plans and expansion of health savings accounts.

"We must make health care more affordable and give families greater access to good coverage and more control over their health decisions," he said.

These proposals are not new to his second term, but the 2004 presidential campaign helped refocus the discussion on health care reform.

Over the past 10 years, the debate around tax credits has evolved from whether to implement them to how to implement them, said Robert Moffitt, PhD, director of the Center for Health Policy Studies at the Heritage Foundation.

The AMA has proposed a system of refundable tax credits inversely related to income.

"President Bush's call for tax credits to help low-income workers buy insurance is an important step toward making health insurance affordable for many Americans," Dr. Nelson said.

Early reports of the success of health savings accounts could provide support for Bush's expansion proposal, which would allow individuals to deduct the cost of high-deductible health insurance from their taxes.

But some experts argue that tax credits and HSAs won't do much to help the bulk of the 45 million uninsured Americans buy coverage.

In response to Bush's speech, Ron Pollack, executive director of the consumer group Families USA, said HSAs do little more than shift the rising cost of health care to patients. He compared tax credit proposals to "throwing a 10-foot rope to a person in a 40-foot hole."

The president's push for association health plans could prove even more controversial. House legislation already has been introduced that would allow such plans to be regulated by the federal government, rather than states.

Proponents argue that such a move would allow AHPs to build a much larger risk pool and thus make insurance more affordable for association members.

But opponents, including many insurers, argue that the plans would be able to offer stripped-down coverage attractive to healthier individuals. This would divide the risk pool and make coverage more expensive for those unable to purchase an association plan.

In his address, Bush also highlighted his administration's efforts to help build more community health centers. The president's past budget requests have included significant increases for the health centers, with the goal of creating or expanding 1,200 centers. The administration is about halfway to that target.

Bush further noted continued support for investing in health information technology and wants to increase federal funding to $125 million next year.