The legal and medical communities have debated the impact and necessity of medical liability reform for over twenty years. At the heart of the debate is the question of how to strike a balance between compensating patients and their families for the thousands of deaths and injuries resulting from medical errors that occur annually, and encouraging physicians to continue to care for patients across America. While several states have passed medical liability reform laws previously, on March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA)—colloquially known as the “health care bill”—that contains provisions on medical liability reform. Unfortunately, the ACA has no legal effect on the medical liability system and, therefore, is unable to create real reform in this area. Interestingly, the lack of true federal reform comes at a time when some state supreme courts have held that laws capping non-economic damages in medical liability cases are unconstitutional, while other state supreme courts have held that such laws are constitutional. The different rulings among the states are problematic because they lead to doctors abandoning states that do not have caps, higher incidences of defensive medicine, and higher health care costs for Americans.

This Article focuses on how the ACA and recent state supreme court rulings regarding caps on non-economic damages negatively affect medical liability reform. Part II of this Article discusses the cost and quality of the health care system, explains the medical liability debate regarding which reforms Congress should enact, introduces relevant state court rulings and ACA provisions, and discusses the constitutional question of the reforms. Part III analyzes how the different state court rulings affect the health care system, examines what the ACA could have provided based on its legislative history, explains why Congress must reform the medical liability system, and considers the constitutionality of a federal cap and its effect on patients and doctors. Part IV recommends that Congress pass a law capping non-economic damages and creating mandatory health courts. Part V concludes by urging Congress to find the balance between the need to compensate injured patients and the need to ensure that doctors provide adequate care.