News in brief - Feb. 6, 2006

States delve into tort reform issues - Maryland Legislature overturns veto of "Wal-Mart" health insurance bill - Medicaid, SCHIP eligibility cuts would hurt emergency departments - HHS awards e-prescribing grants - Bush calls for HSA improvements, association health plans

States delve into tort reform issues

Several states have started debating medical liability reform.

Kentucky Gov. Ernie Fletcher, MD, has said he would push for a constitutional amendment on tort reform as part of his 2006 legislative agenda. While he did not unveil any specifics of the plan in his January budget address, Dr. Fletcher said it was necessary to help keep doctors in the state.

In Colorado, Gov. Bill Owens, in his State of the State Address, called for a law requiring a certificate of merit in medical malpractice lawsuits. Owens said he wanted to encourage doctors to practice in Colorado and end the yearly waste of millions of dollars on frivolous lawsuits.

In January, the Indiana House Judiciary Committee discussed for the first time a bill to prevent plaintiffs from submitting doctors' apologies as evidence against them in malpractice lawsuits. Other statements of sympathy or condolence, or a description of events of treatment, also would be exempt from liability. The proposed law also would apply to other claims that allege harm, such as car crashes. Some legislators said the law should not apply to apologies in which doctors admit fault. Utah lawmakers in January began pushing for a similar apology law, approved by the Senate Judiciary Committee.

In December, Maryland legislators began seeking tougher oversight by the Board of Physicians. This would include more disclosure of medical liability claims. The 2003 law creating the board expires this year.

Lawmakers discussed public access to disciplinary hearings. Physicians say this could hurt physicians targeted by frivolous complaints.

Maryland Legislature overturns veto of "Wal-Mart" health insurance bill

The Maryland General Assembly last month overturned Gov. Robert Ehrlich's veto of a bill that would require businesses with 10,000 or more employees to pay at least 8% of their payroll toward health benefits. The measure was widely perceived as being targeted at Wal-Mart, the only private employer in the state that didn't meet the thresholds established in the legislation.

Wal-Mart spokeswoman Sarah Clark noted that more than three-fourths of the retailers' associates have health insurance. "This vote was never about health care. This was about partisan politics in the Maryland gubernatorial race."

The AFL-CIO, which backed the law and is pushing for similar legislation in other states, applauded the vote. "What the Maryland victory shows is that the tide is turning because working people are not just fed up, they are ready to get active to set our country in a different direction," said John J. Sweeney, union president.

Medicaid, SCHIP eligibility cuts would hurt emergency departments

Policies that aim to save Medicaid or State Children's Health Insurance Program money by restricting eligibility would lead to an increase in uncompensated care in emergency departments but little change in overall ED volume, a recent study said.

Medicaid and SCHIP enrollees already depend on EDs for much of their care, often because access to physicians who will accept the insurance is limited, said Peter J. Cunningham, a senior health researcher at the Center for Studying Health System Change in Washington, D.C. Because the uninsured use the emergency department with less frequency, dropping people from the public health rolls actually would result in a net decrease in ED visits, he said.

Such a move, however, would have a big downside for hospitals, the study concluded. "Although ED volumes and overcrowding might not increase, the loss of Medicaid revenue and increase in uncompensated care could reduce hospitals' ED capacity and their ability to respond to public emergencies," Cunningham said.

HHS awards e-prescribing grants

The Dept. of Health and Human Services recently named recipients of four grants totaling $6 million for testing federal electronic prescribing standards. The grantees will determine if electronic data transmission standards adopted by HHS last year can be used to make adequate improvements in patient safety and quality of care through e-prescribing. Part of the testing will involve assessing physician use of drug formulary and medication history systems.

Grant winners are RAND, Santa Monica, Calif.; Brigham and Women's Hospital, Boston; SureScripts, Alexandria, Va.; and Achieve Healthcare Information Technology in Minnesota.

Bush calls for HSA improvements, association health plans

In a recent radio address, President Bush called on lawmakers to pass legislation to help expand health insurance access. "This year, I will ask Congress to take steps to make [health savings accounts] more available, more affordable and more portable," Bush said.

Bush also will press for association health plans, which would allow small businesses to pool their risk so they can get the same health insurance discounts that big companies get.