Insurance Law Commons^™

The Benefits Of Opt-In Federalism, Brendan S. Maher

Faculty Scholarship

The Affordable Care Act (“ACA”) is a controversial and historic statute that mandates people make insurance bargains. Unacknowledged is an innovative mechanism ACA uses to select the law that governs those bargains: opt-in federalism.

Opt-in federalism – in which individuals choose between federal and state rules – is a promising theoretical means to make and choose law. This Article explains why, and concludes that the appeal of opt-in federalism is independent of ACA. Whatever the statute’s constitutional fate, future policymakers should consider opt-in federalist approaches to answer fundamental but exceedingly difficult questions of health and retirement law.

Commerce Games And The Individual Mandate, Leslie Henry, Maxwell Stearns

Maxwell L. Stearns

While the Supreme Court declined an early invitation to resolve challenges to the Patient Protection and Affordable Care Act (“PPACA”), a recent split between the United States Courts of Appeals for the Sixth Circuit (sustaining the PPACA’s “individual mandate”) and the Eleventh Circuit (striking it down) virtually ensures that the Court will decide the fate of this centerpiece of the Obama Administration’s regulatory agenda. Whatever the Court’s decision, it will likely affect Commerce Clause doctrine- and related doctrines - for years or even decades to come.

Litigants, judges, and academic commentators have focused on whether the Court’s “economic activity” tests, …

Commerce Games And The Individual Mandate, Leslie Meltzer Henry, Maxwell L. Stearns

Leslie Meltzer Henry

While the Supreme Court declined an early invitation to resolve challenges to the Patient Protection and Affordable Care Act (“PPACA”), a recent split between the United States Courts of Appeals for the Sixth Circuit (sustaining the PPACA’s “individual mandate”) and the Eleventh Circuit (striking it down) virtually ensures that the Court will decide the fate of this centerpiece of the Obama Administration’s regulatory agenda. Whatever the Court’s decision, it will likely affect Commerce Clause doctrine- and related doctrines - for years or even decades to come. Litigants, judges, and academic commentators have focused on whether the Court’s “economic activity” tests, …

Constitutionality Of The Patient Protection And Affordable Care Act Under The Commerce Clause And The Necessary And Proper Clause, Wilson Huhn

Akron Law Faculty Publications

The Patient Protection and Affordable Care Act is a comprehensive federal statute that attempts to extend health insurance coverage to tens of millions of Americans and to expand health insurance coverage by eliminating exclusions for preexisting conditions, increase medical loss ratios, abolish annual and lifetime limits, and other reforms. A necessary provision of this law (the individual mandate) requires most individuals to maintain health insurance coverage. The individual mandate has been challenged in a number of lawsuits on the ground that Congress lacks the power under the Constitution to require individuals to purchase health insurance. The power of Congress to …

Revenue-Cycle Management And Reimbursement: The Impact Of Health Law And Health Reform On Providers, Timothy D. Martin

Timothy D Martin

Healthcare payment systems are complex and difficult to administer. Over the years, providers have developed a complex process, called revenue-cycle management, for administering their interactions with payers operating under various payment systems. The Patient Protection and Affordable Care Act of 2010 will have a significant impact on payment systems—as will other recent reform measures. This paper contains primers on revenue-cycle management, health insurance systems, medical claims, claim coding, electronic-data interchange (EDI), claims processing, and public and private reimbursement methods for hospitals and physicians. But its focus is on the impact recent healthcare reform initiatives have had and are likely to …

Constitutionality Of The Patient Protection And Affordable Care Act Under The Commerce Clause And The Necessary And Proper Clause, Wilson Huhn

Wilson R. Huhn

The Patient Protection and Affordable Care Act is a comprehensive federal statute that attempts to extend health insurance coverage to tens of millions of Americans and to expand health insurance coverage by eliminating exclusions for preexisting conditions, increase medical loss ratios, abolish annual and lifetime limits, and other reforms. A necessary provision of this law (the individual mandate) requires most individuals to maintain health insurance coverage. The individual mandate has been challenged in a number of lawsuits on the ground that Congress lacks the power under the Constitution to require individuals to purchase health insurance. The power of Congress to …

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 …