NEW YORK (CNN/Money) -
The battle over medical liability reform officially kicks off this week.
One day after a new Republican-controlled Congress gets to work, President Bush will fly to Illinois Wednesday to step up his efforts to convince lawmakers to cap jury awards for non-economic damages in medical lawsuits to $250,000 per case.
As the backdrop for his speech, Bush has picked Madison County, Illinois, which last month was selected by a pro-tort reform group as the leading "judicial hellhole" in the country.
The American Tort Reform Association, in its annual compilation of the nation's worst courts for businesses, picked Madison County as its No. 1 site for the second-year running because, the association said, it has become a "magnet" for asbestos and other class-action claims, medical or otherwise.
That the president has picked medical liability as his first domestic policy speech of the new year signals how seriously he considers litigation reform.
In welcoming new members of Congress Monday, Bush listed "legal reform" as a top priority, along with disaster aid to South Asian tsunami victims, an overhaul of Social Security and the federal income tax code, and education, among other issues.
The president's repeated calls for court reform is fueling a longstanding debate over whether jury verdicts in personal injury cases are a problem.
What's more, the battle is almost certain to reignite a tug-of-war over whether Washington should regulate the country's $200 billion tort system, which traditionally has been the province of state governments.
Last year the House passed three bills aimed at curbing personal injury lawsuits, all of which failed to pass the Senate.
The battle lines
Reform advocates argue that outsized jury verdicts in medical cases are driving doctors out of business due to stratospheric malpractice insurance rates.
Recent news reports have said that roughly 200 doctors in southwestern Illinois, which includes Madison Co., quit the profession or left the state last year because of steep insurance costs. A shrinking pool of medical care providers, reform proponents argue, hurts both the economy and patients alike.
"The president is to be commended for going to a place where too much excess liability has dramatically affected how people live because they can't get access to medicine," said Victor Schwartz, general counsel of the American Tort Reform Association.
Critics, however, dismiss claims that lawsuits are driving up insurance premiums and limiting access to medical care.
Joanne Doroshow, executive director of The Center for Justice & Democracy, an anti-tort reform group, said that insurance rates are a problem not because of personal injury lawsuits but because of lax state insurance regulations, including Illinois.
"You can cap damages all you want, but unless you get control over the insurance industry's own business practices you're not going to solve doctors' problems," said Doroshow.
"A lot of this is fear mongering," she said, referring to calls for litigation reform.
Last November's election invigorated the pro-reform camp.
The Republicans, who are traditionally allied with business groups and support tort reform, gained four Senate seats, bringing the party's majority to 55. There are 44 Democrats and one Independent. Likewise, in the House, Republicans now hold 232 out of 435 seats.
If history is any guide, the Senate is likely to be the key battleground in the 109th Congress that convened Tuesday. Pro-reform groups will need 60 Senate votes to end a Democrat filibuster and bring any legislation to a vote.
Even with a sizable Senate majority, it's not clear whether the Republicans can muster enough votes. One reason is that some Republican Senators, including newly elected conservatives from Oklahoma and Georgia, are strong defenders of states rights over federal power. Tort law has been governed by states since the earliest days of the Republic.
The challenge for Bush, will be to convince the pro-states rights side that enough federal money pours into the nation's health care system that it is in fact an issue for Washington, said one key official involved in the tort reform debate.
Another debate worth watching: "medical liability" versus "medical malpractice" reform. The former term implies protections not just for doctors but also for other health care providers, including big drug companies. The latter refers just to efforts to protect doctors and hospitals.
In calling for reform, Bush and other reform advocates consistently use the phrase "medical liability."