Republicans’ long-sought curbs on medical malpractice awards are likely to top the congressional health care agenda when lawmakers return in January, even as Democrats prepare for a clash over potential cuts to Medicaid, aides said Friday.

An aide to Senate Majority Leader Bill Frist of Tennessee told reporters Wednesday that capping doctors’ liability in lawsuits will be at the top of his boss’s list when the 109th Congress convenes in early 2005.

The caps were a cornerstone of President Bush’s domestic agenda in his re-election campaign, though the Senate has so far balked at passing them over strong opposition from Democrats.

“We’re going to have to get something done this year on that,” said Dean Rosen, Frist’s chief health care policy advisor, at a briefing hosted by the Alliance for Health Reform and the Robert Wood Johnson Foundation.

Frist has long pushed for limiting lawsuits, so his interest in resurrecting the issue comes as no surprise. But support in the Senate is likely to grow because of the Republican gain of four seats in the November elections.

In addition, an analysis from the Healthcare Leadership Council, a corporate health policy group favoring caps, concluded that eight of nine incoming freshmen senators favor limits in some form.

Weakened Democrats are still vowing to oppose the caps. Liz Fowler, a Democratic health policy aide on the Finance Committee, pointed out that many lawmakers, including a handful of Republicans, remain opposed to measures backed by Frist that included liability protections for drug companies and medical device manufacturers.

Those protections could become difficult to defend in the wake of the recent outcry over prescription drug safety spurred by the recall of Vioxx and new suicide warnings on antidepressants, she said.

“I don’t know that there’s 60 votes” for caps, said Fowler, referring to Senate rules requiring a three-fifths majority to pass controversial legislation.

On other issues, Rosen said that Republicans intend to expand tax breaks for individual health savings accounts, and to renew efforts to give small businesses the right to band together to buy health insurance in entities known as association health plans.

But Congress’s biggest fight could come over how to shore up the Medicaid program for the poor.

The Bush Administration backed an optional plan two years ago increasing federal Medicaid payments to the states now in exchange for the states’ acceptance of lump-sum Medicaid block grants several years later. Democrats blasted the move, complaining that it was the beginning of a GOP attempt to cut federal Medicaid support to the states.

Fowler said that her party will mount “a huge fight” if Republicans try to pass block grant legislation or cut Medicaid funding in an effort to reduce the federal budget deficit.

“The Democrats are gearing up for that. Medicaid, with major cuts, would be a major battle,” she told reporters.

About Medicaid, Rosen only said that Republicans want to find a way to expand outreach to some six million children eligible for Medicaid or State Children’s Health Insurance Program (SCHIP) but who are not enrolled.