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Senators Talk Schedule; CBO Eyes Medical Malpractice

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Lawmakers are bickering about why getting a health bill through the Senate is taking so long, and the Congressional Budget Office head has been explaining the finer points of tort reform impact forecasts.

Senate Majority Harry Reid, D-Nev., who created H.R. 3590, the Patient Protection and Affordable Care Act bill, began the day by saying Democrats want to wait until the Congression Budget Office analyzes the effects of health bill compromise they have negotiated before giving any information about the compromise.

The CBO score will not be available until next week, Reid said.

Meanwhile, he said, the Democrats would like the Republicans to help them get an appropriations bill to the floor while waiting for the PPACA bill compromise CBO score.

“Whatever they want to do, it is in their hands,” Reid said. “But everyone should understand that, procedurally, no one can stop us from moving to the appropriations bills.”

Sen. Michael Enzi, R-Wyo., scoffed at the idea that Republicans are responsible for PPACA debate delays, and he noted that the Senate has voted on just a handful of the amendments awaiting consideration.

“Right now,” Enzi said, “the majority is filibustering their own bill, and I have no idea why that’s happening.”

Enzi accused Democrats of continuing to shut Republicans out of efforts to work on the health bill.

“There wasn’t a Republican involved in the behind-the-doors stuff that Leader Reid did to put together the bill that we’ve got now,” Enzi said. “That’s not bipartisan. And there hasn’t been a single person from the Republican side even briefed on this new proposal that’s going to save the world.”

Sen. Judd Gregg, R-N.H., complained about the process being used to draft the Democratic health bill compromise.

First, the Democrats shoved all Republican health bill amendments aside, Gregg said.

Now senators are “hearing about a massive, massive rewrite of this bill that is going to appear from the majority leader’s office and fundamentally change the way health care is delivered in this country,” Gregg said. “Is that going to be bipartisan?”

Sen. John McCain, R-Ariz., complained about Reid expecting senators to go home over the weekend without knowing anything about the compromise proposal.

“We need to stay in,” McCain said. “We need to know what the proposals are.”

Sen. Max Baucus, D-Mont., called the Republicans’ arguments “a little surreal.”

“They say they want to move ahead, and then they refuse to enter into any reasonable time agreement to consider a necessary appropriations measure,” Baucus said. “I’m very impressed how the minority can maintain both that they want to move more quickly and not move at all.”

Also today:

- Sen. Bernard Sanders, Independent-Vt., who identifies himself as a democratic socialist, denounced the H.R. 3590 provision that would impose a 40% “Cadillac plan” excise tax on health benefits with a value over a certain level.

“I think that’s wrong,” Sanders said. “I think that is regressive…. Let me tell you, give the soaring cost of health care in America today, what maybe a Cadillac plan today is going to be a junk car plan in 5 years from now. Millions of Americans are going to be forced to pay taxes on their health care benefits, or else their employer is going to come back on those benefits and they’re going to have to pay for them out of their own pocket.”

- CBO Director Douglas Elmendorf wrote to Sen. John Rockefeller IV, D-W.Va., to explain why one recent CBO analysis suggested a common package of medical malpractice reform proposals would lead to about $5 billion in spending decreases and revenue increases from 2010 to 2019, and another analysis suggested the package would lead to $54 billion in spending decreases and revenue increases over the same period.

Many Republicans and some Democrats would like the Senate health bill to put more emphasis on medical malpractice reform as means of reducing health care costs. Critics of that strategy have argued that efforts to change the malpractice system would have little effect on overall health care costs, or that the effects are too hard to estimate.

Elmendorf says the CBO analysis showing that medical malpractice system changes would have a bigger impact, prepared for Sen. Orrin Hatch, R-Utah, includes a larger estimate of the effect of tort reform on malpractice costs; the effect of a gradual shift away from defensive medicine on medical spending; and the effect of a shift away from defensive medicine on federal health program spending.

The CBO believes “the combination of direct savings in malpractice costs and indirect savings in health care services would reduce national health spending in response to the proposed reforms by roughly 0.5%,” Elmendorf writes.

The CBO also has increased its estimate of the effects of tort reform on medical malpractice insurance costs, Elmendorf writes.

The CBO now believes tort reform could cut malpractice insurance costs 10%, Elmendorf writes. Earlier, the CBO had estimated the reduction would be about 6%.


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