Post-speech debates: Illegal immigrant coverage, tort reform, abortion funding

Sep 11 2009

President Obama's speech opened the door for experts and lawmakers to examine his proposed health reforms, with questions ranging from how reforms affect illegal immigrants' coverage to abortion funding.

The Washington Post: "To counter claims that universal health care would cover illegal immigrants, Democrats and independent arbiters have pointed to language in the House legislation that says the federal subsidies, or 'affordability credits,' that would be the main avenue to expanding coverage would not be available to illegal immigrants. This language does not assuage the bill's critics, who say the proposals lack the verification tools needed to assure that illegal immigrants do not gain coverage either through federal credits or expanded Medicaid eligibility for the poorest of the uninsured" (MacGillis, 9/11).

The Wall Street Journal: "According to an analysis last month by the Congressional Research Service, Congress's nonpartisan research body, the House version of an overhaul that was passed over the summer excludes illegal immigrants from a requirement that most uninsured people either purchase insurance or pay a tax. The House bill also prevents illegal immigrants from receiving government payments for 'affordability credits' that would defray the cost of private insurance purchased on an insurance exchange. ... But it doesn't bar them from participating in the exchange. Mr. Obama's health plan goes further: it would exclude illegal immigrants not only from federal credits that would save them money on health insurance but also from the exchange, White House aides said Thursday" (Williamson, 9/11).

ABC News reports more on the CRS report: "(H)ow will the government make sure that subsidies don't go to illegal immigrants? The mechanism is left entirely up to the Health Commissioner, who is instructed by law that he or must have some process to establish immigration status before giving subsidies. … (The House bill) would extend Medicaid coverage up to 133 1/3% of poverty for populations that previously were not covered such as some parents and childless adults. That expansion could — could — mean more illegal immigrants would become eligible for Emergency Medicaid. Which is not to say that citizens don't pay for those costs anyway through extra hospital fees, but this would clearly be a more direct billing to the taxpayer" (Tapper, 9/10).

In the meantime, experts and media debate medical malpractice tort reform. CNNMoney: "The Congressional Budget Office, the federal agency that will calculate how much money health reform will cost or save, has estimated that medical malpractice costs -- which include defensive medicine -- amount to less than 2% of overall health care spending" (Kavilanz, 9/10).

The Washington Post in a second story: "Obama said he wants the Department of Health and Human Services to encourage states to experiment with ways to reduce malpractice litigation. But he was sketchy about the details of the 'demonstration projects' he has in mind. White House officials said Thursday that the state-level experiments could include a method, already being used in roughly half the states, in which patients who want to sue must first get a certificate from a panel of medical experts that their case appears to have some merit" (Goldstein, 9/11).

CongressDaily: "An HHS official said the department will institute a grant program left languishing by the Bush administration for state pilot projects that attempt to get a handle on expensive and sometimes frivolous medical malpractice lawsuits. The grants would go toward early disclosure or certificate-of-merit programs. Early disclosure programs encourage physicians to reveal mistakes sooner rather than later and apologize if appropriate" (Edney and Dann, 9/11).

States could be the harbingers for tort reform, The Wall Street Journal reports in a second story: "One [demonstration project] adopted by hospitals in Michigan, Minnesota, Kentucky and elsewhere, encourages doctors to disclose errors early and apologize, when appropriate. This approach is designed to address hospitals' reluctance to disclose medical mistakes for fear of being sued. It encourages hospitals and patients to enter mediation ...  to resolve disputes. Another initiative, adopted by lawmakers in Florida, Georgia and Illinois, requires plaintiffs' lawyers to have their cases vetted by physicians before filing them. This is designed to weed out frivolous suits while giving the truly harmed an avenue to the courts" (Koppel and Martinez, 9/11).

Negotiators in Congress are looking at the issue, too, The Associated Press reports: "Senators on the Finance Committee are looking at the possibility of special courts in which a judge with medical expertise would hear malpractice cases, says Sen. Kent Conrad, D-N.D. The theory is that medical judges wouldn't be as easily swayed by emotion as are lay juries. Other possibilities include the option of arbitration, as well as some liability protection for doctors who follow 'best practice' clinical standards in treating their patients" (Alonso-Zaldivar and Werner, 9/11).

Abortion's place in reform is also getting attention. The Los Angeles Times: "President Obama, a supporter of reproductive rights, forcefully reiterated in his speech to Congress this week that his healthcare plan would not lead to government funding of abortion. The trouble is, abortion foes don't believe him. … The logic goes like this: Most of the proposals for expanding coverage include a provision for people who can't afford private health insurance. They could receive federal subsidies to help them buy insurance. Abortion foes say that if a private plan offers abortion coverage and a federal subsidy is used to purchase it, this would mean taxpayers are subsidizing abortion. Abortion rights supporters say that scenario twists the facts" (Abcarian, 9/11).

Politico: "Factcheck.org said House and Senate legislation would allow a government-run health insurance plan to cover abortions and provides subsidies to low and moderate income people to choose those plans. The site also points out that Obama has said that 'reproductive services' would be covered by a public plan 'so it' likely any new federal insurance plan would cover abortion unless Congress expressly prohibits that.'" (Frates, 9/11).

Finally, The New Orleans Times-Picayune reports on debate surrounding Medicare Advantage spending cuts: "Medicare Advantage is an option utilized by one in five Medicare beneficiaries. More than 145,000 Louisianians are enrolled in the program, which provides additional benefits, from glasses and hearing aids to preventive care services," but also costs the program much more per person than the standard fee-for-service version of the program (Tilove, 9/11).

Related KHN story: Democrats Target Federal Subsidies For Medicare's Private Plans