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Articles 1 - 30 of 37
Full-Text Articles in Law
Anomalies In The Affordable Care Act That Arise From Reading The Phrase “Exchange Established By The State” Out Of Context, Timothy Stoltzfus Jost, James Engstrand
Anomalies In The Affordable Care Act That Arise From Reading The Phrase “Exchange Established By The State” Out Of Context, Timothy Stoltzfus Jost, James Engstrand
Timothy S. Jost
The Supreme Court is currently considering in King v. Burwell whether residents of all States can receive premium tax credits under the Patient Protection and Affordable Care Act (ACA). The Plaintiffs-Petitioners brought this litigation as a challenge to the validity of a Treasury Department rule allowing all ACA health insurance Exchanges or marketplaces, including federally facilitated Exchanges (FFEs), to support and grant the credits. They invite the Court to focus solely on four words in two subsections of Section 36B of the Internal Revenue Code that they interpret as limiting tax credits to individuals who can use a State-operated Exchange …
The Supreme Court Limits Lawsuits Against Managed Care Organizations, Timothy Stoltzfus Jost
The Supreme Court Limits Lawsuits Against Managed Care Organizations, Timothy Stoltzfus Jost
Timothy S. Jost
In Aetna Health Inc. v. Davila, the United States Supreme Court revisited the question of whether the Employee Retirement Income Security Act (ERISA) precludes state lawsuits against ERISA plans. The Court held that ERISA preempts damage actions brought against managed care organizations under the Texas Health Care Liability Act because ERISA itself provides the exclusive remedy for challenging ERISA plans' coverage decisions. The Court suggested, however, that health plans might be liable for treatment decisions made by employed physicians. It also volleyed back to Congress the question of whether ERISA beneficiaries should have any remedy for damages caused by coverage …
Self-Insurance For Small Employers Under The Affordable Care Act: Federal And State Regulatory Options, Timothy Stoltzfus Jost, Mark A. Hall
Self-Insurance For Small Employers Under The Affordable Care Act: Federal And State Regulatory Options, Timothy Stoltzfus Jost, Mark A. Hall
Timothy S. Jost
As implementation of the Affordable Care Act reshapes the US health insurance market, state and federal policy makers should be prepared to revisit regulation of stop-loss coverage — a form of reinsurance — for small businesses. Aspects of the reform law could motivate small businesses to self-insure, rather than participate in state-regulated markets either inside or outside the new health insurance exchanges. If younger or healthier groups self-insure, premiums for insured plans will rise, perhaps to an extent that could seriously impair the regulated market. State or federal lawmakers can influence small businesses to participate in the regulated market by …
Predicting The Fallout From King V. Burwell - Exchanges And The Aca, Nicholas Bagley, David K. Jones, Timothy Stoltzfus Jost
Predicting The Fallout From King V. Burwell - Exchanges And The Aca, Nicholas Bagley, David K. Jones, Timothy Stoltzfus Jost
Timothy S. Jost
The U.S. Supreme Court's surprise announcement on November 7 that it would hear King v. Burwell struck fear in the hearts of supporters of the Affordable Cara Act (ACA). At stake is the legality of an Internal Revenue Service (IRS) rule extending tax credits to the 4.5 million people who bought their health plans in the 34 states that declined to establish their own health insurance exchanges under the ACA. The case hinges on enigmatic statutory language that seems to link the amount of tax credits to a health plan purchased "through an Exchange established by the State." According to …
The Tenuous Nature Of The Medicaid Entitlement, Timothy Stoltzfus Jost
The Tenuous Nature Of The Medicaid Entitlement, Timothy Stoltzfus Jost
Timothy S. Jost
Though Medicare was from the outset an entitlement under federal law, the status of Medicaid has always been less certain. Arguably, it was the Supreme Court, rather than Congress that first recognized that Medicaid recipients (and providers) could sue the states in federal court to enforce federal Medicaid requirements. A recent widely reported federal court decision, however, called radically into question the continuing existence of a federal Medicaid entitlement. Though this decision has now been reversed, and rejected by other courts, it illustrates the tenuous nature of the Medicaid entitlement, and the need to reconstitute Medicaid as an exclusively federal …
Beyond Repeal--A Republican Proposal For Healthcare Reform, Timothy Stoltzfus Jost
Beyond Repeal--A Republican Proposal For Healthcare Reform, Timothy Stoltzfus Jost
Timothy S. Jost
Not available.
Consumer-Driven Health Care In South Africa: Lessons From Comparative Health Policy Studies, Timothy Stoltzfus Jost
Consumer-Driven Health Care In South Africa: Lessons From Comparative Health Policy Studies, Timothy Stoltzfus Jost
Timothy S. Jost
Consumer-driven health care, based on health savings accounts and high deductible health insurance policies, seems to be the next big thing in U.S. health policy. Long supported by conservative and libertarian advocacy groups, it received a big-boost with the HSA tax subsidy provisions of the Medicare Modernization Act. The question remains, however, whether consumer-driven health care can really bring down health care costs while improving quality and access, as its supporters claim that it will. This article examines the experience of South Africa, where medical savings accounts have long been available and are widely used. It concludes that South Africa's …
Loopholes In The Affordable Care Act: Regulatory Gaps And Border Crossing Techniques And How To Address Them, Timothy Stoltzfus Jost
Loopholes In The Affordable Care Act: Regulatory Gaps And Border Crossing Techniques And How To Address Them, Timothy Stoltzfus Jost
Timothy S. Jost
Not available.
The Real Constitutional Problem With The Affordable Care Act, Timothy Stoltzfus Jost
The Real Constitutional Problem With The Affordable Care Act, Timothy Stoltzfus Jost
Timothy S. Jost
Not available.
The Most Important Health Care Legislation Of The Millennium (So Far): The Medicare Modernization Act, Timothy Stoltzfus Jost
The Most Important Health Care Legislation Of The Millennium (So Far): The Medicare Modernization Act, Timothy Stoltzfus Jost
Timothy S. Jost
Whether or not one believes that the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) in fact improves or modernizes Medicare, the legislation obviously changes the program radically. The extent and nature of these changes make the MMA the most important piece of health care legislation to be adopted by Congress to date in this young millennium. The MMA also contains what are arguably the most important amendments to the Medicare program since its creation. This Essay first describes the identifying characteristics of the current Medicare program, then examines the significant changes that the MMA makes in the program, and …
Medicare And Medicaid False Claims: Prohibitions And Sanctions, Timothy Stoltzfus Jost
Medicare And Medicaid False Claims: Prohibitions And Sanctions, Timothy Stoltzfus Jost
Timothy S. Jost
Both state and federal agencies are cracking down on health care professionals who file false Medicare claims, but physicians who make good faith attempts to comply with the law are fairly secure from prosecution, since both criminal and civil penalties must be based on willful or knowing breaches of the law.
The Supreme Court And The Future Of Medicaid, Timothy Stoltzfus Jost
The Supreme Court And The Future Of Medicaid, Timothy Stoltzfus Jost
Timothy S. Jost
Not available.
Pharmaceutical Research And Manufacturers Of America V. Walsh: The Supreme Court Allows The States To Proceed With Expanding Access To Drugs, Timothy Stoltzfus Jost
Pharmaceutical Research And Manufacturers Of America V. Walsh: The Supreme Court Allows The States To Proceed With Expanding Access To Drugs, Timothy Stoltzfus Jost
Timothy S. Jost
On May 19, 2003, the Supreme Court in Pharmaceutical Research and Manufacturers of America v. Walsh affirmed a court of appeals decision allowing for the implementation of the Maine Act to Establish Fairer Pricing for Prescription Drugs.' The Maine program attempted to leverage the considerable market power of the Medicaid program to force drug companies to offer the state a discount on pharmaceuticals. The state in turn would pass the savings on to its uninsured residents. Manufacturers that refused to negotiate a discount with the state would face the prospect of their products being available to Maine Medicaid recipients only …
The Independent Medicare Advisory Board, Timothy Stoltzfus Jost
The Independent Medicare Advisory Board, Timothy Stoltzfus Jost
Timothy S. Jost
It is a common realization that neither unconstrained markets nor our current political institutions are capable of governing our health care system. The cost of health care is spinning dangerously out of control, yet market forces alone cannot manage these costs because of a host of relatively well-understood market failures. Moreover, our traditional political institutions - Congress and the executive administrative agencies - have also failed us in this respect. These institutions are too driven by special interest politics and too limited in their expertise and vision to control costs. Both Medicare payment formulas and coverage determinations often seem to …
The Uses Of The Social Transformation Of American Medicine: The Case Of Law, Timothy Stoltzfus Jost
The Uses Of The Social Transformation Of American Medicine: The Case Of Law, Timothy Stoltzfus Jost
Timothy S. Jost
Not available.
Professional Sovereignty In A Changing Health Care System: Reflections On Paul Starr's The Social Transformation Of American Medicine, Timothy Stoltzfus Jost, Keith Wailoo, Mark Schlesinger
Professional Sovereignty In A Changing Health Care System: Reflections On Paul Starr's The Social Transformation Of American Medicine, Timothy Stoltzfus Jost, Keith Wailoo, Mark Schlesinger
Timothy S. Jost
Not available.
The American Right-Wing Policy Agenda, Timothy Stoltzfus Jost
The American Right-Wing Policy Agenda, Timothy Stoltzfus Jost
Timothy S. Jost
Right-wing health policy is alive and well in the United States. Pro-business and libertarian health policy advocacy groups, generously funded by right-wing foundations (and, in some instances, by the health care industry), produce a continuous stream of press releases, policy-statements, books, articles, and symposia, as well as testimony before legislative and administrative bodies. Their positions are taken very seriously by the American media, who make certain that right-wing policy experts are represented in any discussion of current health policy issues.
The Joint Commission On Accreditation Of Hospitals: Private Regulation Of Health Care And The Public Interest, Timothy Stoltzfus Jost
The Joint Commission On Accreditation Of Hospitals: Private Regulation Of Health Care And The Public Interest, Timothy Stoltzfus Jost
Timothy S. Jost
No abstract provided.
Policing Cost Containment: The Medicare Peer Review Organization Program, Timothy Stoltzfus Jost
Policing Cost Containment: The Medicare Peer Review Organization Program, Timothy Stoltzfus Jost
Timothy S. Jost
This Article will first examine the problem of health care cost inflation and the payment strategies the Medicare program has adopted to address that problem. It will then discuss the perverse incentives that these payment strategies create, and the role of the PRO program in addressing harmful provider behavior encouraged by those perverse incentives. The Article examines evidence on whether the PRO program is succeeding or failing in this mission, and suggests possible means of improving the effectiveness of the PRO program in policing cost containment. Specifically, it recommends clarifying and strengthening the deterrent role of the PROs, crafting PRO …
Pegram V. Herdrich: The Supreme Court Confronts Managed Care, Timothy S. Jost
Pegram V. Herdrich: The Supreme Court Confronts Managed Care, Timothy S. Jost
Timothy S. Jost
ERISA, adopted a quarter century ago to reform private pension law, imposed by the end of the twentieth century a seemingly insurmountable barrier to managed care reform. The Supreme Court's decision in Pegram v. Herdrich blocked one path out of the ERISA morass-broader use of breach of ERISA fiduciary obligations suits in federal court. On the other hand, it opened another path to holding HMOs accountable in malpractice cases in state court-and suggested that ERISA might impose fiduciary obligations to disclose incentives on HMOs. It is therefore an important decision. ERISA was intended to give the federal government primary authority …
Comparative And International Health Law, Timothy Stoltzfus Jost
Comparative And International Health Law, Timothy Stoltzfus Jost
Timothy S. Jost
No abstract provided.
The Future Of Medicare, Post Great Society And Post Plus-Choice: Legal And Policy Issues--Foreword, Timothy Stoltzfus Jost
The Future Of Medicare, Post Great Society And Post Plus-Choice: Legal And Policy Issues--Foreword, Timothy Stoltzfus Jost
Timothy S. Jost
No abstract provided.
Why Can't We Do What They Do? National Health Reform Abroad, Timothy Stoltzfus Jost
Why Can't We Do What They Do? National Health Reform Abroad, Timothy Stoltzfus Jost
Timothy S. Jost
This article describes how other countries organize and finance their health care systems, and how the performance of those health care systems compares with that of the United States. It also examines why the United States, unlike all other developed countries, has failed to provide universal access to health care services.
Private Or Public Approaches To Insuring The Uninsured: Lessons From International Experience With Private Insurance, Timothy Stoltzfus Jost
Private Or Public Approaches To Insuring The Uninsured: Lessons From International Experience With Private Insurance, Timothy Stoltzfus Jost
Timothy S. Jost
In the recent past a broad consensus has emerged in the United States that the best way to expand coverage of the uninsured is to use tax subsidies to encourage the purchase of private health insurance policies. Many advocates of this approach also call for replacing employment-related group policies with individual policies, and for minimizing regulation of private insurance. Those who advocate these policies, however, have rarely considered the experience that other nations have had with private health insurance. In fact most other countries have private insurance markets, and in many countries private insurance plays a significant role in financing …
Health Courts And Malpractice Claims Adjudication Through Medicare: Some Questions, Timothy Stoltzfus Jost
Health Courts And Malpractice Claims Adjudication Through Medicare: Some Questions, Timothy Stoltzfus Jost
Timothy S. Jost
No abstract provided.
Oversight Of Marketing Relationships Between Physicians And The Drug And Device Industry: A Comparative Study, Timothy Stoltzfus Jost
Oversight Of Marketing Relationships Between Physicians And The Drug And Device Industry: A Comparative Study, Timothy Stoltzfus Jost
Timothy S. Jost
Throughout the world, complex mutually-dependent relationships exist between physicians and pharmaceutical and medical device companies. This articlef ocuses on one particulara spect of these relationships--paymentsm ade by drug and device companies to physicians and their organizations and institutions to market drugs and devices. It is widely believed that drug and device company marketing to physicians creates conflicts of interest that corrupt physician judgment and increase the cost of medical care. This article examines first the economic basis of physician/industry relationships that causes conflicts to arise. It next considers the measures that a number of developed countries have taken to respond …
Our Broken Health Care System And How To Fix It: An Essay On Health Law And Policy, Timothy Stoltzfus Jost
Our Broken Health Care System And How To Fix It: An Essay On Health Law And Policy, Timothy Stoltzfus Jost
Timothy S. Jost
No abstract provided.
Global Health Care Financing Law: A Useful Concept?, Timothy Stoltzfus Jost
Global Health Care Financing Law: A Useful Concept?, Timothy Stoltzfus Jost
Timothy S. Jost
No abstract provided.
The Massachusetts Health Plan: Public Insurance For The Poor, Private Insurance For The Wealthy, Self-Insurance For The Rest?, Timothy Stoltzfus Jost
The Massachusetts Health Plan: Public Insurance For The Poor, Private Insurance For The Wealthy, Self-Insurance For The Rest?, Timothy Stoltzfus Jost
Timothy S. Jost
No abstract provided.
Optimizing Qui Tam Litigation And Minimizing Fraud And Abuse: A Comment On Christopher Alexion’S Open The Door, Not The Floodgates, Timothy Stoltzfus Jost
Optimizing Qui Tam Litigation And Minimizing Fraud And Abuse: A Comment On Christopher Alexion’S Open The Door, Not The Floodgates, Timothy Stoltzfus Jost
Timothy S. Jost
No abstract provided.