Key speech on medical errors
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BIAA Health Care Reform Update
The Brain Injury Association of America's Sarah D'Orsie reports:
Health Care Reform Update
On November 7, 2009, the House of Representatives approved their health care reform overhaul package by a vote of 220-215. The bill includes the provisions below: (provided by Congressional Quarterly, CQ Today)
Coverage Requirements
Individual Mandate
* Requires nearly all individuals to obtain health care coverage beginning in 2013.
* Permits individuals to keep their current health plan as a "grandfathered" plan.
* Excludes from the mandate those exempt from filing income tax returns and others who receive a hardship waiver.
* Subjects those who do not obtain coverage to a penalty tax of 2.5 percent of adjusted gross income above a threshold.
Employer Mandate
* Requires employers to offer their employees health care insurance, or make an insurance contribution on their behalf, starting in 2013.
* Exempts firms with payrolls of $500,000 or less.
* Subjects businesses that fail to provide coverage to penalties of up to 8 percent of their payroll.
Purchase of Coverage
Health Insurance Exchange
* Creates a federal exchange, to begin operation in 2013, that would allow individuals and small businesses to purchase health insurance from insurers participating in the exchange.
* Allows states to apply to operate their own state-based health insurance exchanges.
Public Option
* Requires the establishment of a public health insurance option within the insurance exchange by 2013.
* Directs the Health and Human Services Department to run the public option and negotiate with providers to determine rates.
* Requires those rates to be no lower than those under Medicare and no higher than the average for private plans.
Additional Options
* Authorizes loans to entities that want to create health insurance cooperatives.
* Permits states to enter into compacts that allow for the sale of insurance across state lines.
Affordability
Individual Subsidies
* Provides affordability credits to individuals and families with incomes of up to 400 percent of the federal poverty level.
* Requires that subsidies would be used to reduce premiums and out-of-pocket costs.
Small Businesses
* Provides tax credits for certain small businesses that offer health insurance to their employees.
Requirements for Insurance Companies
Pre-Existing Conditions
* Bars insurance companies from denying or reducing coverage based on pre-existing medical conditions, beginning in 2013.
* Restricts how long insurers can continue to limit coverage for pre-existing conditions until the full ban takes effect.
* Prohibits companies from considering domestic violence a pre-existing condition.
Coverage Caps
* Prohibits annual or lifetime coverage limits.
Premiums
* Limits variations on premiums based on the age of the beneficiary to a ratio of 2-to-1.
* Permits variations on premiums based on geography and family size.
Out-of-Pocket Expenses
* Limits annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family.
* Guarantees no out-of-pocket costs for preventive care.
Essential Benefits Package
* Requires all qualified health benefits plans to provide coverage that meets or exceeds the standards of an "essential benefits package."
* Requires an essential benefits package to, at a minimum, cover hospitalization, outpatient hospital and clinic services, professional services of physicians and other health professionals, prescription drugs, rehabilitative services; mental health and substance use disorder services; preventive services, maternity care, well-baby and well-child care, and medical equipment.
* Establishes a Health Benefits Advisory Committee, chaired by the surgeon general, to make recommendations to HHS regarding the details of covered health benefits included in the essential benefits plan.
Medicare and Medicaid
Medicaid Expansion
* Expands eligibility for Medicaid by allowing enrollment for those making up to 150 percent of the poverty level, beginning in 2013.
* Beginning in 2015, states would pay 9 percent of costs associated with the expanded coverage.
* Requires Medicaid to cover newborns during the first 60 days of life.
Medicare Advantage
* Reduces payments under the Medicare Advantage program over a three-year period beginning in 2011.
* Makes the rates for Medicare Advantage the same as those for traditional fee-for-service Medicare by 2014.
* Provides bonus payments to insurance plans in the program that offer high-quality insurance plans in low-cost areas.
As part of the debate, Congressman Bill Pascrell, Jr., Co-Chairman of the Congressional Brain Injury Task Force, offered a statement including BIAA's guiding principles for health care reform. Also included in the statement, which can be viewed by clicking on the link below, was language regarding payment initiatives such as the bundling of services.
http://www.biausa.org/elements/policy/2009/house_cr_statement_bp.pdf
The statement detailed BIAA's position that "post-acute payment systems must facilitate, not impede, improvements in functional status of individuals with brain injury and their ability to return to their homes and communities. BIAA supports a deliberative planning process and rigorous pilot testing."
Congressman Pascrell has been a true champion in the fight for securing access to care for persons with brain injury during the health care reform debate. Please take a minute to click on the link below and thank him for his dedication to this important issue:
http://pascrell.house.gov/contact/
It is also important to note that BIAA's Business and Professional Council was integral in creating the content of BIAA's health care reform guiding principles.
Now that the House has passed its measure, BIAA is monitoring Senate activity closely. Senate Majority Leader Harry Reid has alluded to Senate action on their leadership bill as soon as next week.
Five Myths About Medical Negligence
American Association of Justice published "Five Myths about Medical Malpractice Negligence." I reprint it below.
It is especially interesting since the Nevada Supreme Court is currently considering whether to make the "Keep Our Doctor's in Nevada" bill, passed in 2004, retroactive. A woman is suing her lawyer for taking 40% of her over $5,000,000 award for a lawsuit she retained him for in 1999. She is arguing that the attorney fee limits should apply retroactively and the attorney's fees be reduced. Interestingly she is not arguing that her recovery be limited retroactively to the current ceiling on medical malpractice cases of $350,000.
Those opposed to real health care reform are flailing to come up with real, alternative solutions to our current crisis. With all the talk of death panels, government takeovers, and rationing of care, now tort reform has been thrown into the mix.
Yet it will do practically nothing to lower health care costs, and certainly will not fix our broken health care system. However, it will most definitely hurt patients injured through no fault of their own. Seemingly, the effects of legislation on real people have somehow evaporated from the discussion.
To break through all the hyperbole, lies, and distortions, the American Association for Justice today released a new report, "Five Myths About Medical Negligence." The next time a cable news pundit or opponent of health care reform starts talking about tort law changes, chances are this manual will rebut their claims.
As the health care debate moves forward, here are the key myths and facts:
Myth #1: There are too many "frivolous" malpractice lawsuits.
Fact: There's an epidemic of medical negligence, not lawsuits. Only one in eight people injured by medical negligence ever file suit. Civil filings have declined eight percent over the last decade, and are less than one percent of the whole civil docket. A 2006 Harvard study found that 97 percent of claims were meritorious, stating, "portraits of a malpractice system that is stricken with frivolous litigation are overblown."
Myth #2: Malpractice claims drive up health care costs.
Fact: According to the National Association of Insurance Commissioners, the total spent defending claims and compensating victims of medical negligence was just 0.3% of health care costs, and the Congressional Budget Office and Government Accountability Office have made similar findings.
Myth #3: Doctors are fleeing.
Fact: Then where are they going? According to the American Medical Association's own data, the number of practicing physicians in the United States has been growing steadily for decades. Not only are there more doctors, but the number of doctors is increasing faster than population growth. Despite the cries of physicians fleeing multiple states, the number of physicians increased in every state, and only four states saw growth slower than population growth; these four states all have medical malpractice caps.
Myth #4: Malpractice claims drive up doctors' premiums.
Fact: Empirical research has found that there is little correlation between malpractice payouts and malpractice premiums paid by doctors. A study of the leading medical malpractice insurance companies' financial statements by former Missouri Insurance Commissioner Jay Angoff found that these insurers artificially raised doctors' premiums and misled the public about the nature of medical negligence claims. A previous AAJ report on malpractice insurers found they had earnings higher than 99% of Fortune 500 companies.
Myth #5: Tort reform will lower insurance rates.
Fact: Tort reforms are passed under the guise that they will lower physicians' liability premiums. This does not happen. While insurers do pay out less money when damages awards are capped, they do not pass the savings along to doctors by lowering premiums. Even the most ardent tort reformers have been caught stating that tort reform will have no effect on insurance rates.
Over 98,000 people die every year from preventable medical errors. That's like two 737s crashing every day for a whole year. Instead of focusing on tort law changes that won't fix health care, let's make sure people aren't injured in the first place. Not only will that lower costs, but most importantly, will improve health care for everyone.
Read more at: http://www.huffingtonpost.com/anthony-tarricone/calls-for-tort-reform-des_b_345438.html&cp
You can view AAJ President Anthony Tarricone’s article on the Huffington Post and link to the article by clicking here.
Malpractice Tort Reform Update
President Obama continues his quest to appease skeptics of his health care reform:
Since President Obama proposed using $25 million to test new ways to handle malpractice lawsuits, suitors have been lining up, the The Associated Press reports. One leading idea is to appoint expert panels to sort fact from fiction in malpractice claims. The "American Hospital Association has been shopping a new plan to lawmakers," and malpractice reform advocates are expected to propose another strategy for a pilot program at a Health and Human Services hearing next week. Doctors say they perform extra tests on patients because they fear lawsuits.
Read More Here.
Tort Reform Experimentation
President Barack Obama can look to a variety of models as he seeks to fulfill a pledge to fund state tort reform experiments, a longtime wish-list item for physicians, the New York Times reports. States have so far tried a few approaches, with mixed results, and considered more.
They include, a cap on non-economic damages supported by the American Medical Association; medical screening panels that "attempt to weed out frivolous suits;" "apology statutes" that ban physicians admission of error from being used as evidence in court; early compensation offers by physicians and hospitals that preclude law suits; safe harbor systems that protect doctors from law suits when they follow practice guidelines; birth funds that compensate families for childbirth injuries and are financed by physician surcharges; and, special medical courts that would approach malpractice cases with more specialized expertise (Underwood, 10/13).
This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.
