Law Commons^™

Navigating The Health Insurance Exchanges: Will State Regulations Guide Consumers Or Chart Them Off-Course?, Kirsten Dunham

Missouri Law Review

This Comment examines the navigator program in the ACA and the political and legal issues surrounding state navigator licensure laws. To provide context, Part I outlines the legislative and legal background of the ACA at the federal level and in Missouri. Going into more detail on the navigator program, Part II first examines the federal regulations as they relate to the requirements of exchanges, the types and functions of consumer assistance programs, and the role of insurance agents and brokers. Part II then analyzes Missouri’s state navigator licensure law and regulation.

Unreasonable Religious Accommodation?: Fighting Irish Challenge The Opt-Out Form To The Affordable Care Act's "Contraceptive Mandate", Emily A. Herbick

Seventh Circuit Review

The Patient Protection and Affordable Care Act of 2010 (ACA) has been controversial from its inception, especially in regard to the "contraceptive mandate," which requires certain employers with group health plans to provide contraceptive coverage for their female employees without cost-sharing. In order to respect both the federal statutory right to contraceptive coverage and the religious rights of employers who provide health insurance for their employees, regulations were promulgated that provided exceptions to the contraceptive mandate. For example, religious employers who incorporate as non-profits are exempt from providing contraceptive coverage to their employees under the ACA. To receive this accommodation, …

Ftc V. Actavis: Analysis Of The Court’S Decision And How It Affects Drug Prices For Those Who Need Them The Most, Kyle Virtue

Washington and Lee Journal of Civil Rights and Social Justice

No abstract provided.

“Justice Is What Love Looks Like In Public”: How The Affordable Care Act Falls Short On Transgender Health Care Access, Rachel C. Kurzweil

Washington and Lee Journal of Civil Rights and Social Justice

No abstract provided.

The Commerce Power And Congressional Mandates, Dan T. Coenen

Scholarly Works

In National Federation of Independent Business v. Sebelius, a five-Justice majority concluded that the commerce power did not support enactment of the so-called “individual mandate,” which imposes a penalty on many persons who fail to buy health insurance. That ruling is sure to spark challenges to other federal laws on the theory that they likewise mandate individuals or entities to take certain actions. Federal laws founded on the commerce power, for example, require mine operators to provide workers with safety helmets and (at least as a practical matter) require mine workers to wear them. Some analysts will say that laws …

Employer-Based Health Care Insurance: Not So Exceptional After All, David Orentlicher

University of Arkansas at Little Rock Law Review

No abstract provided.

Health Care Reform: Treatment Effectiveness Information Nationwide, Robert B. Leflar

University of Arkansas at Little Rock Law Review

No abstract provided.

Medicare Fraud In The United States: Can It Ever Be Stopped?, Chelsea Hill, Alex Hunter, Leslie Johnson, Alberto Coustasse

Management Faculty Research

The majority of the United States health care fraud has been focused on the major public program, Medicare. The yearly financial loss from Medicare fraud has been estimated at about $54 billion. The purpose of this research study was to explore the current state of Medicare fraud in the United States, identify current policies and laws that foster Medicare fraud, and determine the financial impact of Medicare fraud. The methodology for this study was a literature review. Research was conducted using a scholarly online database search and government Web sites. The number of individuals charged with criminal fraud increased from …

Competitive Federalism: Five Clarifying Questions, Larry Yackle

Faculty Scholarship

Before I looked into the two fine books we are reviewing here,1 I would have said that arguments from federalism are typically fraudulent, neither more nor less than deliberate attempts to cloud the discussion of real issues. Now that I have read what Sotirios A. Barber and Michael S. Greve have written, I am largely confirmed in my prejudices. But my suspicions about federalism contentions have been shaken a bit – enough to ask some questions of Professor Greve, whose answers might persuade me that there is some good in this federalism business, after all. I doubt it, but I …

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 …

The Affordable Care Act And Its Impact On The Professional Tax Preparation Market In Kingsport, Tennessee, Robert S. Forney Jr.

Undergraduate Honors Theses

The objective of this study is to test whether the Affordable Care Act will have an effect on the professional tax preparation industry of Kingsport, Tennessee. To accomplish this objective, the researcher collected surveys concerning taxpayers’ initial reaction to the realization that the law affects their 1040. A two proportion test for equality was performed and failed to reject the idea that the ACA will have an effect on the tax preparation industry of Kingsport. Because this study failed to prove that the change in legislation causes a jump in clientele for the professional tax preparation market, the fight for …

Putting Insurance Reform In The Aca's Rear-View Mirror, William M. Sage

Faculty Scholarship

This Commentary acknowledges and applauds efforts to understand the mechanisms of insurance reform contained in the ACA and to evaluate their success or failure. But the Commentary’s principal purpose is to examine the pros and cons of connecting insurance reform to health care and health—the pen and the french fry—and to convey the importance to the country of moving beyond insurance reform as quickly as possible. The Commentary begins by describing the potential synergies among the three health policy domains and offering reasons why the ACA sought to make simultaneous changes. It then identifies the vulnerabilities that are revealed in …

Farewell, School House Rock (Understanding Legislative History Through The Lens Of The Aca), Nicole Huberfeld

Law Faculty Popular Media

In this blog post, Professor Nicole Huberfeld reviews John Cannan's article A Legislative History of the Affordable Care Act: How Legislative Procedure Shapes Legislative History, 105 L. Library J. 131 (2013).

Beyond Repeal—A Republican Proposal For Healthcare Reform, Timothy Stoltzfus Jost

Scholarly Articles

Not available.

Expanding Women’S Healthcare Access In The United States: The Patchwork “Universalism” Of The Affordable Care Act, Randy Albelda, Diana Salas Coronado

Center for Social Policy Publications

This paper explores the promise of the Patient Protection and Affordable Care Act, commonly called “Obamacare” (referred to here as the ACA), with attention to the ways gender matter by tracing the development and implementation of key US social protection systems, an examination of the current health system with particular attention to women’s coverage, and the potential impacts of the ACA, including how it conforms to international human rights norms for health care. The ACA promises to vastly improve the key dimensions of health coverage in the US, but it conforms with other US social policy by relying on market-based …

The Affordable Care Act, Remedy, And Litigation Reform, Brendan S. Maher

Faculty Scholarship

The Patient Protection and Affordable Care Act of 2010 (“ACA”) rewrote the law of private health insurance. How the ACA rewrote the law of civil remedies, however, is — to date — a question largely unexamined by scholars. Courts everywhere, including the United States Supreme Court, will soon confront this important issue.

This Article offers a foundational treatment of the ACA on remedy. It predicts a series of flashpoints over which litigation reform battles will be fought. It identifies several themes that will animate those conflicts and trigger others. It explains how judicial construction of the statute’s functional predecessor, the …

The Uneasy Relationship Of Hobby Lobby, Conestoga Wood, The Affordable Care Act, And The Corporate Person: How A Historical Myth Continues To Bedevil The Legal System, Malcolm J. Harkins Iii

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Community Benefit 501(R)Edux: An Analysis Of The Patient Protection And Affordable Care Act’S Limitations Under Community Benefit Reform, Zachary J. Buxton

Saint Louis University Journal of Health Law & Policy

No abstract provided.

The Individual Mandate Tax Penalty, Jeffrey H. Kahn

University of Michigan Journal of Law Reform

In 2010, President Obama signed legislation that significantly altered the healthcare and health insurance markets in the United States. An integral part of that reform is the individual mandate, a provision that requires individuals to purchase and maintain healthcare insurance. Failure to maintain such coverage subjects an individual to a tax penalty. The Supreme Court upheld the constitutionality of that provision under Congress’s taxing power. Despite the Supreme Court upholding the individual mandate, fundamental questions remain. This Article addresses the question of whether the use of a tax penalty to encourage taxpayers to do something that the government desires is …

How An Environmental Commerce Clause Challenge Presaged The Decision Of Chief Justice Roberts In Nfib V. Sebelius, M. Reed Hopper

Kentucky Journal of Equine, Agriculture, & Natural Resources Law

No abstract provided.

Paging Dr. Derrida: A Deconstructionist Approach To Understanding The Affordable Care Act Litigation, Laura A. Cisneros

Publications

Sovereignty federalism and cooperative federalism represent the two dominant federalism narratives among Supreme Court justices and scholars. The Court consistently invokes formal protections to safeguard the states' right to preside over their own empires.' Sovereignty scholars tend to embrace this dualistic vision of federalism that locates federalism's success in the state's ability to exercise supreme policymaking authority within its own sphere of influence without federal interference. By contrast, academics that lean toward cooperative federalism locate the states' power in their position as federal servants, not separate sovereigns. Scholars have commented that even though these academics tend to resist the rigid …

Taxation Without Limitation: The Prohibited Pretext Doctrine V. The Sebelius Theory, Brett W. Hastings

Marquette Elder's Advisor

The Article posits that the Supreme Court erred in its ruling regarding the Affordable Care Act by overlooking a well-established constitutional principle, dubbed the Prohibited Pretext Doctrine. This doctrine, which prohibits the exercise of a prohibited power through the pretextual use of a power granted, faded from memory due to the post- Lochner era expansion of the Commerce Clause. Nevertheless, the doctrine remains valid law. In overlooking the Prohibited Pretext Doctrine, the Supreme Court established a new and contradictory doctrine, labeled the “Sebelius Theory.” The Sebelius Theory turns the Prohibited Pretext Doctrine on its head by explicitly allowing the government …

The Spending Power And Environmental Law After Sebelius, Erin Ryan

Erin Ryan

This article analyzes the Supreme Court’s new spending power doctrine and its impact on state-federal bargaining in programs of cooperative federalism, using the laboratory of environmental law. (It expands on the legal analysis in an Issue Brief originally published by the American Constitution Society on Oct. 1, 2013.) After the Supreme Court ruled in the highly charged Affordable Care Act case of 2012, National Federation of Independent Business vs. Sebelius, the political arena erupted in debate over the implications for the health reform initiative and, more generally, the reach of federal law. Analysts fixated on the decision’s dueling Commerce Clause …

Menu Labeling: The Unintended Consequences To The Consumer, Ellen A. Black

Law Faculty Scholarship

Why are Americans, along with the rest of the most populous nations, more overweight than twenty or thirty years ago? Most nutritionists and scientists agree that the answer is complex and multifaceted, with genetics, exercise, and diet all playing at least a partial role. Americans, for the last thirty years, have been reportedly eating out at restaurants more frequently than they have been eating at home; as a result, the restaurant industry has been blamed, in part, for the rise in obesity, based upon the presumption that more calories are consumed at restaurants than at home. Yet determining the underlying …

The Individual Mandate Tax Penalty, Jeffrey H. Kahn

Scholarly Publications

In 2010, President Obama signed legislation that significantly altered the healthcare and health insurance markets in the United States. An integral part of that reform is the individual mandate, a provision that requires individuals to purchase and maintain healthcare insurance. Failure to maintain such coverage subjects an individual to a tax penalty. The Supreme Court upheld the constitutionality of that provision under Congress’s taxing power.

Despite the Supreme Court upholding the individual mandate, fundamental questions remain. This Article addresses the question of whether the use of a tax penalty to encourage taxpayers to do something that the government desires is …

The Spending Power And Environmental Law After Sebelius, Erin Ryan

Scholarly Publications

This article analyzes the Supreme Court’s new spending power doctrine and its impact on state-federal bargaining in programs of cooperative federalism, using the laboratory of environmental law. (It expands on the legal analysis in an Issue Brief originally published by the American Constitution Society on Oct. 1, 2013.) After the Supreme Court ruled in the highly charged Affordable Care Act case of 2012, National Federation of Independent Business vs. Sebelius, the political arena erupted in debate over the implications for the health reform initiative and, more generally, the reach of federal law. Analysts fixated on the decision’s dueling Commerce Clause …

Mind The Gap: Basic Health Along The Aca’S Coverage Continuum, Sallie Thieme Sanford Sanfords@Uw.Edu

Articles

As ACA implementation proceeds, expansion states should mind the gap — the gap between Medicaid and Marketplace. In this transition between insurance platforms, people can stumble. As a bridge between expanded Medicaid and the insurance Marketplaces, the ACA allows states to enact a Basic Health Program (BHP) supported by federal funds. The BHP option, which has been delayed until 2015, aims to reduce insurance costs and increase care continuity for low-income individuals and families. Interested states face a complicated calculus, one with significant unknowns and moving parts. In this article, I first place this new insurance affordability program in the …

Allocating Responsibility For Health Care Decisions Under The United States Affordable Care Act, Wendy K. Mariner

Faculty Scholarship

This article summarizes the major elements of the ACA's insurance reforms and how they affect responsibility for making decisions about the health care that people receive. A key example of the difficulty of allocating decision making responsibility is the effort to define a minimum benefit package for insurance plans, called essential health benefits. While the ACA should achieve its goal of near-universal access to care, it leaves in place a multiplicity of processes and decision-makers for determining individual treatment. As a result, decisions about what care is provided are likely to remain, much as they are today, divided among government …

Why The Affordable Care Act Authorizes Tax Credits On The Federal Exchanges, David Gamage, Darien Shanske

Articles by Maurer Faculty

This Essay refutes Adler’s and Cannon’s argument that the Affordable Care Act (“Obamacare”) does not authorize premium tax credits for insurance policies purchased from the federal healthcare Exchanges. Adler’s and Cannon’s argument is the basis of challenges in a number of ongoing lawsuits, including Oklahoma ex rel. Pruitt v. Sebelius and Halbig v. Sebelius. This Essay conducts a textual analysis of the Affordable Care Act and concludes that the text clearly authorizes premium tax credits for insurance policies purchased from the federal healthcare Exchanges.

On November 7th, 2014, the U.S. Supreme Court agreed to hear the appeal of the King …

It's A Mistake: Insurer Cost Cutting, Insurer Liability, And The Lack Of Erisa Preemption Within The Individual Exchanges, Christopher Smith

Cleveland State Law Review

In today’s society, most people receive their health insurance through their employers. If their employment-based insurer engages in cost cutting that leads to patient injury, Employee Retirement Income Security Act of 1974 (“ERISA”) preemption means that these people have no state tort-based recourse against their insurers. ERISA is a federal statute that regulates employee benefit plans, and the Supreme Court has interpreted the ERISA statute to preempt most beneficiary state tort claims against an employment-based insurer. In other words, even if the insurer, and not the doctor, caused the patient’s harm, the patient with employment-based insurance can only sue their …