Law Commons^™

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

Scholarly Works

No abstract provided.

Medicaid Expansion By Any Other Name: Exploring The Feasibility Of Expanded Access To Care In The Wake Of Nfib V. Sebelius, Michele Johnson, Kristin Ware

Belmont Law Review

This Article will examine aspects of the Tennessee Plan for Medicaid coverage in order to make the argument that Tennessee must either accept the Medicaid expansion as codified in the Affordable Care Act, or make modifications to the Tennessee Plan that better comport with the federal waiver program, the central goals of Medicaid, the United States Constitution, and the spirit of cooperative federalism.

The Real Constitutional Problem With The Affordable Care Act, Timothy Stoltzfus Jost

Timothy S. Jost

Not available.

Professional Sovereignty In A Changing Health Care System: Reflections On Paul Starr's The Social Transformation Of American Medicine, Timothy Stoltzfus Jost, Keith Wailoo, Mark Schlesinger

Timothy S. Jost

Not available.

Rural Roads To Acos: Inter-Community Collaboration Is Key To Rural Accountable Care Organizations' Success Under Medicare's Shared Savings Program, Justin Kearns

West Virginia Law Review

No abstract provided.

Health Courts And Malpractice Claims Adjudication Through Medicare: Some Questions, Timothy Stoltzfus Jost

Timothy S. Jost

No abstract provided.

Our Broken Health Care System And How To Fix It: An Essay On Health Law And Policy, Timothy Stoltzfus Jost

Timothy S. Jost

No abstract provided.

The Massachusetts Health Plan: Public Insurance For The Poor, Private Insurance For The Wealthy, Self-Insurance For The Rest?, Timothy Stoltzfus Jost

Timothy S. Jost

No abstract provided.

Better Health, But Less Justice: Widening Health Disparities After National Federation Of Independent Business V. Sebelius, Emily W. Parento, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

At the time it was enacted in 2010, the Patient Protection and Affordable Care Act (ACA) was widely applauded by health activists, as it meant that the United States would at last join the overwhelming majority of industrialized countries in providing its population with guaranteed access to affordable health care. Roughly half of the increase in access to health insurance was to come from the expansion of Medicaid eligibility to all U.S. citizens and legal residents with income below 138% of the Federal Poverty Level. However, the Supreme Court’s 2012 ruling in National Federation of Independent Business v. Sebelius ( …

Death Panels And The Rhetoric Of Rationing, Elizabeth Weeks Leonard

Scholarly Works

This essay offers an explanation for the United States' continued resistance to universal health care as grounded in two taboos: taxation and rationing. Even we were willing to pay more in taxes to directly subsidize the cost of medical care for those in need, rather than our current system of indirect subsidization through private insurance risk-pooling and cost-shifting, we still would face the unavoidable reality of resource limitations. Attempts to limit resource consumption, however, have been strongly opposed, as evidenced by the "death panels" controversy. Governor Palin's grossly erroneous characterization of the Patient Protection and Affordable Care Act (ACA) rendered …

Post-Reform Medicaid Before The Court: Discordant Advocacy Reflects Conflicting Attitudes, Nicole Huberfeld

Faculty Scholarship

The Supreme Court will decide two major Medicaid cases this term that raise major questions about the program and the tensions it creates between the federal government and the states. The Court heard oral arguments on October 3d in Douglas v. Independent Living Center, a dispute between California and its Medicaid providers regarding reimbursement cuts due to California’s budget crisis. The Medicaid providers argue that these proposed cuts are so extreme as to violate federal law and thus the Supremacy Clause. Their contention hinges on the Equal Access Provision of the Medicaid Act, which commands states to pay healthcare providers …

Erisa, Agency Costs, And The Future Of Health Care In The United States, John Bronsteen, Brendan S. Maher, Peter K. Stris

John Bronsteen

Because so many Americans receive health insurance through their employers, the Employee Retirement Income Security Act (ERISA) of 1974 plays a dominant role in the delivery of health care in the United States. The ERISA system enables employers and insurers to save money by providing inadequate health care to employees, thereby creating incentives for these agents to act contrary to the interests of their principals. Such agency costs play a significant role in the current health care crisis and require attention when considering reform. We evaluate the two major health care reform movements by exploring the extent to which each …

Bootstrapping, Stuart M. Benjamin

Law and Contemporary Problems

Virtually every action depends on some conditions precedent. Law is no exception. The common law and precedent involve reliance on earlier developments, as do more particularized phenomena like slippery slopes and path dependence. In some situations, an actor undertakes permissible action Y and thereby renders its action Z legally permissible, a phenomenon I refer to as bootstrapping. Some commentators have raised concerns about the consequences of allowing bootstrapping, notably in the context of the individual mandate in the 2010 health care act. In this article I consider whether we, as citizens, should find bootstrapping, or a particular category of bootstrapping, …

Drawing Lines In Shifting Sands: The U.S. Supreme Court's Mixed Messages On Erisa Preemption Imperil Health Care Reform, Mary Ann Chirba

Mary Ann Chirba

This article explains how and why the U.S. Supreme Court’s increasingly erratic preemption jurisprudence has fueled a health care system that routinely harms patients, frustrates health care providers, and derails state reform efforts. It begins by describing the mechanics of ERISA preemption, and then analyzes the Court’s 30 year odyssey from no preemption of state law claims against managed care payers, to broad preemption, retreating to limited preemption and, for now at least, trending again toward broad preemption. This is an extremely unstable area of the law which, at this point, demands not just an update but a thorough overview. …

Brief Of Amici Curiae: The Leadership Conference On Civil And Human Rights, Asian American Legal Defense And Education Fund, National Aids Housing Coalition, National Economic And Social Rights Initiative, National Health Care For The Homeless Council, National Law Center On Homelessness & Poverty, Poverty & Race Research Action Council, Urban Justice Center And Wild For Human Rights In Support Of Respondents Regarding Medicaid Expansion, In The Supreme Court Of The United States, State Of Florida, Et Al., V. United States Department Of Health And Human Services, Et Al., On Writ Of Certiorari To The United States Court Of Appeals For The Eleventh Circuit, No. 11-400, Martha F. Davis, Margaret Woo, Risa E. Kaufman

Margaret Y. K. Woo

This amicus brief was filed before the Supreme Court in the Medicaid Expansion portion of the Affordable Care Act (ACA) litigation on behalf of the Leadership Conference on Civil and Human Rights and other national organizations concerned with the international human rights implications of the ACA litigation, particularly with regard to race discrimination. The brief first argues that the international context of the ACA is relevant to the Court’s consideration of the law’s constitutionality, noting the many times when Court has taken international law into account in rendering decisions. The brief then chronicles the occasions on which international bodies and …

Healthcare Reform Hangs In The Balance, Lawrence O. Gostin

O'Neill Institute Papers

In this timely new briefing, Professor Lawrence O. Gostin, University Professor and Faculty Director, O’Neill Institute for National and Global Health Law, Georgetown University writes:

Prior to Tuesday’s arguments, I believed that the Supreme Court would uphold the health insurance purchase mandate by a comfortable margin. But now I believe that health care reform hangs in the balance. Here are the key arguments on which the future of President Obama’s health care reform depends: a greater freedom, cost-shifting, the health care market, acts versus omissions, limiting principles, the population-base approach, and what is necessary and proper. If the Court strikes …

Why The Affordable Care Act's Individual Purchase Mandate Is Both Constitutional And Indispensable To The Public Welfare, Lawrence O. Gostin

O'Neill Institute Papers

Integral to the Affordable Care Act's (ACA’s) conceptual design is the individual purchase mandate, which requires most individuals to pay an annual tax penalty if they do not have health insurance by 2014. Despite the vociferous opposition, the mandate is the most “market-friendly” financing device because it relies on the private sector. Ironically, less market-oriented reforms such as a single-payer system clearly would have been constitutional.

It is common sense for everyone to purchase health insurance and thus gain security against the potentially catastrophic costs of treating a serious illness or injury. However, Congress’ method of ensuring that everyone has …

Breaking The Cycle Of ‘Unequal Treatment’ With Health Care Reform: Acknowledging And Addressing The Continuation Of Racial Bias, Ruqaiijah Yearby

Faculty Publications

Since the Civil War access to health care in the United States has been racially unequal. This racially unequal access to health care remains even after the passage of Title VI of the Civil Rights Act of 1964 ("Title VI") and the election of an African-American President. Both of these events held the promise of equality, yet the promise has never been fulfilled. Now, many hail the passage of the Patient Protection and Affordable Health Care Act ("ACA") as the biggest governmental step in equalizing access to health care because it has the potential to increase minority access to health …

Valuing Health Care: Improving Productivity And Quality, Barak D. Richman, Arti K. Rai

Faculty Scholarship

No abstract provided.

How The Gun-Free School Zones Act Saved The Individual Mandate, Richard A. Primus

Articles

For all the drama surrounding the Commerce Clause challenge to the in-dividual mandate provision of the Patient Protection and Affordable Care Act (“PPACA”), the doctrinal question presented is simple. Under existing doctrine, the provision is as valid as can be. To be sure, the Supreme Court could alter existing doctrine, and many interesting things could be written about the dynamics that sometimes prompt judges to strike out in new directions under the pressures of cases like this one. But it is not my intention to pursue that possibility here. My own suspicion, for what it is worth, is that the …

A Proposal For Comprehensive And Specific Essential Mental Health And Substance Use Disorder Benefits, Stacey A. Tovino

Scholarly Works

This Article analyzes the initial efforts of the Federal Department of Health and Human Services to implement the essential mental health and substance use disorder services benefit required by section 1302(b)(1)(E) of the Affordable Care Act and proposes the adoption of a comprehensive and specific essential mental health and substance use disorder benefit set. At a minimum, the benefit set should cover medically necessary and evidence-based inpatient and outpatient mental healthcare services, inpatient substance abuse detoxification services, inpatient and outpatient substance abuse rehabilitation services, emergency mental healthcare services, prescription drugs for mental health conditions, participation in psychiatric disease management programs, …

An Essay On Originalism And The 'Individual Mandate': Rounding Out The Government’S Case For Constitutionality, Dan T. Coenen

Scholarly Works

The Supreme Court now has under advisement the landmark federal health care law case. Much attention has focused on the law’s minimum coverage provision—or so-called “individual mandate” — and, in particular, its constitutionality under the Commerce Clause and the Necessary and Proper Clause. In a separate and much lengthier article, I offer two main observations about the arguments made to the Court on that issue. First, I show that the challengers of the minimum coverage provision emphasized originalist reasoning in their briefs and oral arguments, while the federal government did not. Second, I explain why — contrary to the impression …

Tax-Exempt Hospitals, Community Health Needs And Addressing Disparities, Mary Crossley

Articles

The Affordable Care Act (ACA) imposes a number of new requirements on hospitals seeking to maintain their tax-exempt status under federal law. One requirement is that hospitals must conduct a “community health needs assessment” (CHNA) at least every three years and then develop and implement a strategy to address the needs identified in the assessment. This essay explores the potential this provision may offer for identifying, understanding, and reducing health care disparities. By calling on hospitals to focus less on individuals and more on communities, the CHNA requirement may offer a valuable addition to the toolkit for combating disparities. Thinking …

California’S Vanishing Community Hospital: An Endangered Institution, Craig B. Garner

Craig B. Garner

Across the nation, America’s community hospitals are under siege. Once considered indispensable to our health care system, the twenty-first century finds the local hospital fighting an uphill battle against a convergence of factors that favors the sharing of resources by multiple facilities. Rising health care expenses, challenging regulatory hurdles, and a reimbursement structure in the midst of transition all bear some responsibility for the obstacles faced by today’s community hospital. Nowhere is this phenomenon more pronounced than in California, where regular hospital closings amid an ever-growing population stand as incentive for remaining hospitals to team up (or remain teamed up) …

Federalizing Medicaid, Nicole Huberfeld

Faculty Scholarship

Medicaid fosters constant tension between the federal government and the states, and that friction has been exacerbated by its expansion in the Patient Protection and Affordable Care Act of 2010 (PPACA). Medicaid was an under-theorized and underfunded continuation of existing programs that retained two key aspects of welfare medicine as it developed: bias toward limiting government assistance to the “deserving poor,” and delivery of care through the states that resulted in a strong sense of states’ rights. These ideas regarding the deserving poor and federalism have remained constants in the program over the last forty-six years, but PPACA changes one …

The Other Side Of Health Care Reform: An Analysis Of The Missed Opportunity Regarding Infertility Treatments., Nizan Geslevich Packin

The Scholar: St. Mary's Law Review on Race and Social Justice

Recent studies show that one in eight American couples suffered from infertility. Infertility treatments are riddled with accessibility barriers including high costs, marital status, and sexual orientation. Despite President Obama’s promise of universal health care, his health care reform acts missed the opportunity to squarely address this widespread problem. In fact, the recent health care reform did not include any provisions specific to fertility. Despite this glaring oversight, this article argues that regulators interpreting the acts can still provide the desired relief. The minimum coverage requirements beginning in 2014 can be interpreted to include fertility care if infertility is treated …

The Constitutionality Of The Patient Protection And Affordable Care Act In The Courts Of Appeals, Mel Cousins

Mel Cousins

Having undergone an extensive process of political discussion and debate, the ACA (properly the Patient Protection and Affordable Care Act) is now under intensive legal challenge with over 20 different cases from both states and organizations and individuals having been initiated. The challengers argue that the Act lacks a constitutional basis and/or infringes on their constitutional rights. These cases involve a fascinating intersection of legal, political and policy issues and, regardless of the outcome, will have important implications for the future direction of US health care policy. There have now been four decisions of the courts of appeal on the …

Competing Stories: A Case Study Of The Role Of Narrative Reasoning In Judicial Decisions, Kenneth D. Chestek

Kenneth D. Chestek

Abstract:

Within minutes after President Obama signed into law the Patient Protection and Affordable Care Act (derisively referred to by some as the “Obamacare” law), the lawsuits started flying. Literally dozens of suits were filed all across the country. Some were frivolous, but many others raised serious issues of federalism and the reach of Congress’ power under the Commerce Clause.

Of the initial spate of lawsuits, ultimately five were decided by various trial courts on the merits of the Commerce Clause issue. Three judges found the law constitutional, and two others found it unconstitutional. But since the issue is almost …

Foreword, Orna Rabinovich-Einy

Law and Contemporary Problems

The U.S. healthcare system has undergone dramatic changes in the past year, which will have a profound impact on American society. While the "Patient Protection and Affordable Care Act of 2010" seeks to ensure healthcare coverage for the vast majority of Americans, controversies relating to scope of coverage, cost and course of treatment chosen, quality of care rendered, healthcare staff demeanor, and bioethical dilemmas are bound to persist. Indeed, in all likelihood, these controversies will even expand with the growth in the number of healthcare recipients under the federal scheme. Moreover, the changes introduced through the U.S. healthcare reform act …

Scaling Up Deliberative Democracy As Dispute Resolution In Healthcare Reform: A Work In Progress , Carrie Menkel-Meadow

Law and Contemporary Problems

No abstract provided.