	Introduction

Medical malpractice has attracted congressional attention numerous times over the past few decades, particularly in the midst of three "crisis" periods for medical malpractice liability insurance in the mid-1970s, the mid-1980s, and the early 2000s. These periods were marked by sharp increases in medical liability insurance premiums, difficulties in finding any liability insurance in some regions and among some specialties as insurers withdrew from providing coverage, reports of providers leaving areas or retiring following insurance difficulties, and a variety of public policy measures at both the state and federal levels to address the market disruptions. The overall medical liability insurance market is not currently exhibiting the same level of crisis as in previous time periods. Nonetheless, problems with the affordability and availability of malpractice insurance persist, especially in particular regions and physician specialties (e.g., obstetricians). In addition, concern about claims for medical malpractice may affect individual provider decisions particularly through increased use of tests and procedures to protect against future lawsuits ("defensive medicine"), which may affect health care costs. The malpractice system also experiences issues with equity and access. For example, some observers have criticized the current system's performance with respect to compensating patients who have been harmed by malpractice, deterring substandard medical care, and promoting patient safety. Public policy measures that have been effective in addressing the successive insurance market disruptions, and those that may be effective in the future, have been a matter of debate. H.R. Legislation addressing medical liability reform in greater depth passed the House, as discussed below. 5, S. 218, and S. 1099)

H.R. The House passed H.R. H.R. H.R. 5 , an amendment to eliminate a provision in H.R. 5 foresees a 0.5% decrease in overall health spending and a reduction in the federal budget deficit of $57 billion over a 10-year period. CBO estimates that this version of H.R. The other two amendments adopted by the House are (1) H.Amdt. H.R. 5652)

H.R. FY2013 President's Budget

The President's FY2013 budget does not include language on general medical malpractice reform, which is similar to the budget for FY2012. Monies for these grants have not been appropriated as of this time. Costs of Medical Malpractice

Medical malpractice insurance premiums add little to the direct cost of health care relative to total health care spending, but medical malpractice tort reform may still result in savings over time by reducing indirect costs to the system. Medical malpractice insurance premiums written in 2009 totaled approximately $10.2 billion, whereas health expenditures were $2.6 trillion in 2010 as reported by the National Health Expenditure Accounts (NHEA). Indirect costs, particularly increased use of tests and procedures by providers to protect against future lawsuits ("defensive medicine"), have been estimated to be higher than direct costs, and particularly, medical malpractice insurance premiums. 5 estimated that federal tort reforms would reduce national health care spending by 0.4%-0.5% (equivalent to approximately $9 billion to $11 billion in 2010) depending on the exact provisions included. In its analyses of H.R.
As a policy area, medical malpractice involves issues related to its prevalence in the health care system; the market for provider liability insurance; and the resolution of malpractice complaints through the tort system.
Medical malpractice has attracted congressional attention numerous times over the past decades, particularly in the midst of three "crisis" periods for the liability insurance market in the mid-1970s, the mid-1980s, and the early 2000s. These periods were marked by sharp increases in medical liability insurance premiums, difficulties in finding any medical liability insurance in some areas as insurers withdrew from providing coverage, reports of providers leaving areas or retiring following insurance difficulties, and a variety of public policy measures at both the state and federal levels. The effectiveness of various public policy measures in addressing the issues in the medical malpractice liability market has been a matter of debate, in part because these difficulties have arisen at the intersection of the health care, tort, and insurance systems.
The overall medical liability insurance market is not currently exhibiting a comparable level of disruption to that in the "crisis" periods. Nonetheless, concerns persist regarding the affordability and availability of malpractice insurance in particular regions and for certain physician specialties (e.g., obstetricians). In addition, concern about medical malpractice claims may affect individual provider decisions and the cost of health care.
In terms of direct costs, medical malpractice insurance adds relatively little to the overall cost of health care. Medical malpractice premiums in 2010 totaled approximately $10.2 billion, whereas overall health expenditures were $2.6 trillion in 2010 according, respectively, to data from insurance rating firm AM Best and the National Health Expenditure Accounts. Indirect costs, particularly increased use of services by providers to protect against future lawsuits ("defensive medicine"), have been estimated to be higher than direct costs. CBO estimated that enacting federal tort reforms would reduce health care spending by approximately 0.4%-0.5% (roughly $9 billion-$11 billion) and the federal budget deficit by between $40 billion and $57 billion over a 10-year period.
The malpractice system also faces issues of equity and access. For example, some observers have criticized the current system's performance with respect to (1) compensating patients who have been harmed by malpractice, (2) deterring substandard medical care, and (3) promoting patient safety. There are differing opinions as to the extent that each of these areas has been affected by the current malpractice system.
In the 112th Congress, the primary vehicle addressing medical malpractice has been H.R. 5, which focused on medical liability tort reform when introduced but was amended to include language similar to other legislation, specifically H.R. 157, H.R. 1150, H.R. 1943, and H.R. 3586. The amended version of H.R. 5 passed the House in March 2012. Language similar to the introduced version of H.R. 5 was included in H.R. 5652, the House budget reconciliation bill for FY2013, which passed the House in May 2012. The Senate has yet to consider H.R. 5 or S. 218 and S. 1099, companion bills to H.R. 5 as introduced. The President's budgets for FY2012 and FY2013 both requested $250 million for grants to test a variety of reform proposals, but this funding has not been appropriated by Congress.