Law Commons^™

Health Care And The Myth Of Self-Reliance, Nicole Huberfeld, Jessica L. Roberts

Law Faculty Scholarly Articles

King v. Burwell asked the Supreme Court to decide if, in providing assistance to purchase insurance “through an Exchange established by the State,” Congress meant to subsidize policies bought on the federally run exchange. With its ruling, the Court saved the Patient Protection and Affordable Care Act’s low-income subsidy. But King is only part of a longer, more complex story about health care access for the poor. In a move toward universal coverage, two pillars of the ACA facilitate health insurance coverage for low-income Americans, one private and one public: (1) the subsidy and (2) Medicaid expansion. Although both have …

An Empirical Perspective On Medicaid As Social Insurance, Nicole Huberfeld, Jessica L. Roberts

Law Faculty Scholarly Articles

This Essay begins to explore how Medicaid, after the Patient Protection and Affordable Care Act, metamorphoses from exclusion and limitations in access and benefits to a form of social insurance that implicates theories of social justice. The social justice aspect of universality provides an important lens for understanding these numbers, both in terms of the states that are expanding and the states that are opting out. States that refuse to expand their Medicaid programs are denying millions of Americans the benefit of a precious legal entitlement. It is essential that the states understand the power—and the potential—of this evolving social …

The Universality Of Medicaid At Fifty, Nicole Huberfeld

Law Faculty Scholarly Articles

This essay explores how the law of Medicaid after fifty years creates a meaningful principle of universalism by shifting from fragmentation and exclusivity to universality and inclusivity. The universality principle provides a new trajectory for all of American health care, one that is not based on individual qualities that are unrelated to medical care but rather grounded in non-judgmental principles of unification and equalization (if not outright solidarity). To that end, this Essay first will study the legislative reformation that led to universality and its quantifiable effects. The Essay then will assess and evaluate Medicaid’s new universality across four dimensions, …

The Pay Or Play Penalty Under The Affordable Care Act: Emerging Issues, Kathryn L. Moore

Law Faculty Scholarly Articles

The Affordable Care Act does not require that employers provide employees with health care coverage. It does, however, impose an excise tax on large employers that fail to offer their employees affordable employer-sponsored health care coverage. The excise tax, commonly referred to as a “pay-or-play penalty,” was scheduled to go into effect beginning in 2014. The United States Treasury Department (“Treasury”), however, has delayed enforcement of the penalty until 2015 for employers with 100 or more full-time employees, and until 2016 for employers with 50 to 99 employees.

Implementation of the pay-or-play penalty has given rise to a host of …

A Comparison Of The Role Of The Employer In The French And U.S. Health Care Systems, Kathryn L. Moore

Law Faculty Scholarly Articles

The United States is unique among developed nations in its heavy reliance on employment-based health insurance. The United States, however, is not the only nation in which employers play an important role in the financing of health care. Indeed, long before employment-based health insurance became common in the United States, countries with social insurance systems, such as France, Germany, Hungary, and the Czech Republic, provided for the delivery of mandatory social insurance benefits, including health insurance, through the workplace.

This article explores the role of the employer in the health care system in one such country: France. The French health …

The Future Of Employment-Based Health Insurance After The Patient Protection And Affordable Case Act, Kathryn L. Moore

Law Faculty Scholarly Articles

In the United States, unlike in all other advanced industrial states, health care is financed principally through employment-based health insurance. In 2009, more than 156 million individuals under the age of sixty-five, or 59% of that population, were covered by employment- based health insurance.

On March 21, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA). Described as seminal as the enactment of the Employee Retirement Income Security Act (ERISA), PPACA fundamentally reforms the American health care system. PPACA, however, does not eliminate the system’s reliance on employment- based health insurance. Instead, it builds on, and arguably …

Conditional Spending And Compulsory Maternity, Nicole Huberfeld

Law Faculty Scholarly Articles

More than forty-six million Americans are uninsured, and many more are seeking government assistance, which makes congressional spending for federal programs a significant issue. Federal funding often comes with prerequisites in the form of statutory conditions. This Article examines the impact that conditions placed on federal healthcare spending have on the individuals who rely on that spending by exploring the ongoing disconnect between Spending Clause jurisprudence and women's reproductive rights. The first Part reviews the foundational Supreme Court precedents and places them in context from both a statutory and theoretical perspective. The second Part studies what the author denominates "pure …

Tackling The “Evils” Of Interlocking Directorates In Healthcare Nonprofits, Nicole Huberfeld

Law Faculty Scholarly Articles

The nonprofit sector and matters of nonprofit governance have been in the national spotlight much of late. One area of heightened interest is directors of healthcare entities regularly serving on the board of more than one healthcare organization. Even when board membership of related entities is relatively independent, one corporation's business plan frequently is affected (or even controlled) by the business needs of a separately incorporated parent, affiliate, or other related organization. Very little case law addresses "interlocking" directorates for nonprofit board members, and the case law that does exist tends to address narrow, fact-based state law interpretive issues rather …

Be Not Afraid Of Change: Time To Eliminate The Corporate Practice Of Medicine Doctrine, Nicole Huberfeld

Law Faculty Scholarly Articles

This article focuses on three key reasons that the corporate practice of medicine doctrine should be laid to rest. First, the motives for creating the corporate practice of medicine doctrine are long gone; it has been some time since physicians have been able to operate as a guild of autonomous providers of health care. The delivery and financing of health care places physicians in an integrated system that is only frustrated by the corporate practice of medicine doctrine. Second, it is disingenuous to pretend that physicians are not influenced by financial gain. This is handily evidenced by the federal and …

Quality Control, Enterprise Liability, And Distintermediation In Managed Care, Nicole Huberfeld, John V. Jacobi

Law Faculty Scholarly Articles

In this article, the authors examine the potential of enterprise liability in light of current health-care finance realities. The article begins by addressing background issues of medical malpractice theory and the development of proposals for a form of plan-based enterprise medical liability centered on managed care organizations (MCOs). The authors then describe recent trends in the evolution of more loosely structured MCOs, including the emergence of "disintermediated," or patient-directed, plans. The authors examine the extent to which these developments weaken the rationales for plan-based enterprise liability. The article concludes nevertheless that plan-based enterprise liability best serves the goal of reducing …