would have a more significant impact in states without similarly enacted laws. In 2009, the Congressional Budget Office (CBO) estimated the potential impact of reforms such as those included in H.R. 5 on health care costs and predicted a 10-percent reduction in MM insurance premiums, a 0.2-percent reduction in direct aggregate health care expenditures, and a 0.3-percent reduction in expenditures related to defensive medicine (CBO, 2009a, 2009b). The most recent CBO projections, based on these estimates, suggest that H.R. 5 would reduce federal expenditures on health care by $40 billion from 2011 to 2021, a small share of health care costs overall but a non-negligible dollar amount (CBO, 2011). Another potential effect of liability reforms is on access to healthcare, in the form of an impact on physician labor supply. A number of recent studies have concluded that reforms reducing the expected cost of liability increase the availability of physician services, particularly for high risk specialties such as obstetrics and for rural areas (Kessler et al., 2005; Klick & Stratmaan, 2007; Matsa, 2007; Helland & Showalter, 2009). While these studies mostly consider the impact of reforms more generally, it is likely that a package of reforms such as those introduced by H.R. 5 could generate a small increase in the supply of physicians and increase access to care. · H.R. 5 §3—Limiting time to sue (speedy resolution of claims) Using data from state MM closed-claims databases, the Bureau of Justice Statistics estimated that medical malpractice claims are reported within 15–18 months, on average, although the median reporting lag for cases involving surgeons is almost two years (Cohen & Hughes, 2007). In Florida, a state that has a publicly available closed-claim database, almost 5 percent of MM cases resolved during 1999–2004 took longer than three years to report. By inference, a new federal statute of limitations would presumably reduce some fraction of MM claims and associated costs, perhaps approximating the rate in Florida from 1999 to 2004. To the best of our knowledge, adjustment to the statute of limitations has not been evaluated as frequently as other types of tort reform, so the empirical evidence for its effectiveness as a cost-control device in MM litigation is lacking. 3 · H.R. 5 §4—Damage caps (compensating patient injury) Caps on noneconomic damages are among the most commonly proposed statutory interventions to MM liability. Empirical evidence is stronger concerning the ability of caps to lower MM costs, and thus health care costs, than for most other forms of tort intervention. Even if these caps succeed in lowering MM costs, however, they may raise some concerns. There is evidence to suggest that cases with the greatest percentage reductions in total awards are those with small economic losses but in which juries found great damage to the plaintiff’s quality of life. One major study found, for example, that the effect of noneconomic damage caps tend to be most pronounced in cases involving elderly plaintiffs (whose wage losses are likely to be smaller) or wrongful deaths (Pace et al., 2004). · H.R. 5 §4—Fair share rule (compensating patient injury) Modification of the joint-and-several liability rule in MM litigation would make each defendant to an MM claim liable only for his or her proportional share of fault in connection with the injury. This has an important legal effect of making the plaintiff responsible for joining all relevant defendants at the beginning of MM litigation, or else risk losing some compensation for injuries. According to RAND COMPARE, empirical evidence concerning the effectiveness of eliminating joint-and-several liability in reducing MM litigation or its associated costs has been weak and mixed. CBO commented on joint-andseveral liability reform specifically in its 2009 letter to Orrin Hatch and observed that this kind of reform might actually increase utilization and defensive medicine costs in some circumstances (CBO, 2009). · H.R. 5 §5—Contingency fee limits (maximizing patient recovery) Attorney fee limits (AFLs) are another key feature of MICRA-style statutory tort intervention. The direct impact of this reform is to increase the share of a given award that is recovered by the plaintiff and decrease the share that is recovered by the plaintiff’s attorney(s). Pace (2004) found that the contingency fee schedule adopted by MICRA significantly increased potential compensation to plaintiffs, offsetting about half of the decline that was imposed by the adoption of the noneconomic damage cap. This suggests that contingency fee limits possibly play a key role in minimizing the adverse impact of other tort reforms on the compensation awarded to plaintiffs. However, it is also possible that contingency fees could reduce the ability of potential plaintiffs to obtain the services of an attorney. It is intuitive that a plaintiff attorney’s willingness to take a case on a contingency basis may decline if contingency fee percentages are significantly reduced, and at least one survey study of plaintiff attorneys supports this assertion (Garber et al., 2009). If attorneys are less willing to take cases, that may reduce the volume of MM litigation overall. Whether the impact on attorney representation is a net negative or positive from a social standpoint depends on whether the impact is felt on meritorious or non-meritorious