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Full-Text Articles in Insurance Law
Health Care Fraud Means Never Having To Say You're Sorry, Jacob T. Elberg
Health Care Fraud Means Never Having To Say You're Sorry, Jacob T. Elberg
Washington Law Review
For decades, the Department of Justice (DOJ) has issued a steady flood of press releases announcing False Claims Act (FCA) settlements against health care entities and extolling the purportedly sharp message sent to the industry through these settlements about the consequences of engaging in wrongdoing. The FCA is the primary mechanism for government enforcement against health care entities engaged in wrongdoing, and it is expected to be DOJ’s key tool for addressing fraud arising out of government programs in response to the COVID-19 pandemic. DOJ has pointed to three key goals of its enforcement efforts (deterrence, incentivizing cooperation, and building …
Charting The Middle Course: An Argument For Robust But Well-Tailored Health Care Discrimination Protection For The Transgender Community, John E. Farmer
Charting The Middle Course: An Argument For Robust But Well-Tailored Health Care Discrimination Protection For The Transgender Community, John E. Farmer
Georgia Law Review
Section 1557 of the Patient Protection and Affordable
Care Act offers sweeping discriminationprotections for
patients, applicable to both health insurers and health
care providers who receive federal funding or are
subject to federal administration. Placing itself in the
canon of federal antidiscriminationlaws, Section 1557
incorporates Title IX of the Education Amendments of
1972 to prohibit discrimination on the basis of sex.
Just how sweeping this aspect of Section 1557s
prohibitions is has been the subject of controversy
exemplified in litigation in the federal courts, as well as
in the starkly contrasting views of two presidential
administrations. The Department of Health …
The Affordable Care Act, Experience Rating, And The Problem Of Non-Vaccination, Eric Esshaki
The Affordable Care Act, Experience Rating, And The Problem Of Non-Vaccination, Eric Esshaki
University of Michigan Journal of Law Reform Caveat
Polio, the whooping cough, and the mumps, among many other communicable diseases, were once prevalent in communities within the developed world and killed millions of people.1 The advent of vaccinations contained or eradicated several of these diseases.2 However, these diseases still exist in the environment3 and are making a comeback in the United States.4 Their persistence is directly attributable to the rising trend among parents refusing to vaccinate their children.5 One proposed solution to this problem is to hold parents liable in tort when others are harmed by their failure to vaccinate. Another proposed solution argues that parents should pay …
Court Of Appeals Of New York, Consumers Union Of United States, Inc. V. New York, Daphne Vlcek
Court Of Appeals Of New York, Consumers Union Of United States, Inc. V. New York, Daphne Vlcek
Touro Law Review
No abstract provided.
Building A Better Laboratory: The Federal Role In Promoting Health System Experimentation, Kristin Madison
Building A Better Laboratory: The Federal Role In Promoting Health System Experimentation, Kristin Madison
Pepperdine Law Review
While expanding federal involvement in the health care system, the Patient Protection and Affordable Care Act (ACA) preserves states' roles as policy laboratories and private providers' roles as health care delivery laboratories. State-based and provider-based laboratories suffer from many shortcomings, however, as mechanisms to develop, evaluate, and facilitate diffusion of reforms within the health system. This Article argues that the federal government can take steps to address these shortcomings. It first briefly reviews ACA provisions that promote policy and delivery experimentation. It then suggests that by tying funding to policy outcomes, making use of regulatory variation and regulatory menus, and …
Comparative Effectiveness Research As Choice Architecture: The Behavioral Law And Economics Solution To The Health Care Cost Crisis, Russell Korobkin
Comparative Effectiveness Research As Choice Architecture: The Behavioral Law And Economics Solution To The Health Care Cost Crisis, Russell Korobkin
Michigan Law Review
With the Patient Protection and Affordable Care Act (“ACA”) set to dramatically increase access to medical care, the problem of rising costs will move center stage in health law and policy discussions. “Consumer directed health care” proposals, which provide patients with financial incentives to equate marginal costs and benefits of care at the point of treatment, demand more decisionmaking ability from consumers than is plausible due to bounded rationality. Proposals that seek to change the incentives of health care providers threaten to create conflicts of interest between doctors and patients. New approaches are desperately needed. This Article proposes a government-facilitated …
The Independent Medicare Advisory Committee: Death Panel Or Smart Governing?, Robert Coleman
The Independent Medicare Advisory Committee: Death Panel Or Smart Governing?, Robert Coleman
Journal of the National Association of Administrative Law Judiciary
No abstract provided.
An Insurance Structure To Encourage Investment In Preventative Health Care, Nicholas Georgakopoulos
An Insurance Structure To Encourage Investment In Preventative Health Care, Nicholas Georgakopoulos
University of Michigan Journal of Law Reform
The incentives for investments in Americans' health are poorly aligned. Health insurers are not sufficiently motivated to invest for the long term. The structure of health insurance does not compensate insurers for investments in lasting health, such as measures preventing chronic disease. If an American changes insurers, the new insurer reaps the benefits of the good health the prior insurer's investment produced. This Essay explores insurers' incentives to invest in health, illustrates how those incentives fail, explores possible improvements, and shows that subsequent insurers should have an obligation to compensate the prior insurer for the averted expenses of expected diseases …
Access To Medicaid: Recognizing Rights To Ensure Access To Care And Services, Colleen Nicholson
Access To Medicaid: Recognizing Rights To Ensure Access To Care And Services, Colleen Nicholson
University of Michigan Journal of Law Reform Caveat
The Supreme Court has defined Medicaid as “a cooperative federal-state program through which the Federal Government provides financial assistance to States so that they may furnish medical care to needy individuals.” In June 2012, the Court found the Patient Protection and Affordable Care Act’s (PPACA) Medicaid expansion unconstitutional. The Court took issue with the threat to withhold all of a state’s Medicaid funding if they did not comply with the expansion, finding it coercive and a fundamental shift in the Medicaid paradigm. However, Medicaid in its current form may not always be effective at providing beneficiaries with timely access to …
Re-Thinking Health Insurance, Hans Biebl
Re-Thinking Health Insurance, Hans Biebl
University of Michigan Journal of Law Reform Caveat
In May 2009, while promoting the legislation that would become the Patient Protection and Affordable Care Act (PPACA), President Obama said that rising health care costs threatened the balance sheets of both the federal government and private enterprise. He noted that any increase in health care spending consumes funds that “companies could be using to innovate and to grow, making it harder for them to compete around the world.” Despite the rancorous debate that surrounded this health care legislation and which culminated with the Supreme Court’s decision in National Federation of Independent Businesses, the PPACA was not a radical piece …
Crisis On Campus: Student Access To Health Care, Bryan A. Liang
Crisis On Campus: Student Access To Health Care, Bryan A. Liang
University of Michigan Journal of Law Reform
College-aged adults are an overrepresented group in the uninsured population of the United States, and traditionally underserved minorities are disproportionately affected. Students with private health insurance are often functionally uninsured as well, since most schools refuse to accept this traditionally elite calling card on campus. Consequently, the large uninsured and functionally uninsured populations often rely on school-sponsored health insurance plans for access to care. These plans have uneven coverage, limited benefits, exclusions and high co-pays and deductibles, and provide little health care security for their beneficiaries. Further, schools and insurance companies have profited substantially from these student plans, raising the …
Whom Would Jesus Cover - A Biblical, Ethical Lens For The Contemporary American Health Care Debate, Jeffrey R. Baker
Whom Would Jesus Cover - A Biblical, Ethical Lens For The Contemporary American Health Care Debate, Jeffrey R. Baker
Journal of Law and Health
This paper attempts a view of the contemporary health care debate in America through the prism of Biblical scripture and proposes that people of faith should recognize the current state of the American health care system as a moral crisis of justice and charity. First, I provide a survey of the current state of American health care for the uninsured, describing the demographic and economic circumstances of the uninsured and the resources available to them when they need medical care. Second, I ask whether, in light of scripture, this state of affairs presents a moral question that should drive our …
Universal Health Care, American Pragmatism, And The Ethics Of Health Policy: Questioning Political Efficacy, Daniel S. Goldberg
Universal Health Care, American Pragmatism, And The Ethics Of Health Policy: Questioning Political Efficacy, Daniel S. Goldberg
The University of New Hampshire Law Review
[Excerpt] “This article will explore the conceptual implications of applying ethical critique and analysis to health policy. This is not to imply any reductionist conception of health policy in which ethics is absent. As Deborah Stone and John W. Kingdon both note, policy is fraught with ethical implications, and value prioritization is a sine qua non for health policy. Nevertheless, I wish to suggest that there are some conceptually significant distinctions in thinking of the ethics of health policy as opposed to thinking separately about ethics and about health policy. Moreover, these distinctions themselves are of value, both in thinking …
Consumer-Directed Health Care And The Chronically Ill, John V. Jacobi
Consumer-Directed Health Care And The Chronically Ill, John V. Jacobi
University of Michigan Journal of Law Reform
Insurance plans with consumer-controlled spending accounts are advocated as tools for reducing health costs and empowering consumers. This Article describes their recent development and argues that they are likely to fail. Instead of focusing on the small number of consumers with chronic illnesses who account for the bulk of health spending they focus on the majority of relatively well consumers. This Article proposes market-based and regulatory changes focused on high-cost patients. To best serve cost and quality goals, health finance responsibility should be divided between consumers and their employers for predictable and routine costs, and government for chronic and catastrophic …
Health Care Law, Peter M. Mellette, Emily W. G. Towey, J. Vaden Hunt
Health Care Law, Peter M. Mellette, Emily W. G. Towey, J. Vaden Hunt
University of Richmond Law Review
No abstract provided.
Managed Care- The First Chapter Comes To A Close, Sallyanne Payton
Managed Care- The First Chapter Comes To A Close, Sallyanne Payton
University of Michigan Journal of Law Reform
Introduction to the symposium, Managed Care: What's the Prognosis: Managing Care in the Next Century.
Clearing The Way For An Effective Federal-State Partnership In Health Reform, Eleanor D. Kinney
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 …
Managed Care Regulation: Can We Learn From Others? The Chilean Experience, Timothy Stoltzfus Jost
Managed Care Regulation: Can We Learn From Others? The Chilean Experience, Timothy Stoltzfus Jost
University of Michigan Journal of Law Reform
Because the United States relies on private insurance for financing health care to a much greater degree than do other nations, and because managed care as a form of private insurance is further developed in the United States than elsewhere, it is arguable that we have little to learn from other nations about managed care regulation. This Article tests this hypothesis with respect to Chile, a country where private insurance is widespread and managed care is emerging. It concludes that by studying the experience of other nations we might gain a larger perspective on the context of our concerns in …
The Competitive Impact Of Small Group Health Insurance Reform Laws, Mark A. Hall
The Competitive Impact Of Small Group Health Insurance Reform Laws, Mark A. Hall
University of Michigan Journal of Law Reform
This Article reports on findings from an extensive study of small group health insurance market reforms in seven states, enacted during the early 1990s. After summarizing the content and purpose of these reforms, this evaluation focuses on the impact these reforms have had on the nature and degree of market competition. The principal findings are: (1) small group health insurance markets are highly competitive, both in price and in product innovation and diversity; (2) although some insurers have left some or all of these states in part because of these reforms, an ample number of active competitors remain, even in …
Chicago Hope Meets The Chicago School, Gail B. Agrawal
Chicago Hope Meets The Chicago School, Gail B. Agrawal
Michigan Law Review
Twenty-five years after the enactment of the Federal Health Maintenance Organization Act and nearly five years after the failure of proposed federal health care reform, managed care has come to dominate the medical marketplace. As a result, the relationships among patients, payers, and physicians have changed fundamentally and dramatically. In this market-driven environment, health care - how much it costs, who receives treatment, and who pays for it - may have surpassed the weather as a topic of everyday conversation at dinner tables and water coolers across the country. In the popular press, reports concerning managed care, usually derogatory, are …
Democratizing Hmo Regulation To Enforce The "Rule Of Rescue", Kent G. Rutter
Democratizing Hmo Regulation To Enforce The "Rule Of Rescue", Kent G. Rutter
University of Michigan Journal of Law Reform
Despite heightened public concern about HMOs, misguided regulatory measures have not guaranteed HMO patients access to the treatment options many consider vital. This Note recommends four changes to the current regulatory system that would preserve HMOs' ability to control health care costs while allowing patients and doctors, rather than lawmakers or HMO administrators, to set health care priorities.
The Medicaid Cost Crisis: Are There Solutions To The Financial Problems Facing Middle-Class Americans Who Require Long-Term Health Care, Kenneth Hubbard
The Medicaid Cost Crisis: Are There Solutions To The Financial Problems Facing Middle-Class Americans Who Require Long-Term Health Care, Kenneth Hubbard
Cleveland State Law Review
Medicaid was originally designed as a welfare program to provide healthcare to the poor. Despite the initial intentions of Congress, Medicaid has instead become "a multi-billion-dollar insurance policy" for elderly middle-class Americans who require long-term health care. The Medicaid crisis has been described as "a battle between elderly people's desire for long-term care coverage and their concomitant reluctance to pay for it themselves." This battle is waged between the older and younger generations, commencing when the younger generation observes that their inheritance is growing smaller or disappearing altogether due to the immense cost of their parents' long-term health care.
Regulation Through The Looking Glass: Hospitals, Blue Cross, And Certificate-Of-Need, Sallyanne Payton, Rhoda M. Powsner
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 …
The Impact Of Michigan's Health Maintenance Organization Act, Roger Alan Petzke
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 …
A Proposed Cure For The Intervention Blues, Lawrence E. Hard
A Proposed Cure For The Intervention Blues, Lawrence E. Hard
University of Michigan Journal of Law Reform
This article does not purport to provide a study of the doctrine of subrogation and the merits of that doctrine in the context of insurance coverage. There are several difficult questions which could be raised as to the proper role of subrogation in insurance litigation. This article assumes the propriety of extending the right of subrogation to the type of medical and hospital payment plans offered by the Services and analyses the device of intervention as a method of enforcing the Services' right to contractual subrogation.
Non-Profit Hospital Service Plans, Leo A. Simpson
Non-Profit Hospital Service Plans, Leo A. Simpson
Cleveland State Law Review
Hospital service plans fulfill a vital social need. In view of the continuing support and apparently expanding activities of the plans, it is well to understand their legal nature. At the present time problems are arising that could not have been foreseen 25 years ago. The favorable treatment which hospital service plans have received under the law should be continued so long as the plans continue realistically to meet these problems as they have in the past.