Health Law and Policy Commons^™

Limiting State Flexibility In Drug Pricing, Nicholas Bagley, Rachel E. Sachs

Articles

Throughout the United States, escalating drug prices are putting immense pressure on state budgets. Several states are looking for ways to push back. Last year, Massachusetts asked the Trump administration for a waiver that would, among other things, allow its Medicaid program to decline to cover costly drugs for which there is limited or inadequate evidence of clinical efficacy. By credibly threatening to exclude such drugs from coverage, Massachusetts hoped to extract price concessions and constrain the fastest-growing part of its Medicaid budget.

Suggestions For State Laws On Biosimilar Substitution, Gary M. Fox

Michigan Telecommunications & Technology Law Review

Biologic drugs offer major advancements over small-molecule drugs when it comes to treating serious diseases. Biosimilars, which mimic innovative biologic drugs, have the potential to further revolutionize the practice of medicine. States now have decades of experience regulating the substitution of generic, small-molecule drugs for their brand-name equivalents. But the complexities of biologic drugs and biosimilars force states to confront novel scientific and legal issues. Many states have begun tackling those issues by passing laws that regulate when pharmacists may substitute biosimilars for their corresponding biologic drugs. Other states have yet to do so. This Note surveys five provisions common …

Small Change, Big Consequences — Partial Medicaid Expansions Under The Aca, Adrianna Mcintyre, Allan M. Joseph, Nicholas Bagley

Articles

Though congressional efforts to repeal and replace the Affordable Care Act (ACA) seem to have stalled, the Trump administration retains broad executive authority to reshape the health care landscape. Perhaps the most consequential choices that the administration will make pertain to Medicaid, which today covers more than 1 in 5 Americans. Much has been made of proposals to introduce work requirements or cost sharing to the program. But another decision of arguably greater long-term significance has been overlooked: whether to allow “partial expansions” pursuant to a state Medicaid waiver. Arkansas has already submitted a waiver request for a partial expansion, …

Black Health Matters: Disparities, Community Health, And Interest Convergence, Mary Crossley

Michigan Journal of Race and Law

Health disparities represent a significant strand in the fabric of racial injustice in the United States, one that has proven exceptionally durable. Many millions of dollars have been invested in addressing racial disparities over the past three decades. Researchers have identified disparities, unpacked their causes, and tracked their trajectories, with only limited progress in narrowing the health gap between whites and racial and ethnic minorities. The implementation of the Affordable Care Act (ACA) and the movement toward value-based payment methods for health care may supply a new avenue for addressing disparities. This Article argues that the ACA’s requirement that tax-exempt …

No Good Options: Picking Up The Pieces After King V. Burwell, Nicholas Bagley, David K. Jones

Articles

If the Supreme Court rules against the government in King v. Burwell, insurance subsidies available under the Affordable Care Act (ACA) will evaporate in the thirty-four states that have refused to establish their own health-care exchanges. The pain could be felt within weeks. Without subsidies, an estimated eight or nine million people stand to lose their health coverage. Because sicker people will retain coverage at a much higher rate than healthier people, insurance premiums in the individual market will surge by as much as fifty percent. Policymakers will come under intense pressure to mitigate the fallout from a government loss …

For The Love Of The Game: The Case For State Bans On Youth Tackle Football, Adam Bulkley

University of Michigan Journal of Law Reform Caveat

This football season, millions of Americans enjoying their favorite pastime might feel pangs of a guilty conscience. Years of scientific research into the long-term neurological effects of tackle football and a recent settlement between the National Football League (NFL) and thousands of retired NFL players have made football-related traumatic brain injuries (TBI) a topic of national conversation. Current and former NFL players and even President Obama have participated in the conversation, saying that they would hesitate to let their sons play the game for fear of possible brain injury. Because research has uncovered signs of permanent brain damage in players …

Abortion And Informed Consent: How Biased Counseling Laws Mandate Violations Of Medical Ethics, Ian Vandewalker

Michigan Journal of Gender & Law

If we slightly change the facts of the story about the discouraging doctor, it becomes a story that happens every day. Abortion patients face attempts to discourage them from terminating their pregnancies like those the imaginary doctor used, as well as others-and state laws mandate these attempts. While the law of every state requires health care professionals to secure the informed consent of the patient before any medical intervention, over half of the states place additional requirements on legally effective informed consent for abortion. These laws sometimes include features that have ethical problems, such as giving patients deceptive information. Unique …

In The Laboratory Of The States: The Progress Of Glucksberg'S Invitation To States To Address End-Of-Life Choice, Kathryn L. Tucker

Michigan Law Review

It has now been ten years since the Supreme Court handed down Glucksberg and Quill, rulings on laws that forbid "assisted suicide." In that time, normative and legal developments in the fields of law, medicine, and psychology have changed the landscape of the discourse on the choice of a mentally competent, terminally ill individual to choose to self-administer medications to bring about a peaceful death. Although the Court rejected petitioners' claims that state laws denying them the ability to end their terminal illnesses through self-administered medication violated the Constitution, it left states with the opportunity to experiment with legislation …

Physician-Assisted Suicide In Oregon: A Medical Perspective, Herbert Hendin, Kathleen Foley

Michigan Law Review

This Article examines the Oregon Death with Dignity Act from a medical perspective. Drawing on case studies and information provided by doctors, families, and other care givers, it finds that seemingly reasonable safeguards for the care and protection of terminally ill patients written into the Oregon law are being circumvented. The problem lies primarily with the Oregon Public Health Division ("OPHD"), which is charged with monitoring the law. OPHD does not collect the information it would need to effectively monitor the law and in its actions and publications acts as the defender of the law rather than as the protector …

The Choice To Limit Choice: Using Psychiatric Advance Directives To Manage The Effects Of Mental Illness And Support Self-Responsibility, Breanne M. Sheetz

University of Michigan Journal of Law Reform

Psychiatric advance directives are a valuable tool for individuals with mental illnesses. Ulysses directives, in particular, allow individuals to bind themselves to treatment in advance of needing it for the purpose of overcoming illness-induced refusals. This Note evaluates the effectiveness of state advance directive statutes in three areas that are especially important for Ulysses directives: defining competency to execute, activate, and revoke directives; waiving the constitutional right to refuse treatment; and encouraging provider compliance. This Note ultimately advocates for other states to adopt provisions similar to a Washington State statute. The Washington statute authorizes Ulysses directives by allowing advance consent …

The Common Law Power Of The Legislature: Insurer Conversions And Charitable Funds, Jill R. Horwitz, Marion R. Fremont-Smith

Articles

New York's Empire Blue Ccoss and Blue Shield conversion from nonprofic cofor­ profic form has considerable legal significance. Three aspects of the conversion ma.ke checase unique: the role of the scace legislature in directing the disposicion of the conversion assets, che face chac it made itself che primary beneficiary of chose assets, and the actions of che scace attorney general defending the state rather than che public inceresc in che charitable assets. Drawing on several cenruries of common Law rejecting the Legislacive power to direct the disposition of charitable funds, chis article argues chat the legislature lacked power cocontrol che …

Vanishing Vaccinations: Why Are So Many Americans Opting Out Of Vaccinating Their Children?, Steve P. Calandrillo

University of Michigan Journal of Law Reform

Vaccinations against life-threatening diseases are one of the greatest public health achievements in history. Literally millions of premature deaths have been prevented, and countless more children have been saved from disfiguring illness. While vaccinations carry unavoidable risks, the medical, social and economic benefits they confer have led all fifty states to enact compulsory childhood vaccination laws to stop the spread of preventable diseases. Today, however, vaccines are becoming a victim of their success-many individuals have never witnessed the debilitating diseases that vaccines protect against, allowing complacency toward immunization requirements to build. Antivaccination sentiment is growing fast in the United States, …

Clearing The Way For An Effective Federal-State Partnership In Health Reform, Eleanor D. Kinney

University of Michigan Journal of Law Reform

At century's end, states have assumed a very different role in the design, implementation, and operation of health service programs than they did twenty-five years ago. In the current volatile political atmosphere particularly at the federal level, states have taken up the mantle of healthcare reform in the final years of the 1990s. Yet there remain problems and difficulties with the current federal-state relationship in health reform. The critical question is whether states can successfully accomplish genuine reform given its politically charged, complex and costly nature. This question takes on particular significance for the most important reform-expanding coverage to the …

Justification By Faith, Carl E. Schneider

Articles

In June 1997 a sixteen-year-old girl named Shannon Nixon began to feel ill. Her parents belonged to the Faith Tabernacle Church, one of a number of American sects which believe that illness should be treated spiritually rather than medically. Accordingly, the Nixons prayed for Shannon and took her to be anointed at their church. Shannon reported that she felt better and that the spiritual treatment had gained her her victory-her recovery. Before long, however, Shannon again felt ill. She became weaker and weaker and then fell into a coma. A few hours later she died. An autopsy revealed that she …

A Study In Regulatory Method, Local Political Cultures, And Jurisprudential Voice: The Application Of Federal Confidentiality Law To Project Head Start, Richard C. Boldt

Michigan Law Review

This article focuses on one particular set of issues raised by the effort to coordinate the activities of Head Start centers with those of substance abuse treatment programs and the introduction of treatment and prevention functions into the daily interactions of Head Start staff and parents. These issues involve the disclosure of potentially damaging information about a Head Start parent's drug or alcohol abuse and the confidentiality considerations that arise when she or he has sought or received treatment for that abuse. Although it is possible to characterize these issues as technical, doctrinal questions of statutory and regulatory interpretation, it …

A Study In Regulatory Method, Local Political Cultures, And Jurisprudential Voice: The Application Of Federal Confidentiality Law To Project Head Start, Richard C. Boldt

Michigan Law Review

This article focuses on one particular set of issues raised by the effort to coordinate the activities of Head Start centers with those of substance abuse treatment programs and the introduction of treatment and prevention functions into the daily interactions of Head Start staff and parents. These issues involve the disclosure of potentially damaging information about a Head Start parent's drug or alcohol abuse and the confidentiality considerations that arise when she or he has sought or received treatment for that abuse. Although it is possible to characterize these issues as technical, doctrinal questions of statutory and regulatory interpretation, it …

Tales Of Two Cities: Aids And The Legal Recognition Of Domestic Partnerships In San Francisco And New York, David L. Chambers

Articles

Here are two stories. They are of the quite different ways that domestic partnerships of lesbian and gay couples have come to be recognized, for some purposes, in San Francisco and New York City. I tell the stories for their own sake, but with a particular focus on the role that AIDS played in the political process in each city.

The Theory And Practice Of Civil Commitment, Andrew Scull

Michigan Law Review

A Review of The Court of Last Resort: Mental Illness and the Law by Carol A.B. Warren, contributions by Stephen J. Morse and Jack Zusman

Regulation Through The Looking Glass: Hospitals, Blue Cross, And Certificate-Of-Need, Sallyanne Payton, Rhoda M. Powsner

Michigan Law Review

A clear focus on the commitment of the public health and hospital establishments to the large teaching hospital and their belief in rationalizing the health care system through community-based planning allows us to understand the ideas and institutions that have produced our present system of hospital regulation. It can also help us to understand the structure and behavior of the hospital industry and can illuminate current controversies over health care policy.

What follows is a narrative account of the development of regional planning and certificate-of-need legislation. As part of that story, we trace the evolution of the Blue Cross, explain …

Michigan's Nursing Home Reform Law, John D. Croll

University of Michigan Journal of Law Reform

This article examines Michigan's new nursing home reform law, which has been hailed as "landmark legislation" and as a model for the entire country. Part I examines the past failures of nursing home regulation and the need for reform. Part II analyzes the law's key provisions. Part III examines the weaknesses of certain enforcement measures. The article proposes the following improvements: (1) extension of the law's protection to residents of homes for the aged; (2) greater access to patients by approved organizations; (3) adoption of nurse-patient ratios; (4) improvement of inspection procedures; and (5) allowance for patients or their representatives …

Michigan's Revised Mental Health Code, William David Serwer

University of Michigan Journal of Law Reform

This note will evaluate the three chapters of the Michigan Code which present the most significant legislative attempts to safeguard the rights of the mentally ill. Chapter Four of the Code extends several traditional due process guarantees to the civil commitment process. By guaranteeing the right to adequate notice, the right to be present at the hearing, the right to be represented by counsel, and the right to notice of trial by jury, the Code offers better protection from unwarranted commitment. However, due to the difficulty of defining mental illness and accurately identifying those in need of treatment, the possibility …

New York's Revised Nursing Home Legislation, Michael G. Mcgee

University of Michigan Journal of Law Reform

This note undertakes an analysis of the extensive package of nursing home legislation recently enacted in New York. First, specific regulations will be examined in relation to problems they are designed to remedy. Next, the note critically appraises three key, innovative provisions, making recommendations for implementation or revision of each. Finally, the broad changes needed to bring about lasting improvement of nursing care are discussed and a summary of pending legislation is provided.

The Impact Of Michigan's Health Maintenance Organization Act, Roger Alan Petzke

University of Michigan Journal of Law Reform

Growing dissatisfaction with the shortcomings of the traditional system of health care has led to renewed interest in the Health Maintenance Organization (HMO) concept in recent years. Although some HMO's have been operating in the United States for over forty years, conditions have been less than favorable to their growth and development. Major obstacles have been opposition from the medical profession, lack of public understanding about the nature and function of HMO's, and state laws restricting or prohibiting the establishment of HMO's. In order to create a more favorable legal climate and encourage HMO development, a number of states, including …

Police Initiated Emergency Psychiatric Detention In Michigan, Mark F. Mehlman

University of Michigan Journal of Law Reform

While performing his duties a police officer may frequently be confronted with the behavior of an individual which threatens or has resulted in self-inflicted injury, or which poses an imminent threat to the safety of others. Under such circumstances an officer may determine that criminal arrest is inappropriate but that some form of restraint is necessary. Michigan has provided an alternative course of action by authorizing temporary emergency psychiatric detention of an individual whom a police officer deems to be "mentally ill and manifesting homicidal or other dangerous tendencies."

Mental Illness And Criminal Commitment In Michigan, Grant H. Morris

University of Michigan Journal of Law Reform

This article concentrates on one vital issue: to what extent are differences in treatment justified because of a mentally ill person's "criminal" involvement. While the article is primarily concerned with Michigan institutions and Michigan statutes, the discussion and the solutions proposed are in many respects applicable to all states of the Union. Not only must all states reevaluate their policies toward criminal commitment of the mentally ill in light of ever-changing medical and penal theory, but they must also consider the developing constitutional concepts in this area. These constitutional issues are raised here only to the extent necessary to alert …

The Language Of Involuntary Mental Hospitalization: A Study In Sound And Fury, Steven H. Levinson

University of Michigan Journal of Law Reform

Involuntary civil commitment is the business of hospitalizing and treating, without their consent, persons whom a court, with the aid of professional diagnosticians, determines to be psychologically disturbed or mentally ill. The purpose of the present study will be to demonstrate that the medical diagnoses of mental illness which justify involuntary civil commitment are achieved on the basis of at least unreliable and at worst invalid sets of diagnostic categories and assessments. For the purpose of determining the reliability of these diagnostic findings, the author selected a representative sample of the involuntary mental hospitalization proceedings of the Wayne County Probate …

Compulsory No-Fault Medical Insurance For Automobile Owners, William L. Schlosser

University of Michigan Journal of Law Reform

The enactment of the Massachusetts compulsory no-fault insurance bill, and Senator Phillip Hart's recent introduction of national no-fault insurance legislation, indicate the serious consideration no-fault insurance is receiving as a method of reforming the existing auto accident compensation system. The current tort system of recovery of auto accident medical expenses is inefficient, and, in many cases, does not adequately compensate the injured parties. Compulsory no-fault insurance is well suited to remedy these deficiencies. Under a no-fault insurance plan, benefits would be paid without regard to the question of fault; consequently, every accident victim would receive compensation without first having to …

Constitutional Law--Police Power--Michigan Statute Requiring Motorcyclists To Wear Protective Helmets Held Unconstitutional, Michigan Law Review

Michigan Law Review

The effects of the helmet decisions on the law in general may be substantial. On the one hand, if a helmet statute is held constitutional, inroads could be made upon personal liberty; the legislature might rely on similar strained and unproved relationships to the general welfare in order to justify regulations impinging upon other areas of individual conduct. On the other hand, to hold such a statute unconstitutional may require the judiciary to interfere unreasonably with the legislature's conception of public welfare. In light of these considerations, courts dealing with challenges to such regulations in the future should pay closer …

Constitutional Law - Substantive Due Process - Statute Prohibiting Use Of Contraceptives, Erik J. Stapper S.Ed.

Michigan Law Review

A Connecticut statute prohibits the use of contraceptives to prevent conception. Plaintiff-doctor sought a declaratory judgment to have the statute declared unconstitutional as an unreasonable restraint on his right to practice his profession inasmuch as his advice would render him an accessory to a violation of the statute. Three companion cases were also brought, one by a patient to whom another pregnancy would present serious danger, and two by married couples who could not give birth to normal children. The patients claimed that the statute deprived them of the doctor's best medical advice which would relieve them of a dangerous …

Physicians And Surgeons-Status Of Osteopaths-Limitations On Practice, Daniel W. Reddin, Iii S.Ed.

Michigan Law Review

Until recently, the osteopath has generally been given a limited license. The present status of the osteopath is best understood by a comparison with that of the unlimited practitioner. Though most of the statutes have been examined, this comment is based primarily upon those of Illinois, New York, Pennsylvania, Ohio, Michigan, California, Massachusetts and Indiana, which are fairly typical of the rest. These statutes vary widely in their provisions, but for the purposes of discussion, they have been treated in three arbitrary categories: (1) statutes in which the scope of the osteopath's license is considerably narrower than that of the …