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.

More States Refuse “Free” Money for High-risk Pools

If you’re the governor of a state, Congress is asking you, “do you feel lucky?” That is, do you take federal funds and set up a new high-risk pool for a few thousand people, and risk having demand outstrip the federal subsidy, or do you tell your electorate, “sorry, I’m not going to help you; go talk to the feds?” I wrote about 8 states this the other day.

Now Arizona has become one of 19 states (by one tally) that have rejected federal funds. Gov. Jan Brewer told Kathleen Seblius, head of the U.S. Department of Health and Human Services, ”In light of Arizona’s existing fiscal challenges, I cannot commit the state to a program without confidence that there is funding available to sustain it.”

Idaho will also opt out. Gov. Butch Otter said, “Put simply, Idaho cannot afford to subsidize a second high-risk pool program, especially during these difficult economic times.” According to one account, “Otter said estimates prepared by the Idaho Department of Insurance indicate that the $24 million allocated for Idaho would provide only a month or two of coverage for the approximately 33,400 people who may qualify – even though it’s a four-year program.” He also cited lack of staff to administer a second pool, and the fact that the new pool discriminates against people who have already entered the state pool.

Wyoming Gov. Dave Freudenthal rejected the new federal pool, too, citing its financial uncertainty. He added, “In the end, either the state or the federal government are going to contract with some kind of a nonprofit insurer. So why do I need 12 more people in the Department of Health to oversee a contract that the feds are going to be overseeing anyway?” The governor, a Democrat, has rejected calls to have the state join the multistate lawsuit against the Obama Administration.

According to the Idaho Statesman, the following states have decided to not roll the dice on incurring a partly-funded mandate: Alabama, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Louisiana, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia and Wyoming.

Wyoming Contemplates Dropping Medicaid

Federal health “reform” legislation will increase the number of people eligible for Medicaid by 50% nationally. But did you know that state governments can drop their Medicaid programs entirely? Though the U.S. government imposes a number of requirements on states that participate–including most lately a new set of rules on income limits–states don’t have to participate.

Given the fact that the national government gives matching funds for state spending (it varies by state and situation, but it’s at least a dollar-for-dollar match), the idea of states dropping out of Medicaid could have been dismissed out of hand as an impossibility.

Until now.

From Wyoming, “Gov. Dave Freudenthal has said because he believes the national health care reform law “significantly changes the terms of the state and federal governments’ partnership” in the Medicaid program, he is considering withdrawing Wyoming from the program.”

The concern in the state government is that Congress will, over time, shift more costs to Wyoming. The state’s Medicaid department is looking into the matter but so far it’s run into a fog of uncertainty.

By the way, last July, The Heritage Foundation speculated that state governments might find it worthwhile to drop Medicaid entirely.

Victory for Wyoming Midwives

Wyoming now allows certified midwives to oversee home births. Before, only nurse midwives were permitted to work in homes. See this excellent editorial for details of the political battles that preceded the change in policy.

Missouri legalized midwifery a couple years ago. It’s good that other states are following Missouri’s lead and giving women more choices in health care.