Open Access. Powered by Scholars. Published by Universities.®
- Discipline
- Institution
- Publication
- Publication Type
Articles 1 - 8 of 8
Full-Text Articles in Insurance Law
Health Insurance, Risk, And Responsibility After The Patient Protection And Affordable Care Act, Tom Baker
Health Insurance, Risk, And Responsibility After The Patient Protection And Affordable Care Act, Tom Baker
All Faculty Scholarship
This essay explores the new social contract of healthcare solidarity through private ownership, markets, choice, and individual responsibility embodied in the Patient Protection and Affordable Care Act. This essay first explains the four main health care risk distribution institutions affected by the Act – Medicare, Medicaid, the individual and small employer market, and the large group market – with an emphasis on how the Act changes those institutions and how they are financed. The essay then describes the “fair share” approach to health care financing embodied in the Act. This approach largely rejects the actuarial fairness vision of what constitutes …
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
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 …
A Cautious Path Forward On Accountable Care Organizations, Barak D. Richman, Kevin A. Schulman
A Cautious Path Forward On Accountable Care Organizations, Barak D. Richman, Kevin A. Schulman
Faculty Scholarship
The wave of new Accountable Care Organizations (ACOs), spurred by financial incentives in the Affordable Care Act, could become the latest chapter in the steady accumulation of market power by hospitals, health care systems, and physician groups. The main purpose behind forming many ACOs may not be to achieve cost savings but instead to strengthen negotiating power over purchasers in the private sector. This would be an unfortunate sequel to the waves of mergers in the 1990s when health care entities sought to counter market pressure from managed care organizations. The possibility that ACOs might further concentrate health care markets …
The Provider-Monopoly Problem In Health Care, Clark C. Havighurst, Barak D. Richman
The Provider-Monopoly Problem In Health Care, Clark C. Havighurst, Barak D. Richman
Faculty Scholarship
Although federal judges have resisted giving due effect to standard antitrust principles in scrutinizing mergers of nonprofit hospitals, the presence of health insurance makes it especially important to oppose monopoly in health services markets. U.S.-style health insurance gives monopolist providers extraordinary pricing freedom, thus exacerbating monopoly’s usual redistributive effects. Significant allocative inefficiencies - albeit not the kind generally associated with monopoly - also result when the monopolist is a nonprofit hospital. Because it is probably impossible to undo past hospital mergers creating undue market power, we suggest some alternative remedies. One is to apply antitrust rules against "tying" arrangements so …
Four Constitutional Limits That The Minimum Coverage Provision Respects, Neil S. Siegel
Four Constitutional Limits That The Minimum Coverage Provision Respects, Neil S. Siegel
Faculty Scholarship
Opponents of the minimum coverage provision in the Affordable Care Act charge that if Congress can require most people to obtain health insurance or pay a certain amount of money, then Congress can impose whatever mandates it wishes—or, at least, whatever purchase mandates it wishes. This Essay refutes that claim by identifying four limits on the Commerce Clause that the minimum coverage provision honors. Congress may not use its commerce power: (1) to regulate noneconomic subject matter; (2) to impose a regulation that violates constitutional rights, including the right to bodily integrity; (3) to regulate at all, including by imposing …
Why It's Called The Affordable Care Act, Nicholas Bagley, Jill R. Horwitz
Why It's Called The Affordable Care Act, Nicholas Bagley, Jill R. Horwitz
Articles
The Patient Protection and Affordable Care Act of 2010 (“ACA”) raises numerous policy and legal issues, but none have attracted as much attention from lawyers as Section 1501. This provision, titled “Maintenance of Mini-mum Essential Coverage,” but better known as the “individual mandate,” requires most Americans to obtain health insurance for themselves and their dependents by 2014. We are dismayed that the narrow issue of the mandate and the narrower issue of free riding have garnered so much attention when our nation’s health-care system suffers from countless problems. By improving quality, controlling costs, and extending coverage to the uninsured, the …