Insurance Law Commons^™

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, …

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 …

Daedalean Tinkering, Sean J. Griffith

Michigan Law Review

Part I of this Review describes Skeel's account of corporate scandal, focusing on the central theme of excessive risk-taking. Part II examines Skeel's most original policy proposal-the creation of an investor insurance scheme to protect against excessive risk. Although the proposal takes up only a few pages of the book, it targets the books' core concern-the risk of corporate fraud. In evaluating the proposed investor insurance regime, this Review raises a set of objections based on cost and administrability and argues that an insurance regime would be duplicative of existing mechanisms that effectively spread the risk of financial fraud. Part …

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 …

The Nonprofit Health Care Corporation Reform Act Of 1980, David L. Hollister, Patience A. Drake

University of Michigan Journal of Law Reform

In recent years, Blue Cross/Blue Shield has been the subject of considerable controversy. Its critics charge the non-profit, tax-exempt corporation with being unduly secretive, arrogantly unresponsive to consumer interest and not vigorous in its cost containment efforts. These criticisms, along with a variety of other factors, led to the legislative reform I am here to talk to you about this evening.

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 …

No-Fault Auto Reparation In Florida: An Empirical Examination Of Some Of Its Effects, Joseph W. Little

University of Michigan Journal of Law Reform

This article discusses certain aspects of reparations systems that can be described by statistical parameters, but it does not attempt to evaluate whether or not pervasive sociological changes may result from legal modifications of the concept of fault. It may be that any erosion of fault as a legal concept will result in a decline in individual responsibility. The fact that some members of the bar and some members of the medical profession allegedly regularly engage in conspiracies to defeat the $1,000 medical expense threshold of the Florida statute could be cited as evidence of such deterioration. Nevertheless, this writer …

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 …

Due Process Problems Of Property Damage No-Fault Insurance, Stephen L. Jones

University of Michigan Journal of Law Reform

Michigan, Florida, and Massachusetts have recently enacted automobile property damage no-fault legislation. Similar to the concept of personal injury no-fault plans, the property damage legislation bars tort recovery for damage to vehicles involved in collisions and substitutes a system of insurance protection that would compensate the vehicle's owner for these losses without regard to fault. There are, however, two essential differences between the property damage and personal injury proposals. First, because property damage claims have been minor as compared to those for personal injuries, the property damage proposals have permitted the vehicle owner to self-insure for the former losses by …

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 …

Insurance-State Regulation-Surplus Line Insurance, James C. Lockwood S.Ed.

Michigan Law Review

Plaintiff, a New York corporation doing business in Texas, purchased insurance covering risks located in Texas from insurers not licensed to do business in that state. The entire insurance transaction was consummated outside Texas, and any adjustment for losses was to be made outside the state. Pursuant to a Texas statute, plaintiff was taxed an amount equal to five percent of its gross premiums. Plaintiff instituted the present suit in a state court in Texas to recover the tax, which had been paid under protest. The trial court's decision for plaintiff was affirmed by the court of civil appeals, and …

Insurance-State Regulation-Unauthorized Insurers False Advertising Process Act, Chester A. Skinner

Michigan Law Review

Recent Illinois legislation subjects foreign insurers who are not authorized to do business in Illinois and who circulate false advertising there to the jurisdiction of the state courts and the State Insurance Commissioner. When the Insurance Commissioner is informed of false or misleading advertising, he is to notify the supervisory insurance official of the domicile state of the foreign insurer. If this notice does not result in the cessation of the activity, the Commissioner may proceed against the insurer under the state's Unfair Trade Practice Act. Since the typical mail order insurer will not have agents or property within the …

Insurance-Regulation Under The Mccarran-Ferguson Act-Ftc Jurisdiction Not Ousted By A State Statute Proporting To Control Deceptive Advertising Mailed To Other States, Thomas D. Heekin

Michigan Law Review

Petitioner issued a cease-and-desist order prohibiting respondent from making statements in its advertising materials which violated the Federal Trade Commission Act. Respondent, a Nebraska health insurance company, mailed its circulars to residents of every state. The McCarran-Ferguson Act provides that "the Federal Trade Commission Act ... shall be applicable to the business of insurance to the extent that such business is not regulated by State law." A Nebraska statute prohibits an insurer domiciled there from engaging in unfair business practices in any state. In an action to set aside the FTC cease-and-desist order, the Court of Appeals for the Eighth …

Comparative Negligence And Automobile Liability Insurance, Cornelius J. Peck

Michigan Law Review

The purpose of this article is not to re-plow the ground of history, case law, and statutory developments which has been so competently tilled by others. Nor is the purpose to give a detailed consideration of each of the practical matters mentioned above. Instead, the focus of this article is on the relationship between comparative negligence and automobile liability insurance. Insurance rates and accident statistics, rather than rules of law and cases, are the primary materials. Such a consideration of the subject it might be hoped would give a positive and substantiated answer to the frequently debated but never documented …

Insurance - Regulation - The Extraterritorial Effect Of Insurance Regulation, With Particular Emphasis On New York, Bartlett A. Jackson S.Ed.

Michigan Law Review

The past fifteen years have seen extensive examination of the process of regulation of the insurance industry. The recognition that insurance is interstate commerce has caused a reappraisal of the traditional system of state regulation. This examination has been primarily oriented toward determining whether diverse regulation by the various states is adequate in the light of the possibility of centralized federal control.

Inheritance Taxation - Selected Provisions Of Michigan, Illinois And Ohio - A Study In Application And Justification, Edward B. Stulberg S.Ed.

Michigan Law Review

This comment will explore the existing variations in four commonly encountered areas: joint interests with rights of survivorship, contingent remainder interests, powers of appointment, and life insurance proceeds. Emphasis will also be placed on treatment accorded the surviving spouse and children and the implicit relationship between such treatment and some of the above areas. The essence of this examination will be to inquire whether adoption of an estate tax would be a more suitable vehicle for implementing a local death tax program.

The Adequacy Of State Insurance Rate Regulation: The Mccarran-Ferguson Act In Historical Perspective, Spencer L. Kimball, Ronald N. Boyce

Michigan Law Review

Any substantial inquiry into the functioning of the insurance commissioner in American society poses the question, at the threshold of the inquiry, whether state regulatory power over the insurance business is likely to continue, or whether insurance will fall increasingly under the aegis of the federal government. This article seeks to ascertain the minimum conditions for the permanent preservation of state regulatory power over the insurance business, and to determine whether they are now satisfied. These conditions may be summarily stated: the Congress of the United States has shown its willingness to apply federal antitrust and marketing legislation to the …

Municipal Corporations - Tort Liability - Purchase Of Liability Insurance As Waiver Of Immunity, Alice Austin S.Ed., William C. Becker

Michigan Law Review

According to a well-established common law rule, a municipal corporation is immune to tort liability for wrongs committed in the performance of governmental or public functions, although it is liable for torts committed in the performance of corporate or proprietary functions. This immunity generally cannot be waived without the authorization of the state legislature, and this authorization must be very clearly stated. Interesting questions arise, therefore, when a municipality, with or without statutory authorization, takes out a liability insurance policy covering itself or its agents, or when it causes its agents to take out bonds for faithful performance. The questions …

Admiralty - Constitutional Law - Effect Of State Regulation Of Marine Insurance On Uniformity Of Maritime Law, Charles G. Williamson, Jr. S.Ed.

Michigan Law Review

Petitioner's houseboat, used to transport passengers commercially on a lake between Texas and Oklahoma, was insured against fire and other loss by respondent. Following destruction of the boat by fire, respondent denied liability because of breaches of policy warranties against assignment, pledging, transferring, and use for hire. The petitioner's action was brought in the state court and removed to a federal court because of diversity of citizenship. Texas statutes provide that breaches of policy provisions by the insured are no defense unless the breach contributes to the loss, and that provisions in policies against pledging are invalid. Petitioner contended that …

Municipal Corporations - Waiver Of Immunity To Suit By Purchase Of Liability Insurance, Chester F. Relyea S.Ed.

Michigan Law Review

The City of Knoxville owned and operated a municipal airport under authority of a state statute which permitted a municipality to acquire, maintain, and operate a municipal airport in its governmental capacity, and which barred suits against the municipality with respect to its operation of the airport. The city carried a policy of liability insurance covering it in the ownership and operation of the airport. Plaintiff was injured by a fall at the airport terminal building, and instituted a negligence action against the city. The city moved for dismissal, relying upon the immunity given it by the statute. Held, …

Insurance-Conditions-Effect Of Non-Compliance With Notice Clause On Insurer's Liability, John W. Hupp S.Ed.

Michigan Law Review

Automobile liability insurance policies invariably contain a provision requiring immediate notice of accident and suit. The purpose of such a provision is to allow the insurer to make an investigation of the accident in order to prepare a defense and to prevent fraudulent and invalid claims. Although compliance with the provision may be of the utmost importance to the insurer, it frequently is a matter of little or no concern to the insured, and so upon the happening of an accident the insured frequently fails to give due notice to the insurer. The succeeding action by the injured party against …

Constitutional Law-Interstate Commerce-Congressional Consent To Discriminatory State Taxation, George Brody S.Ed.

Michigan Law Review

South Carolina statutes imposed upon foreign insurance companies a tax of 3 per cent of the aggregate premiums received from business done within the state, without reference to its interstate or local character, as a condition to receiving a certificate of authority to do business within the state. No similar tax was imposed upon domestic insurance companies. The Prudential Life Insurance Company, a New Jersey corporation doing business in South Carolina, refused to pay, contending that since it was a discriminatory tax it was unconstitutional. Furthermore, Prudential challenged the power of Congress to consent to the levying of such discriminatory …

Is The Business Of Insurance Commerce? A Re-Examination In The Light Of Modern Times, Nathan R. Berke

Michigan Law Review

A question of considerable import which has arisen time and again in recent years, particularly since the enactment of the various federal regulatory acts within the past decade, is whether the business of insurance is commerce. Although not a new question, and by no means unanswered by the courts, it has been a subject of recent reconsideration and in all probability will be reviewed by the United States Supreme Court.

Constitutional Law - Due Process Limitations On Statutes Regulating Extrastate Contracts, Michigan Law Review

Michigan Law Review

Plaintiffs, reciprocal insurance associations which insure against fire and related risks, and whose attorneys-in-fact are located in Illinois, brought a declaratory judgment action in New York state courts for a determination of the applicability to them of the New York law requiring that such co-operative insurance associations obtain a license, or be prohibited from doing "any act which effects, aids or promotes the doing of an insurance business" in New York. As a condition of the license, submission to the New York regulations is required. The activities of the associations within the state of New York include investigation by engineers …

Insurance - Insurable Interest In Life - Right Of Insured To Designate Beneficiary Without Insurable Interest, William D. Sutton

Michigan Law Review

The Metropolitan Life Insurance Company issued a group insurance policy in the sum of $500 upon the life of appellant's husband. The husband paid all the premiums and designated a niece, appellee, the beneficiary therein. Several years prior to the issuance of the policy appellant had ceased to live with the insured, although a divorce had never been obtained. Appellant contested the recovery of the proceeds by appellee on the ground that said niece had no insurable interest in the life of insured. Held, judgment of the trial court awarding proceeds to appellee affirmed, on the ground that appellee …

Insurance - Right Of Insurer Against An Insured Who Has Released The Tortfeasor After Receiving Payment From The Insurer, James A. Lee

Michigan Law Review

Plaintiff insured the defendant against loss on his car due to collision, paid its liability when the defendant's car was damaged by a third party, and took an assignment of plaintiff's claim against the third party to that extent. Defendant then released the third party from liability and plaintiff brought this action to recover the amount paid to the defendant. Held, plaintiff could recover from defendant only for the loss it had sustained by the release, and since plaintiff had failed to prove it could have recovered anything from defendant, it had shown no cause of action. Century Ins. …

Bankruptcy-Corporate Reorganization - Fraternal Benefit Society Entitled To Benefits Of Section 77b, Russel T. Walker

Michigan Law Review

Plaintiff's right to petition for reorganization under section 77 B of the Bankruptcy Act was challenged on the ground that plaintiff was an "insurance corporation" within the meaning of section 4 of the Bankruptcy Act and therefore excepted from the benefits of the act. Held, that when Congress used the words "insurance corporation" in the Bankruptcy Act, it meant a corporation authorized by the law of its creation to do an insurance business. As Congress knew that the various States had authorized the formation of fraternal benefit societies, described as such in enabling statutes, when Congress passed this statute …

Insurance - Supervision By The State - What Constitutes The Insurance Business, Thomas E. Wilson

Michigan Law Review

Plaintiff, a corporation, advertised that any person who bought goods from certain selected stores would be entitled to receive coupons, and when his coupons amounted to a certain sum he would be entitled to certain death and security benefits up to specified amounts. Plaintiff brought suit against the Insurance Commissioner of Pennsylvania to enjoin him from interfering with the plaintiff's business. Held, that the plaintiff was carrying on an insurance business and was subject to supervision by the Insurance Commissioner. Hunt v. Public Mutual Benefit Foundation, (C. C. A. 3d, 1938) 94 F. (2d) 749, certiorari denied (U. …

Constitutionality Of Teachers' Pensions Legislation Ii:The Validity Of The Proposed Michigan Law, Continued, Horace L. Wilgus

Michigan Law Review

We considered the constitutionality of Sections I, and II, of the proposed act in the former paper.

Constitutionality Of Teachers' Pensions Legislation Ii: The Validity Of The Proposed Michigan Law, Horace L. Wilgus

Michigan Law Review

In the preceding paper, we considered pension legislation in general -- its extent, forms, purpose, and relation to the taxing power of the state and nation. It is proposed in this paper to discuss in detail the provisions of the proposed Michigan teachers' pension law in the light of the general principles, set forth in the former paper, with reference to specific constitutional provisions, and the decisions of the courts upon-the validity of pensions for firemen and policemen which are similar in many respects to teachers' pension systems, together with such decisions as have been made concerning the constitutionality of …