Providers set to pursue Medicaid and tort reforms

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When President Bush signed the sweeping Medicare reform bill in December, the Republican party lauded it as a domestic victory, perfectly timed for 2004 election year momentum. During election years, Congressional agendas are typically pushed aside while campaigning dominates.

Legislative triumphs may be harder to muster this year, though long-term care administrators and owners can expect constant updates of the 700-page Medicare reform law,  as associations analyze its impact on facility costs and regulations.

"I'm having difficulty trying to imagine what major legislative initiatives will be pushed," said William F. Benson, president of the board of directors of the National Citizens' Coalition for Nursing Home Reform. "To be honest, I don't see it happening. My anxiety would be higher if it were a non-election year."

As Congress reconvenes the third week in January to divvy up the appropriations bill, and presidential hopefuls gear up for the primaries, provider associations will be fueling their energies toward tackling Medicaid and tort reforms.

"Medicaid is crying for reform and the governors and state legislatures are struggling with how to deal with budget deficit threats," said John Schaeffler, the senior vice president of policy and governmental affairs at the American Health Care Association, Washington. "We understand there are several members in Congress that want to tackle the issue of Medicaid and we want to work with them."

U.S. Rep. Heather Wilson (R-NM) chairs the five-member House Medicaid Task Force, which is currently meeting to figure out legislative steps to take. Wilson conducted the second in a series of hearings for the House Health Subcommittee in October.

"Medicaid is now the largest public health insurance program in the United States with ... expenditures of $280 billion each year," she said in a statement. "While we have spent several years now on improving the Medicare program, Medicaid improvement is only now beginning to emerge as the next major healthcare challenge."

Many observers were optimistic that, with a Medicare reform law passed and out of the way, Medicaid reform can now get key players' full attention.

Shift toward tort reform

Directly after the Senate approved the Medicare bill, however, published reports said President Bush would revert his attention to tort reform for healthcare providers, another issue powerfully impacting nursing homes as liability costs soar.

The Republican-controlled House approved such legislation, the Health Act (HR-5), in March last year. In July, the Senate attempted to bring similar legislation but could not garner enough votes to overcome Democrats' opposition. Both bills would cap non-economic damages in healthcare lawsuits at $250,000.

"We think the president is going to renew his call for caps," said Barbara Gay, the director of information for the American Association of Homes and Services for the Aging. "We're not wedded to the $250,000 limit, but we do think some kind of reasonable cap would be helpful. And we'd like to see more of an insurance premium rating based on nursing homes' actual claims experience."

Lorraine Tarno