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Health Care's Market Bureaucracy, Allison K. Hoffman 2019 University of Pennsylvania Law School

Health Care's Market Bureaucracy, Allison K. Hoffman

Faculty Scholarship at Penn Law

The last several decades of health law and policy have been built on a foundation of economic theory. This theory supported the proliferation of market-based policies that promised maximum efficiency and minimal bureaucracy. Neither of these promises has been realized. A mounting body of empirical research discussed in this Article makes clear that leading market-based policies are not efficient — they fail to capture what people want. Even more, this Article describes how the struggle to bolster these policies — through constant regulatory, technocratic tinkering that aims to improve the market and the decision-making of consumers in it — has produced a massive ...


The Impact Of H.B. 214: A Critical Analysis Of The Texas "Rape Insurance" Bill, Lucie Arvallo 2019 St. Mary's University School of Law

The Impact Of H.B. 214: A Critical Analysis Of The Texas "Rape Insurance" Bill, Lucie Arvallo

St. Mary's Law Journal

Texas House Bill 214 (H.B. 214) is subject to challenge under the Supreme Court precedent protecting a woman’s right to choose. Passed in 2017, H.B. 214 regulates Texas insurance markets by prohibiting coverage for an elective abortion unless a woman affirmatively opts into such coverage through a separate contract and pays a separate premium. Similar restrictions on insurance coverage for elective abortion in other states have been met with mixed results in the courts. What sets H.B. 214 apart from other regulations of insurance coverage for abortion is that it does not include any exceptions for ...


An Implied Defense: Self-Disclosure Offers A Defense To The Expanded False Claims Liability After Universal Health Services V. Escobar, Megan E. Italiano 2019 College of William & Mary Law School

An Implied Defense: Self-Disclosure Offers A Defense To The Expanded False Claims Liability After Universal Health Services V. Escobar, Megan E. Italiano

William & Mary Law Review

No abstract provided.


Dual Regulation Of Insurance, Christopher C. French 2019 Villanova University Charles Widger School of Law

Dual Regulation Of Insurance, Christopher C. French

Villanova Law Review

No abstract provided.


The Practice And Tax Consequences Of Nonqualified Deferred Compensation, David I. Walker 2019 Boston University School of Law

The Practice And Tax Consequences Of Nonqualified Deferred Compensation, David I. Walker

Washington and Lee Law Review

Although nonqualified deferred compensation plans lack explicit tax preferences afforded to qualified plans, it is well understood that nonqualified deferred compensation results in a joint tax advantage when employers earn a higher after-tax return on deferred sums than employees could achieve on their own. But the joint tax advantage depends critically on how plans are operated; chiefly how plan sponsors use or invest deferred compensation dollars. This is the first Article to systematically investigate nonqualified deferred compensation practices. It shows that joint tax minimization historically has taken a backseat to accounting priorities and participant diversification concerns. In recent years, the ...


Table Of Contents, Seattle University Law Review 2019 Seattle University School of Law

Table Of Contents, Seattle University Law Review

Seattle University Law Review

No abstract provided.


The Failed Promise Of Mental Health Parity In Virginia: A Missing Key In Mental Healthcare Access, Zachary Woerner 2019 College of William & Mary Law School

The Failed Promise Of Mental Health Parity In Virginia: A Missing Key In Mental Healthcare Access, Zachary Woerner

William & Mary Business Law Review

For those who suffer from the most serious mental illnesses, access to mental healthcare is critically important, but often frustrated by a Byzantine insurance system. The goal of this Note is to sift through the various mental health insurance parity laws, both nationally and statewide, and determine where this system breaks down. The Note will argue that lack of enforcement of parity laws plays a critical role in much of the dysfunction in the marketplace.

Legislation in Virginia and elsewhere is not always deficient on its face. Instead, laws critically lack regulators willing or able to implement them. This creates ...


Insurance Appraisal In Texas And Its Place In Coverage Litigation, Brendan K. McBride, William J. Chriss, Matthew R. Pearson 2019 McBride Law Firm

Insurance Appraisal In Texas And Its Place In Coverage Litigation, Brendan K. Mcbride, William J. Chriss, Matthew R. Pearson

St. Mary's Law Journal

Insurance appraisal is a contractually agreed process for resolving a disagreement between the insurance carrier and the policyholder about the amount of a loss under an insurance policy. Appraisal clauses have been a feature of insurance policies in Texas for well over a century. Old Texas cases were uniform to the effect that appraisal was a method to establish the “amount” of the loss under circumstances where coverage was not in dispute, but a recent line of cases has allowed insurers to escape liability for breach of contract, attorneys’ fees, statutory and common law “bad faith,” and even liability under ...


Advancing The Aquaculture Industry Through The Federal Crop Insurance Program, Matthew H. Bowen 2019 University of Maine School of Law

Advancing The Aquaculture Industry Through The Federal Crop Insurance Program, Matthew H. Bowen

Ocean and Coastal Law Journal

In recent times, the aquaculture industry has experienced dramatic growth. The growth of the industry is a direct result of an increase in demand for seafood, and a decrease in supply from wild fisheries. The industry, however, is also experiencing growing pains. Aquaculture species, compared to their wild counterparts, are at a higher risk of catastrophic loss from a variety of different perils. These perils make investment in the aquaculture industry significantly risky. The federal crop insurance program could be a tool that mitigates these risks, but the program was designed around terrestrial agriculture, and while aquaculture may be covered ...


The Deterrence Case For Comprehensive Automaker Enterprise Liability, Kyle D. Logue 2019 University of Michigan Law School

The Deterrence Case For Comprehensive Automaker Enterprise Liability, Kyle D. Logue

Journal of Law and Mobility

This Article lays out the potential (at this point purely theoretical) deterrence benefits of replacing our current auto tort regime (including auto products liability law, driver-based negligence claims, and auto no-fault regimes) with a single, comprehensive automaker enterprise liability system. This new regime would apply not only to Level 5 vehicles, but to all automobiles made and sold to be driven on public roads. Because such a system would make automakers unconditionally responsible for the economic losses resulting from any crashes of their vehicles, it would in effect make automakers into auto insurers as well, although such a change will ...


How Liability Insurers Protect Patients And Improve Safety, Tom Baker, Charles Silver 2019 University of Pennsylvania Law School

How Liability Insurers Protect Patients And Improve Safety, Tom Baker, Charles Silver

Faculty Scholarship at Penn Law

Forty years after the publication of the first systematic study of adverse medical events, there is greater access to information about adverse medical events and increasingly widespread acceptance of the view that patient safety requires more than vigilance by well-intentioned medical professionals. In this essay, we describe some of the ways that medical liability insurance organizations contributed to this transformation, and we catalog the roles that those organizations play in promoting patient safety today. Whether liability insurance in fact discourages providers from improving safety or encourages them to protect patients from avoidable harms is an empirical question that a survey ...


The Insurance Data Security Model Law: Strengthening Cybersecurity Insurer-Policyholder Relationships And Protecting Consumers, Koyejo-Isaac Idowu 2019 J.D. 2019, Roger Williams University School of Law

The Insurance Data Security Model Law: Strengthening Cybersecurity Insurer-Policyholder Relationships And Protecting Consumers, Koyejo-Isaac Idowu

Roger Williams University Law Review

No abstract provided.


State Benchmark Plan Coverage Of Opioid Use Disorder Treatments And Services: Trends And Limitations, Stacey A. Tovino 2019 University of Nevada, Las Vegas -- William S. Boyd School of Law

State Benchmark Plan Coverage Of Opioid Use Disorder Treatments And Services: Trends And Limitations, Stacey A. Tovino

Scholarly Works

Professor Tovino offers a survey of state benchmark plan coverage of opioid use disorder treatments and services, and identifies trends and limitations relevant thereto. Part II of the article provides background information regarding opioid use disorder and the treatments and services available for individuals with this disorder. Part III reviews federal mental health parity law and federal mandatory mental health and substance use disorder law as applied to insurance coverage of treatments and services for opioid use disorder, with a focus on the Affordable Care Act's (ACA's) state benchmark health plan selection requirement and the effect on that ...


Dual Regulation Of Insurance, Christopher French 2018 Penn State Law

Dual Regulation Of Insurance, Christopher French

Christopher C. French

Since this country was created, the insurance industry has been principally
regulated by the states with infrequent Congressional interventions.
As the insurance industry has evolved in recent decades, however, individual
states have become unable to adequately regulate some insurers, such
as multinational insurers and foreign insurers, because they lack jurisdiction
over such entities. Simply having the federal government assume responsibility
for regulating insurers will not solve the current regulatory
problems, however, because Congress’ past forays into regulating certain
areas of insurance generally have yielded poor results. Consequently, this
Article makes the novel proposal and argument that, with the creation of ...


Mapping Territorial Limitations On Insurance Coverage, Douglas R. Richmond 2018 University of San Diego

Mapping Territorial Limitations On Insurance Coverage, Douglas R. Richmond

San Diego Law Review

Globalization has come to financial markets and to innumerable industries. U.S. businesses export and import goods and products; many have done so for decades. Domestic companies that sell materials online almost certainly do some international business. American corporations have foreign facilities or operations. Americans travel internationally with relative ease. For those living in states that adjoin Canada or Mexico, international travel can be accomplished simply by driving across the border.

At the same time, insurance policies sold in the United States frequently contain territorial limitations on coverage that superficially seem out of place when compared to many aspects of ...


Century Surety Co. V. Andrew, 134 Nev. Adv. Op. 100 (Dec. 13, 2018) (En Banc), Austin Maul 2018 University of Nevada, Las Vegas -- William S. Boyd School of Law

Century Surety Co. V. Andrew, 134 Nev. Adv. Op. 100 (Dec. 13, 2018) (En Banc), Austin Maul

Nevada Supreme Court Summaries

The Court held that when an insurer breaches its contractual duty to defend the insured, the insurer’s liability is not capped at the policy limits plus the insured’s defense costs; an insurer may be liable for any consequential damages caused by its breach. Moreover, whether the insurer acted in good-faith is irrelevant for determining the damages for a breach of this duty.


Palsgraf-Ian Proximate Cause And Insurance Law: The State Of New York Additional Insured Coverage Following Burlington Insurance Co. V. Nyc Transit Authority, Ryan P. Maxwell 2018 University at Buffalo School of Law (Student)

Palsgraf-Ian Proximate Cause And Insurance Law: The State Of New York Additional Insured Coverage Following Burlington Insurance Co. V. Nyc Transit Authority, Ryan P. Maxwell

Buffalo Law Review

No abstract provided.


The Fatal Failure Of The Regulatory State, W. Kip Viscusi 2018 College of William & Mary Law School

The Fatal Failure Of The Regulatory State, W. Kip Viscusi

William & Mary Law Review

Although regulatory agencies place high values on the benefits associated with the reduction in mortality risks due to regulations, these same agencies substantially undervalue lives in their enforcement efforts. The disparity between the valuation of prospective risks and fatalities that have occurred is often by several orders of magnitude, diminishing whatever safety incentives the regulations might have generated. A review of the practices by the major federal agencies with responsibility for product safety and occupational safety finds that the value placed on fatalities in agencies’ regulatory analyses can be a factor of 1000 times greater than the magnitude of the ...


Does Small Group Health Insurance Deliver Group Benefits? An Argument In Favor Of Allowing The Small Group Market To Die, John Aloysius Cogan Jr. 2018 University of Washington School of Law

Does Small Group Health Insurance Deliver Group Benefits? An Argument In Favor Of Allowing The Small Group Market To Die, John Aloysius Cogan Jr.

Washington Law Review

The small group health insurance market is failing. Today, fewer than one-third of small firms now offer health insurance and the number of people covered by small group insurance continues to drop. These problems invite the obvious question: What should be done about the small group market? Past scholarship on the small group market has largely focused on documenting the market’s problems, evaluating the effectiveness of prior reform efforts, and proposing regulatory changes to stabilize the market. This Article takes a different approach to the small group problem by asking a previously unasked question: Does the small group market ...


The Duality Of Provider And Payer In The Current Healthcare Landscape And Related Antitrust Implications, Julia Kapchinskiy 2018 University of San Diego

The Duality Of Provider And Payer In The Current Healthcare Landscape And Related Antitrust Implications, Julia Kapchinskiy

San Diego Law Review

Health care landscape has changed with the introduction of the ACA and will keep changing due to the proposed repeal. The only constant is the desire of health plans and providers to maximize profits and minimize costs, which is attainable through consolidation. This Comment advocates a revision of the existing antitrust guidelines that would (1) recognize unique nature of health care market, (2) be independent from the current or proposed legislation to the maximum possible extent, and (3) reflect the insurer-provider duality, which heavily influences the quality and accessibility of the healthcare for the consumer.


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