How the GOP’s ‘Access to Care’ bill cuts down states’ rights

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The GOP has long had the brand of being the party of states’ rights and minimalist federal government — it’s no wonder that Paul Ryan has been thinking about sending Medicaid back to the states since he was in college. Indeed, one of the reasons cited by House Republican leadership in the battle over the American Health Care Act for why Medicaid funding should be distributed to states in block grants with fewer federal requirements is that it empowers states to design Medicaid programs that meet each particular state’s needs.

But when it comes to the topic of placing sharp limits on lawsuits by individuals who’ve been injured by negligent or abusive nursing homes or defective drugs, the bill being pushed by Republican leadership (H.R. 1215, the Protecting Access to Care Act) embraces the view that’s what’s good for Medicaid isn’t good for civil justice.

Among other things, H.R. 1215 proposes placing a federal cap of $250,000 on the amount of noneconomic damages state-court juries can award and limits the scope of state-law suits in cases against healthcare and medical providers. But state courts, state law and limits on damages for state-law tort suits have always been very much in province of the state legislatures and courts. If enacted, H.R. 1215 would be an unprecedented intrusion into the operation of state law — the exact opposite of empowering states to design schemes that meet their needs.

{mosads}Though $250,000 may seem like a large amount of money, is it enough to compensate you for never being able to walk or work or hug your child again? In Latracia Satterwhite’s case, the jury didn’t think so.


Ms. Satterwhite was a 33-year-old single working mom who underwent an hour-long relatively minor heart surgery in Mitch McConnell’s home state of Kentucky. The state’s Constitution prohibits the legislature from attempting to place caps on the damages that juries can award to injured persons. The heart surgery was technically a success, but in the process, the doctors misplaced a blood-carrying hose and failed to recognize the red flags indicating that something had gone terribly wrong. As a result of the doctors’ errors, Ms. Satterwhite suffered brain damage and lost the use of her arms and legs. Ms. Satterwhite’s life, and the life of her child, became forever altered. 

After a full trial and hearing all the evidence, the jury awarded her several million dollars in non-economic damages, pale compensation for her preventable, permanent and devastating injuries. Under H.R. 1215, though, without hearing any of the evidence — it apparently doesn’t matter — and without respect to the principles of the Kentucky Constitution, the House Republican leadership would have limited Ms. Satterwhite to only $250,000 for her pain and her experience of not being able to use her arms and legs. Cases like Ms. Satterwhite’s are the reasons why states like Kentucky have declined to adopt those sorts of arbitrary caps.  

But even if you agree with the policy behind H.R. 1215, that medical malpractice and other health-related claims are in need of reform — and we would disagree with you — there a couple of very serious problems with the way it takes a sledgehammer to state law.

First, the federal damages cap proposed by House Republican leaders would override and violate at least 18 state constitutions: in addition to Kentucky, states as diverse as Alabama, Arizona, New Hampshire, New York, Oklahoma, Washington, Wyoming and even Paul Ryan’s home state of Wisconsin. That’s right: Republican leadership wants to strip away your state constitutional rights. What a turnaround from the small-federal-government-states-rights party.

On the AHCA, a large number of Republican House members refused to follow the leadership where they believed it was not respecting core Republican principles. It will be interesting to see if many House Republican members will show a similar respect for the principle of limited federal intrusion into state laws and decisions.

Second, a number of states, including California, Colorado, Texas and Mike Pence’s home state of Indiana, have already enacted changes attempting to get at the same policy goals of H.R. 1215. But H.R. 1215 would partially override those states’ carefully crafted suite of laws, laws designed to balance each other out and address those state’s particular needs. H.R. 1215 gives no respect at all to those states’ lawmakers.

Whether we’re talking about marriage or Medicaid, the GOP has long been an enthusiastic waver of the states’ rights flag, loudly championing the ability of a sovereign state to decide what’s best for its own local community. These principles should apply with equal force to the civil justice system; the area of what state-court juries can award has long been particularly entwined with state law. H.R. 1215, though, would upend that bedrock Republican philosophy. Will House Republicans follow their leadership or their principles on this one?


Paul Bland is executive director of Public Justice, a national public interest law firm that pursues high-impact lawsuits to combat social and economic injustice, protect the Earth’s sustainability and challenge predatory corporate conduct and government abuses. Find him on Twitter @FPBland

Public Justice staff attorney Leah Nicholls contributed to this piece. 

The views of contributors are their own and are not the views of The Hill.

Tags damages Healthcare Lawsuit Medicaid Mike Pence Mitch McConnell Paul Ryan States' rights

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