Congress shouldn't look at Texas tort reform as a model to control national healthcare costs because "Texas has one of the worst healthcare systems in the United States," warns Public Citizen, a national consumer group.
In its report, "Liability Limits in Texas Fail to Curb Medical Costs," the patient advocacy group said Texas reforms, which place a $250,000 per defendant cap on pain and suffering awards similar to that in California, have not held down costs, as some in Congress have touted.
"Members of Congress have conjured the supposed benefits of the Texas law out of thin air," said David Arkush, director of Public Citizen's Congress Watch division. "The only winners have been the insurance companies, and, to a lesser extent, doctors."
Since the liability cap took effect in 2003, "Texas has either failed to improve or grown even worse compared to other states on almost every measure" in healthcare, including its cost of care, rate of uninsured, and access to care. "Texas has regressed," the group reported.
The findings draw statistics from the Dartmouth Atlas of Healthcare, the U.S. Census Bureau health insurance data, and surveys from the Agency for Healthcare Research and Quality.
Officials for the Texas Medical Association and the Texas Hospital Association disagree vehemently.
"This report is completely erroneous," says William Fleming, MD, president of the TMA. "The goal of tort reform was never cost containment. It was to improve access. This report is an apples and oranges comparison."
Before tort reform in Texas, the state was plagued by a physician shortage, especially in rural areas, he says. Throughout the state, high-risk specialists, such as neurosurgeons and obstetricians, were hard to find.
"There were no neurosurgeons in the Rio Grande Valley, and people who needed brain surgery had to come to Houston. Often they died en route," Fleming says.
"There were many counties in the state that had no obstetricians, and women had to travel hundreds of miles for prenatal care," says Amanda Engler, spokeswoman for the THA. Many obstetricians had stopped delivering babies because of exorbitant malpractice costs. Now, these areas are better able to successfully recruit, she says.
Pam Udall, spokeswoman for the TMA, adds that the number of primary care doctors grew 7.76%, which was faster than population growth in Texas during the three years after reforms took effect.
And in the last three years, the number of primary care doctors "has outpaced population growth by 33%, an incredible accomplishment being that Texas is the seventh fastest growing state in the nation and far and away the most populous of the fast-growth states," she adds.
Fleming says that before tort reform in Texas, there were only two medical malpractice companies willing to insure doctors. Now there are 10.
Dan Stultz, MD, president/CEO of the Texas Hospital Association, also responded to the Public Citizen accusations.
"The medical liability reforms passed in 2003 have produced the desired result: more doctors are willing to practice medicine in Texas. As we work to expand healthcare coverage and improve the delivery system, preserving Texans' access to medical services is critical," says Stultz.
According to the Public Citizen report, the cost of healthcare has nearly doubled the national average, spending increases for diagnostic tests exceed the national average, and the number of uninsured increased and remains the highest in the country, all since liability laws took effect.
"Access to care in Texas remains a crisis," according to Public Citizen. "Reductions in malpractice cases [are] a windfall to doctors and insurance companies."
Additionally, the group said, the cost of health insurance has more than doubled, the growth in the number of doctors per capita has slowed, and the number of doctors per capita in underserved rural areas has declined.
Though Fleming says that physician medical malpractice premiums have dropped 37% since 2003, the Public Citizen report said that's "the only improvement."
The advocacy group issued its report because of claims made by several member of Congress, specifically Sen. Jon Kyl (R-AZ), who proposed a Senate health insurance amendment that was filed Dec. 9.
"Liability opponents credit the Texas law with luring droves of new physicians to the state. For example, Kyl claims, 'Because of the Texas reforms, Texas saw an overall growth rate of 31% in the number of new physicians,' according to Public Citizen.
"In fact, the overall population of physicians in Texas has grown at a far slower rate than Kyl claims. But even the increase Texas has seen can mostly be explained by growth in the state's population. The state's per capita physician population increased by only .4 % from 2003 to 2009—which is far less than the 8% per capita increase during the equivalent period of time leading up to the law, from 1997 to 2003."
"The shortage of doctors in rural Texas—for which litigation is often blamed—grew slightly worse after the liability restricts were enacted," the report continued. "From 2003 to 2009, the per capita population of doctors in non-metropolitan areas declined by .8%.