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. In each case, attention receded to some degree after a few years as premium increases moderated and market conditions calmed. 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. Some proposals, such as the current Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act ( H.R. 5 , S. 218 , and S. 1099 ), have addressed the tort system, particularly limits on claims brought in medical liability cases; others have addressed the insurance system, particularly increased direct regulation of insurance companies, or removal of the existing partial exemption from federal antitrust laws for the "business of insurance." The 112 th Congress acted early to address health reform generally and medical malpractice issues specifically. H.R. 2 , which would repeal P.L. 111-148 in its entirety, including the medical malpractice provisions discussed below (under the section " The 111 th Congress "), was introduced by Representative Eric Cantor on January 5, 2011. This bill was passed by the House on January 19, 2011. Legislation addressing medical liability reform in greater depth passed the House, as discussed below. H.R. 5 was introduced by Representative Phil Gingrey on January 24, 2011. The House Committee on the Judiciary marked up the bill on February 9 and February 16, 2011, and reported the bill on March 17, 2011 ( H.Rept. 112-39 , Part 1). The House Committee on Energy and Commerce marked up the bill on May 13, 2011, and reported it on May 23, 2011 ( H.Rept. 112-39 , Part 2). The House passed H.R. 5 on March 22, 2012, as detailed below. In the Senate, S. 218 was introduced by Senator John Ensign on January 27, 2011, and S. 1099 was introduced by Senator Roy Blunt on May 26, 2011. Both bills were referred to the Senate Committee on the Judiciary, which has not acted on either. H.R. 5 and S. 218 , as introduced, are identical bills. S. 1099 has slightly different wording in the findings portions of the bill, but is otherwise identical. H.R. 5 , S. 218 , and S. 1099 as introduced would, with certain exceptions, preempt some aspects of existing state medical malpractice laws. Although the legislation seeks to address both medical malpractice and product liability, this report will discuss only provider medical malpractice. The legislation defines a "health care lawsuit" to encompass not only suits between a provider and patient, but also any claim against a health care organization, manufacturer, distributor, supplier, marketer, promoter, or seller of a medical product and any claims concerning health care goods and services or medical products affecting interstate commerce. Among other things, all three bills would mandate a uniform statute of limitations for health care lawsuits and set parameters and caps for non-economic damages, punitive damages, and attorneys' fees. However, the legislation would also grant states flexibility in that it would not preempt any state law that imposes greater procedural or substantive protections for health care providers and organizations from liability, loss, or damages. The legislation would also not preempt any state law that specifies a particular monetary amount of compensatory or punitive damages, regardless of whether the state's monetary amount is greater or lesser than is provided for in the act. In the February 16, 2011, House Judiciary Committee markup of H.R. 5 , an amendment to eliminate a provision in H.R. 5 that would have allowed juries to hear evidence of "collateral source benefits," such as workers' compensation payments or long-term disability insurance payments, was adopted by voice vote. The amendment also struck a provision that would have prohibited providers of collateral source benefits from recovering any amounts paid after a court award is made to a plaintiff. CBO's cost estimate for this version of H.R. 5 foresees a 0.4% decrease in overall health spending and a reduction in the federal budget deficit of $40 billion over the 10-year period from 2012 to 2021. In the May 11, 2011, House Energy and Commerce Committee markup of H.R. 5 , the bill was amended to add a further exception to the prohibition on punitive damages for products that comply with Food and Drug Administration (FDA) standards. If enacted as reported, punitive damages would be allowed to be awarded in a health care lawsuit if the product which caused the harm was misbranded, adulterated, contaminated, mislabeled, or improperly stored. CBO's cost estimate for this version of 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. This increased savings is largely due to the retention of the collateral source rule that was removed in the Judiciary Committee markup. The full House considered H.R. 5 under the terms of H.Res. 591 on March 21-22, 2012. The base text of the HEALTH act, now Title I of a broader bill entitled the Protecting Access to Healthcare Act, largely followed the version reported by the Committee on the Judiciary, as it did not include the provision on collateral source benefits. The version considered on the floor also included an additional Title II, the Medicare Decisions Accountability Act of 2012. This new title would repeal provisions in the Patient Protection and Affordable Care Act (ACA) establishing the Independent Payment Advisory Board (IPAB). CBO estimates that this version of H.R. 5 would reduce the federal budget deficit by $45.5 billion over the 10-year period from 2013 to 2022. During floor consideration, four amendments were adopted, two of which directly affect civil liability protections for health care providers. These two amendments are (1) H.Amdt. 989 , introduced by Representative Charlie Dent, and (2) H.Amdt. 991 , introduced by Representative Cliff Stearns. The first amendment— H.Amdt. 989 —was adopted by voice vote. It would extend the Federal Tort Claims Act's (FTCA's) civil liability coverage to certain entities, health care providers that are subject to providing stabilization services in emergency departments under the Emergency Medical Treatment and Labor Act (EMTALA). Under this amendment, a claim for medical malpractice arising from health care services rendered pursuant to EMTALA would be brought against the United States in lieu of the entity or health care provider. In other words, the federal government would become responsible for any monetary damages if an entity or provider would have been found liable under the laws of the state where the act or omission occurred. The second amendment— H.Amdt. 991 —was adopted by a vote of 251-157. It would grant limited civil liability protection to health care professionals who volunteer and provide services in response to certain federally declared disasters or public health emergencies as defined by the amendment. The other two amendments adopted by the House are (1) H.Amdt. 987 , introduced by Representative Rob Woodall, and which struck the original findings; and (2) H.Amdt. 990 , introduced by Representative Paul Gosar, which would remove McCarran-Ferguson Act's antitrust exemption as it applies to health insurers. H.R. 5 , as amended, passed the House by a vote of 223-181 with four Members voting present. The report accompanying H.Con.Res. 112 ( H.Rept. 112-421 ) includes language relating to reforming medical malpractice insurance. Specifically, the report states that "the budget supports several changes to laws governing medical liability, including limits on noneconomic and punitive damages." H.Con.Res. 112 includes instructions to various committees to submit legislation reducing the federal deficit in the committees' areas of jurisdiction, including $39.7 billion in deficit reduction from the Committee on the Judiciary and $96.8 billion in deficit reduction from the Committee on Energy and Commerce over the period from FY2012 through FY2022. In response to the budget resolution, the Committee on the Judiciary submitted a committee print that consisted of their version of the HEALTH Act on April 25, 2012, and the Committee on Energy and Commerce approved their version of the HEALTH Act as Title III of a committee print on April 25, 2012. H.R. 5652 was introduced by Representative Paul Ryan on May 9, 2012. It included many of the various committees' recommendations pursuant to H.Con.Res. 112 . The HEALTH Act as passed by the Judiciary Committee was included as Title IV of H.R. 5652 . CBO estimated that Title IV of H.R.