Medical-Tort Law: Ranking the States

How much do a state’s laws governing medical malpractice and other torts relevant to health care affect the availability of care?  Plenty!

Lawrence J. McQuillan’s & Hovannes Abramyan’s 2010 edition of the U.S. Tort Liability Index, which has a number of measurements included in the U.S. Index of Health Ownership, ranks states according to 42 variables.

Eight of the measurements in the U.S. Tort Liability Index are relevant to the U.S Index of Health Ownership: One output and seven inputs. The previous edition of the U.S Index of Health Ownership included six measurements of medical tort, but McQuillan & Abramyan have discovered more variables for their 2010 edition of the Tort Liability Index, allowing more detailed measurement.

As a partial update of the U.S. Index of Health Ownership, this brief analysis calculates a medical-tort index from a simple average of the eight relevant variables.  Mississippi, Nevada, Michigan, Colorado, and Louisiana lead the pack; while Vermont, Rhode Island, Kentucky, Pennsylvania, and Iowa bring up the rear. Even the leaders, however, lag in some measurements.

Mississippi, for example, leads on procedural rules: Pre-trial screening or arbitration and conditions on the use of expert witnesses. However, it does not limit lawyers’ ability to abuse their privilege by limiting their share of awards. Colorado and Louisiana also fail to impose limits. Unfortunately, the laggards do not show a similar pattern: The bottom five states perform poorly in all eight measurements.

Reducing the burden of medical tort is critical to increasing Americans’ health ownership and reducing medical costs that curtail our access to care. Some progress is evident, but states aiming to improve their medical-tort laws still have a long way to go.

Double-dipping Tax Credits in Montana

Insure Montana is a state program that gives tax credits to micro-businesses (2-9 employees) that purchase health insurance for their employees. Employees also get some benefits, too, though it’s means-tested.

There’s some merit in the program, but it depends for funding on cigarette taxes (smoke! It’s for my health insurance!) and currently filled to capacity. And since employees don’t get the entire benefit–and limited to employees of a specific group of businesses–it does nothing to promote insurance portability.

All that’s background to a new story, which is that the Montana insurance commissioner has said that businesses that receive tax credits under the new federal law will be able to participate in the state program.

State governments ration “free” cancer screenings

When you empower government to provide “free” health care (paid by others through taxes), government gets to decide when it’s appropriate for you to receive it.  Here’s yet another example from the Associated Press:

…low-income women in at least 20 states are being turned away or put on long waiting lists for free cancer screenings, according to the American Cancer Society’s Cancer Action Network. In the unofficial survey of programs for July 2008 through April 2009, the organization found that state budget strains are forcing some programs to reject people who would otherwise qualify for free mammograms and Pap smears.

…

New York used to screen women of all ages, but this year the budget crunch has forced them to focus on those considered at highest risk and exclude women under 50….

At least 14 states cut budgets for free cancer screenings this year: Colorado, Montana, Illinois, Alabama, Minnesota, Connecticut, South Carolina, Utah, Missouri, Washington, Ohio, Massachusetts, Pennsylvania and Arkansas.

Preserving Health Care Choice in Montana

The movement to enshrine your right to choose a health plan and a doctor in the constitutions of the 50 states has gotten more momentum today with the announcement that legislators in 20 different states have now declared their support.

Here’s a press release from the American Legislative Exchange Council, which is encouraging the effort:

The American Legislative Exchange Council (ALEC), the nation’s largest individual membership association of state legislators, congratulates Montana State Senators Jim Shockley and Greg Hinkle for announcing their intent to introduce a constitutional amendment to protect the right of individuals to make their own health care choices. Montana now becomes the 20th state where legislators have introduced, or will introduce, legislation modeled after ALEC’s Freedom of Choice in Health Care Act.“We all recognize the need to help make medical care and health insurance more affordable and accessible for more people,” said Iowa Representative Linda Upmeyer, minority whip, family nurse practitioner, and chair of ALEC’s Health and Human Services Task Force. “However, creating new mandates for individuals and employers will not reduce costs or increase competition, it will trample on the rights of individuals to make their own health care choices and hurt our economy,” she added.

The Montana constitutional amendment preserves the rights of individuals to pay directly for medical care—something not allowed in single-payer countries like Canada—and prohibits any individual from being penalized for not purchasing government-defined insurance. Any state attempt to require an individual to purchase health insurance—or forbid an individual from purchasing services outside of the required health care system—would be rendered unconstitutional. The measure may also cause a federalism clash if Congress passes a law with either of these provisions.

“This is not a battle that hasn’t been fought before or won before,” said Christie Herrera, health policy director for the American Legislative Exchange Council, a state legislator group coordinating the effort.

“States are allowed to give greater constitutional protection than what is provided for in the U.S. Constitution. The U.S. Constitution provides a floor, not a ceiling, for the preservation of individual rights,” Herrera added.

Montana now joins legislators in eight states (AK, GA, KS, LA, MO, MS, NH, and UT) that have already publicly announced their intention to file legislation to protect their citizens from any health care mandates. Another 11 states have already filed or pre-filed similar legislation (AZ, FL, IN, MN, ND, NM, MI, OH, PA, WV, WY). Arizona’s measure, which passed the legislature in June, will be put before voters on the 2010 ballot.

Mayo Clinic Drops Medicaid in Two States

President Obama has said he admires the Mayo Clinic model of health care. The heath care “cure” he is most likely to sign leans heavily on expanding Medicaid.

The two just don’t go together: “Mayo Clinic says it will stop serving Medicaid patients from Nebraska and Montana because of low government reimbursement rates.”

You wonder where rationing will come from? Here’s one place. When government tries to buy health care for everyone (else), the logical way to “cover everyone” is to limit what services it pays for. Take the egalitarian ethos to the extreme, and you’ll have government to prevent people from buying supplemental care with their own money, to prevent a two-tier system.

Mayo’s decision isn’t unreasonable, but it is a worrisome sign of things to come.

U.S. Index of Health Ownership 2nd Edition Is Here

Pacific Research Institute has published the 2nd edition of the U.S. Index of Health Ownership, the only ranking of health care in the states that uses criteria of individual choice.

Americans lack the basic freedom to make their own health care decisions. The Index measures the degree to which individuals, be they patients, health professionals, entrepreneurs, or taxpayers, “own” the health care in their states.

The lack of health ownership is a real problem. Almost half of the country’s health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.

The Index uses 24 variables to quantify how state laws and regulations affect the liberty of citizens involved in state government health plans (primarily Medicaid), the private health-insurance market, and the provision of medical services. It also assesses the effect of medical tort on people’s freedom to engage health services.

Alabama, Montana, Nebraska, North Dakota, and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market, and good control of state government programs. Also, the state performs well on medical tort indicators. Alabama’s regulatory environment for providers favors competition, and government health programs run more effectively than in most states.

New York, Massachusetts, Rhode Island, Vermont, and North Carolina rounded out the bottom five, as the states in which the government has taken the most undue control of health care from its citizens. This is the second year that New York was in last place. The state suffers from government health-care programs that are out of control, a grossly overregulated private-insurance market, and almost completely uncompetitive provider markets.

A full listing of all 50 states and their rankings is contained in the Index.

The Index will give concerned citizens a good basis to demand reforms from their state politicians that will put American families in charge of American health care, instead of government and special interests.

Politicized Benefit Design

When you're in a government health care plan, you get the services that the politicians decide to give you. Unless, of course, an outside interest group succeeds in a lawsuit.

In four states, SCHIP does not pay for contraceptives. In Montana, Planned Parenthood has filed suit against the ban.

Whatever you think about giving contraceptives to minors, the point here is that benefits have the stuff of political and legal battles. Expect the same to continue, if not increase, with programs such as Medicare/Medicaid for all.

The Return of the House Call

If you're in Medicaid and live in Montana, you just might get a physician willing to make a house call.

The Montana Health Corps Act uses retired doctors to make the visits. According to the legislation, a "health corps member may charge $10 for a patient contact or visit and may submit a charge to medicare or medicaid."

To make the deal more attractive to doctors, there's some tort reform baked in: "A physician who renders health care within the scope of the physician's license to a patient under [sections 1 through 7] is not liable to a patient or other person for civil damages resulting from the rendering of the care unless the damages were the result of gross negligence or willful or wanton acts or omissions by the physician."

The bill, HB 578, will soon be sent to the governor for his signature.

Another $6 Million for Insure Montana

The Montana House has approved HB258, which expands the Insure Montana program, which gives subsidies to small-business employers and their workers. It still ties people into employment-based coverage, but I suppose that's better than dumping people straight into Medicaid.

Insure Montana depends on tobacco money for its subsidies, so when you light up, you score a trifecta: you enjoy a smoke, you support health care and you support small business.

8 States, 8 Plans for Small Business

Money magazine recently published a quick review of last year's health policy initiatives in 8 states. As you might expect, there's good, bad, and ugly.

Alabama now offers a refundable tax credit for both small businesses and their employees.

Maryland started an insurance subsidy for small businesses that purchase insurance policies for their employees. It's means-tested.

Montana says smoke, it's for your health– or at least for a health care policy subsidized by cigarette taxes. Again, the emphasis is on bolstering the employment-based system of selling insurance.

In Connecticut, the Legislature passed (in 2008) a measure to let small business owners and employees buy into the plan for state employees. The governor vetoed it.

New Hampshire more or less enacted price controls on policies. Wonder how long it will be before companies start leaving the state?

Oklahoma can now use Medicaid funds to subsidize businesses that have up to 250 employees.

In February of 2008, South Carolina amended its law on pooling by small businesses. It hasn't caught on. In fact, the president of the NFIB chapter says it is not aware of any employers that have taken advantage of the law.

The governor of Wisconsin tried to outlaw the purchase of insurance outside of a state-run exchange. He failed. The president of the state's NFIB chapter said "I don't know if BadgerChoice would fail, but I think a lot businesses would probably fail under it."