AMNews: Nov. 25, 2002. Elections boost GOP health care agenda ... American Medical News

Elections boost GOP health care agenda

This year's unfinished business -- Medicare prescription drugs, medical tort reform and health insurance access -- will spill over into next Congress.

By Joel B. Finkelstein, AMNews staff. Nov. 25, 2002. Additional information

Washington -- Now that Republicans control both the House and Senate, President Bush's health care plans are expected to take center stage, according to political analysts. That will shift the tenor of the debate on a variety of physician issues, from liability insurance reform and health insurance access to Medicare prescription drugs and patient protections.

But with the GOP maintaining only a narrow majority in the Senate, the Republican health agenda will not necessarily be a slam dunk. Republicans could still face stiff opposition from Senate Democrats.

A top item on Republicans' list of health care initiatives will be passing a Medicare prescription drug benefit.

GOP control of both chambers of Congress gives a boost to the Republican vision of a drug program -- one that relies on private insurers to offer the benefit. But Democrats will still push for their proposal, which includes a federally managed benefit.

The price tag will continue to cause controversy. Democrats favor spending far more on a drug benefit.

President Bush will have to remain flexible on appropriations levels to avoid getting bogged down in opposition as congressional Democrats try to increase funding levels. The sluggish economy and Republicans' attempts to pass new tax cuts could make funding a drug benefit program that much more difficult, political analysts said.

Premiums rose 20% for ob-gyns and 26% for internists between last winter and summer.

But despite tight economic times, "we are going to have a prescription drug benefit pushed through," predicted Norman J. Ornstein, PhD, resident scholar at the American Enterprise Institute.

Pharmacy discount cards may prove an attractive option for lawmakers, as there is growing experience with this approach and it will cost the government relatively little to administer, said Diane Rowland, ScD, of the Kaiser Family Foundation.

As for comprehensive Medicare restructuring, any proposal likely would face an uphill battle in Congress, Dr. Ornstein said.

Addressing medical liability woes

The burgeoning medical liability insurance crisis also may get lawmakers' attention next year, many experts predicted. With increasing reports of doctors leaving medical practice because they cannot afford or get liability insurance, the American Medical Association and other groups are pushing hard for tort reform.

The Association also will press Congress to prevent continued Medicare physician payment cuts, which it says are hurting access to specialty and primary care physicians, said AMA President Yank D. Coble Jr., MD. At press time, it was unclear whether Congress in its lame-duck session would address Medicare physician payment before closing the current legislative session.

"These two things are creating an enormous barrier to care, and not only for seniors," Dr. Coble said. While specialists, such as obstetrician-gynecologists and emergency department physicians, have been the hardest hit by medical liability insurance problems, he noted, primary care physicians are also starting to feel the pinch.

Rates are rising fastest in states without noneconomic damage caps.

Dr. Coble said the current state of medical liability law rewards lawyers and a few patients, while the majority of patients who have been injured get nothing. States that have adopted their own rules to limit jury awards for noneconomic damages seem to be avoiding the crisis situation seen in other states, which are losing doctors and medical facilities to out-of-control liability insurance premiums.

The AMA's position has been echoed by the Bush administration. A recent report from the Dept. of Health and Human Services showed that professional liability insurance rates are rising at an increasing pace. Premiums rose nearly 20% for obstetrician-gynecologists between last winter and summer and more than 26% for internists. The report also found that rates are rising fastest in states without limits on noneconomic damages, ranging from 36% in Nebraska to 113% in Virginia.

Earlier this year, Bush called for federal tort reform, including caps on noneconomic damages and punitive damages, structured payouts, a statute of limitations on malpractice suits and a provision requiring doctors to pay only the portion of damages for which they are personally responsible.

The House in September passed a tort reform bill including many of those provisions, but Democratic opposition in the Senate has prevented action there. Democrats are likely to continue their fight against sweeping reform next year, experts predicted.

But GOP control of the legislative and executive branches could result in federal court appointments that swing decisions in favor of states trying to pass their own versions of tort reform.

Expanding health insurance access

The GOP takeover also will affect the debate about how to reduce the number of uninsured Americans, which reached 41.2 million last year.

"We may see a modest effort for the uninsured, such as a tax credit to help people pay for private insurance," said Robert Blendon, ScD, director of the Harvard University Program on Public Opinion and Health and Social Policy. But expect Republicans to spend less on health insurance reforms than the Democrats would like, he added.

Tax credits synchronize well with the Bush administration's embrace of tax cuts, but they have been a hard sell with most Democrats, who say the tax credits do nothing for the working poor.

Republicans may be able to pass a tax-credit bill if it is generous enough to help more low-income Americans, political analysts said.

"There is going to be a lot of attention around the public health care system," predicted Kaiser Family Foundation's Dr. Rowland. The Bush administration may seek to further boost the public health infrastructure by way of homeland security and bioterrorism legislation.

Experts predicted that patients' bill of rights legislation may not find its way back on the congressional agenda next year.

"HMO reform has pretty much fallen off the radar screen," said Whitfield Ayres, PhD, whose firm conducted a pre-election survey for the Pharmaceutical Research and Manufacturers of America.

That survey showed that, across the board, managed care reform was the most important issue for just 1% of voters. In a separate survey, the Kaiser Family Foundation found that managed care reform was the top health care issue for 2% of the voters.

Health care issues that don't get addressed by Congress, such as a patients' bill of rights, may fall to the states, though the new governors will be severely restricted by growing budget crises created by overspending during the 1990s, the weakened economy and reduced federal health care spending.

Despite their budget problems, "there is no question you may see a few more states getting into HMO reform," said Dr. Blendon.

Big gubernatorial wins for Democrats may reflect disgust with the current state of the economy, Dr. Ornstein said, but could prove a curse if the economy continues to falter. "This is not going to be a good time to be a governor."

ADDITIONAL INFORMATION:

Voters ho-hum on health

Health care was not a key issue for most voters in the Nov. 5 elections. Only 9% of likely voters named health care issues as their priority, compared with 21% who named the economy and jobs. When likely voters were asked to identify what aspects of health care were of most concern, the breakdown was:

Prescription drug costs: 25%
Health care costs: 18%
Uninsured: 18%
Medicare/Medicaid/elderly care: 14%
HMO reform: 2%
None: 12%
Don't know: 15%

Source: National Public Radio/Kaiser Family Foundation/Harvard University survey

Weblink

Congressional election tracking survey, National Public Radio/Kaiser Family Foundation/Kennedy School of Government, (http://www.kff.org/content/2002/3299/)

Report, "2002 Pre-election Survey of Likely Voters Regarding Health Care Issues," sponsored by PHRMA, in pdf (http://www.phrma.org/publications/publications//2002-11-06.609.pdf)

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