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A medical malpractice bill that limits attorney fees and some patient damage fees in civil lawsuits was passed by the House on Wednesday by a narrow margin of 218 to 210, with numerous Republicans voting against the measure.

The biggest point of contention was over a provision that places a cap of $250,000 on noneconomic damages awards to victims, which includes for pain and suffering. Nineteen Republicans voted against the bill, many of them citing this as a key reason, saying it would trample on states rights because it would take away their ability to establish their own laws on the matter.

At least two dozen states do not cap noneconomic damages, and several state supreme courts including Washington and Florida have determined they are unconstitutional.

This represents a massive expansion of federal authority, said Rep. John J. Duncan Jr. (R-Tenn.), who voted against the bill.

Its a power grab by Washington, said Rep. Steve Cohen (D-Tenn.), who also voted against the measure.

The opposition from Republican members is a break from the past, when conservative lawmakers have consistently united in their support of similar measures. Several conservative groups, such as Frontiers of Freedom and the Institute for Liberty, also opposed the bill. And former U.S. attorney general Edwin Ed Meese, a Republican, announced his opposition Tuesday, calling the bill constitutional malpractice.

In a letter sent to House Speaker Paul D. Ryan (R-Wis.), Meese said the bill was a sweeping effort to federalize tort law with our system of federalism, which reserves that province solely to the states.

The $250,000 cap for noneconomic damages is separate from damages plaintiffs receive based on future economic losses. Noneconomic damages are meant to compensate victims for pain and suffering, as well as permanent disfigurement or other serious disabilities that may not interfere with their ability to work.

The caps would apply broadly to all manner of medical malpractice, including errors in surgery, side effects from unsafe drugs, abuse and neglect in nursing homes, and sexual assault by doctors.

The issue will probably decrease the odds of the Senate taking up the measure, opponents and proponents of the measure said. The Senate has routinely declined to vote on previous tort measures passed by the House, but with Republicans in control of both chambers, some are more optimistic about this bills chances.

Democrats did not break from tradition. They have consistently opposed tort legislation. Republicans have accused them of being swayed by large campaign donations they get from trial lawyers. Democrats have said, and continued to say Wednesday, that they are against such measures because people who have been harmed would be unable to seek justice.

Rep. Hakeem Jeffries (D-N.Y.) called the bill cruel and heartless as he made this argument against the measure.

A Washington Post article earlier this month examined the case of a Pennsylvania man, Steven Hanes, who underwent surgery in 2013 to have a testicle removed that was causing him pain. After a doctor removed the wrong testicle, he filed a medical malpractice suit and was awarded $630,000 in noneconomic damages more than twice the amount that the new bill would allow.

The limits on lawyer fees was not debated Wednesday. That provision would limit fees based on a sliding scale, in some cases cutting by half the amount a lawyer would receive from malpractice awards. On average, lawyers receive between 30 and 40percent of the award, according to several medical and legal groups who follow tort policy.

In a statement released just after the vote, the American Association of Neurological Surgeons a major proponent of the bill said it applauded the bills passage, calling it common sense, proven, comprehensive medical liability reform that will help contain health care costs.

The Center for Justice & Democracy a major opponent of the bill said it strongly condemned its passage.

Joanne Doroshow, the centers executive director, called it a harsh and mean-spirited bill that will harm the most vulnerable and severely injured Americans. This includes brain-damaged children, quadriplegic workers, and seniors in nursing homes.

Read more at PowerPost

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House Republicans pass tort bill by slim margin - Washington Post

By Evan McMullin By Evan McMullin June 28 at 6:33 PM

Evan McMullin is a former CIA operations officer who ran as an independent candidate in the 2016 presidential election. He is co-founder of the nonprofit Stand Up Republic.

Whether its leaders and members realize it, the Republican Party is at risk of becoming the Vladimir Putin-aligned party in the United States. It can be convincingly argued that its already similar to Putin-supported parties in Europe, given Donald Trumps presidency, the Republican bases increasingly favorable views of Moscow and the House GOP leaderships disinterest in investigating and preventing Russian interference.

Increasingly sophisticated Russian influence and cyberoperations threaten Americans ability to choose their own leaders. This isnt hyperbole; in fact, its hard to overstate just how serious this issue is. Yet President Trump continues to sow doubt about whether Moscow even interfered in the 2016 presidential elections and to suggest the questions insignificance by ignoring it all together.

Our commander in chief seems more interested in protecting Moscow than he does in deterring its future attacks. The Post reported that the administration is actually considering allowing the Russian government to reopen the two spy compounds that President Barack Obama closed in late December in response to Russias election attack. There are also reports that the White House plans to step up lobbying efforts against a new Russia sanctions bill that the Senate passed with overwhelming bipartisan support this month. The measure would add new financial sanctions and require congressional review before Trump could lift these or other retaliatory measures currently levied against Moscow, including the closing of the two compounds.

Worse, Trump appears to have some support in this from Republican leaders in the House. Speaker Paul D. Ryan (R-Wis.) and Majority Leader Kevin McCarthy (R-Calif.) have delayed the bill, citing the constitutional requirement that such bills originate in the House.

This is little more than a red herring. Nothing prevents them from inserting the text of the Senate bill into a House measure, passing it and sending it back to the Senate for final approval, which it would likely grant under expedited procedures. Instead, Ryan and McCarthy appear to be more interested in delaying and weakening the bill.

Behind their neglect are changing Republican voter opinions, which are becoming alarmingly more pro-Russian. According to a Morning Consult-Politico poll conducted in May, 49 percent of Republican voters consider Russia to be either an ally or friendly. Only 12 percent consider it an enemy. In 2015, only 12 percent of Republicans held a favorable view of Russian President Vladimir Putin, according to Gallup. As of February, that figure had jumped to 32 percent.

These dangerous trends impair the nations will to protect itself, and they are entirely the result of Republican leaderships failure to oppose Trump from the beginning. Republican voters had long held a healthy distrust of Putin, but Trumps persistent affinity for Moscow and other Republican leaders silence are changing Republican voters minds, now making it politically costly for GOP leaders to defend the nation from this foreign adversary.

Because they control both the executive and legislative branches, it is ultimately up to Republican leaders to prevent future Russian attacks on American democracy, even if such attacks may benefit the party electorally. Deterrence is an indispensable part of this equation. It cannot be accomplished without punishing Moscow for its violations of our sovereignty and threatening harsher responses for future trespasses.

In passing the Russia sanctions bill, Senate Republicans have shown they understand this. GOP leaders in the House must work with their Senate colleagues to pass a strong sanctions package that requires a congressional review of changes to Russia sanctions implementation desired by the president. He simply cannot be trusted to protect the integrity of Americas democracy on his own.

Republican leaders and the party are at a crossroads. They will either choose liberty in an independent America or to serve a distant, foreign master who seeks no more than to enrich and empower himself at the expense of free society everywhere. If Republican leaders choose the latter, the majority of Americans will have no choice but to hold them accountable as opponents to the cause of freedom.

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Republicans are risking becoming the party of Putin - Washington Post

Senate Republicans reconvened behind closed doors Wednesday trying to break the impasse on their healthcare overhaul but emerged with no apparent strategy for resolving differences by an end-of-week deadline.

Senate Majority Leader Mitch McConnell of Kentucky vowed to try again for a vote after the Fourth of July recess, despite having abruptly delayed action this week.

Senators were aiming for a revised bill by Friday, the Republican whip, Sen. John Cornyn of Texas, told reporters, so it could be assessed by the Congressional Budget Office during the break.

But senators remained skeptical after the lengthy lunchtime huddle that appeared to run long on ideas but short on consensus.

I think its going to be very difficult, said Sen. Susan Collins (R-Maine).

McConnell surprised senators by delaying this weeks expected votes once it became clear he did not have a majority for passage or possibly to even open the debate.

As many as 10 Republican senators now publicly oppose the bill, the Better Care Reconciliation Act, and leaders are scrambling to win them over with an estimated $200 billion in savings from the bill that can be applied to their particular states needs.

But even with that fund of resources, it is not clear McConnell will be able to satisfactorily improve the legislation, which now threatens to cut 22 million Americans off health insurance. He can only afford to lose two Republican votes in the face of Democratic opposition.

"It's going to be very difficult to get me to a yes... have to make us an offer we can't refuse, Sen. Dean Heller (R-Nev.) said on a telephone town hall late Tuesday, according tojournalist Jon Ralston, who monitored the call.

Fresh polling Wednesday showed paltry support for the Republican approach to overhauling the Affordable Care Act, known as Obamacare, which has enjoyed a surge in popularity now that Republicans are closer than ever to repealing it. A USA Today poll put approval of the Senate GOP bill at 12%.

Republicans, though, are under enormous pressure from their most conservative supporters and big dollar donors, including the powerful Koch network to deliver on their promised to end Obamacare.

Senate Democrats, meanwhile, suggested that President Trump convene all 100 senators much the way then-President Obama did during his first days in office for a session at Blair House to see how they might be able to work together to improve, rather than repeal, the Affordable Care Act.

Id make my friends on the Republican side and President Trump an offer: Lets turn over a new leaf. Lets start over, said Senate Minority Leader Charles E. Schumer (D-N.Y.).

President Trump, I challenge you to invite us all 100 of us, Republican and Democrat to Blair House to discuss a new bipartisan way forward on healthcare in front of all the American people.

No such invitation, however, seemed forthcoming. Trump dismissed Schumer's proposal "he just doesn't seem like a serious person," the president said and instead promised his own"big surprise" on healthcare.

"Healthcare is working along very well," Trump told reporters at the White House. "We could have a big surprise, with a great healthcare package."

Asked what he meant by a big surprise, Trump simply repeated: "A great, great surprise."

The Republican bill, like its counterpart passed by House Republicans, does not fully gut Obamacare, but rescinds the new taxes imposed on high-incomeindividuals and healthcare companies to pay for expanding coverage through Medicaid and subsidies for private insurance on the ACA marketplace.

Senators said the private talks Wednesday focused mainly on changes to the Obamacare marketplace that could bring down the cost of insurance premiums.

One idea from Sen. Ted Cruz (R-Texas) to allow insurers to offer policies that do not meet the Obamacare benchmarks for what insurance needs to cover met with mixed reaction, senators said.

Sen. Bill Cassidy (R-La.),a physician, warned that such changes would alter the risk pool, keeping insurance costs high.

You end up with policies that, for example, dont cover maternity, Cassidy said. Do you want a policy that doesnt have maternity, which would be principally appealing to young men, when obviously typically men have had a role in that pregnancy?

Other senators were floating new ideas, but McConnell gave no indication whether those proposals would be included in the final revised product.

Michael A. Memolicontributed to this report.

Read more here:
Senate Republicans aim for new healthcare bill by Friday, but skeptics remain - Los Angeles Times

Such arrangements can work only if private firms trust that the United States will be a reliable partner. Historically, this hasnt been a problem.

That appears to be changing. A decline in trust has already caused health insurers to rethink their relationships with their increasingly erratic federal partner. Theyre demanding higher premiums to account for the greater risk. Blue Cross Blue Shield in North Carolina, for example, has said that its planned rate increase of 23 percent next year would be only 9 percent if it had more certainty from the federal government.

Many other insurers have abandoned these partnerships altogether. According to Health Secretary Tom Price, 49 counties wont have a single insurer on the exchanges in 2018.

Why are insurers so skittish? Though much maligned, insurers in the individual market have a tough job. When they set premiums, they have to guess how much health care their enrollees will need. If they set premiums too low, theyll lose their shirts. Too high, and they wont get customers.

Before Obamacare, insurers protected themselves from risk by gathering medical information and screening out people with pre-existing conditions. When Obamacare put a stop to that, insurers were in a bind. They had to set premiums without knowing in advance how sick their customers were. Thats not easy to do which explains much of the fragility of the exchanges over the past three years.

Lawmakers feared all this uncertainty would cause insurers to stay out of the newly formed insurance exchanges. So Obamacare employed a number of tools in particular, financial subsidies and a mandate requiring all individuals to get insurance to reassure firms that the market would be stable and healthy.

Even with protective policies in place, insurers took a big risk entering the markets. At a minimum, insurers that took the plunge deserved the support promised in the law. Congressional Republicans, however, chose instead to sow uncertainty at every turn, hoping that a damaged reform law would be easier to repeal.

These efforts began soon after Obamacare was signed into law. To shield insurers from unexpectedly large losses, the law created a temporary risk corridor program: an upfront financial commitment from the government. Republicans denounced this as a bailout and eventually used an appropriations measure to prohibit the Obama administration from making the promised payments.

As a result, insurers are owed well in excess of $10 billion. Many have sued to recover the payments.

The governments refusal to pay weighs heavily on insurers as they confront two new problems. First, theres the individual mandate, which congressional Republicans hope to repeal. One insurer has already invoked concerns about the mandate as a reason for exiting Iowas market.

Second, Republicans are playing chicken with Obamacare subsidies that are meant to help low-income people cover their out-of-pocket costs. Because insurers dont know whether the government will honor its commitment to pay those subsidies, theyve had to ask for double-digit rate increases.

Republicans appear not to have reckoned with the broader consequences of their uncertainty strategy. For example, Paul Ryan, the House speaker, wants to convert Medicare into a voucher program in which the elderly will shop for private plans. How will that work if insurers, burned by the Obamacare experience, are unwilling partners?

This is perhaps the greatest irony of the Republican actions. Republicans (including one of us) have long believed in the benefits of even greater privatization of government services. But how can any company in any sector trust the United States after seeing health insurers treated so shabbily?

Craig Garthwaite is an associate professor at the Kellogg School of Management at Northwestern University. Nicholas Bagley is a professor of law at the University of Michigan.

Follow The New York Times Opinion section on Facebook and Twitter (@NYTopinion), and sign up for the Opinion Today newsletter.

A version of this op-ed appears in print on June 29, 2017, on Page A21 of the New York edition with the headline: The Uncertainty Strategy.

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The Republicans' Uncertainty Strategy - New York Times

McConnell hopes to strike a deal on a revised version of the bill by Friday and send it to the Congressional Budget Office, according to The Washington Post. But resolving lingering differences could prove difficult in the short window.

Republicans face difficulties in winning over skeptical senators, as tweaks to appease conservatives could alienate moderates, or vice versa.The hurdles threaten to delay a key plank of the sweeping agenda Republicans hoped to pass when Trump won the White House and the GOP held onto both chambers of Congress.

Amid Republicans' push to win over skeptical senators, Trump set some lofty goals for the bill Wednesday.

"I think this has a chance to be a great health care at a reasonable cost. People can save a lot of money. We get rid of the mandates, we get rid of so much. Got rid of a lot of taxes. All the bad parts of Obamacare are gone. Essentially, it's a repeal and replace," Trump said.

A CBO score of the existing bill shows a mixed bag on those counts. It estimated that the bill would lead to 22 million more uninsured Americans by 2026 than under current law, a figure that multiple moderates criticized.

Average premiums would fall by about 20 percent relative to current law by 2026. But out-of-pocket costs could rise for many consumers "because nongroup insurance would pay for a smaller average share of benefits under this legislation," the CBO said.

The Senate plan would lead to an estimated $321 billion in deficit reduction from 2017 to 2026, according to the office.

The bill has received dismal approval ratings in polling so far. In addition, most major medical groups have opposed the proposal.

As Republican leaders pushed to strike a deal on the plan, some GOP senators increased their calls to figure out a bipartisan solution for Obamacare's problems. Sen. Lindsey Graham, R-S.C., told NBC News that if the GOP does not reach a deal by Friday, it may be time to start seeking a bipartisan solution.

Moderate Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, are among the other GOP senators who have said they would be open to a bipartisan solution.

On Tuesday, McConnell indicated that he did not see that as a possibility yet. He said of Democrats: "They're not interested in participating in this."

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Trump predicts a 'big surprise' on health care as Senate GOP pushes to win votes - CNBC