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Saint Louis University Journal of Health Law & Policy

No abstract provided.

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Saint Louis University Journal of Health Law & Policy

No abstract provided.

Addressing Urban Health And Food Policy Through Resiliency Food Hubs: A Case Study From Washington, D.C., Dwane Jones

Saint Louis University Journal of Health Law & Policy

By 2050, the world’s population is projected to exceed nine billion people. Most of this growth is expected to materialize in urban and urbanizing areas, potentially further increasing disparities amongst populations in these environments. Historically, urban environments have lacked ample opportunities for providing locally grown, community-operated, small-scale urban farms that help to minimize food insecurity. Similarly, urban environments have lacked resiliency respective to small-scale farm operations. As a result, many public health issues and related policies are either antiquated or non-existent when it comes to providing opportunities for food security and resiliency in urban environments.

This article suggests several key …

Nutrition And Health Equity: The Role Of Washington, D.C.’S East Capitol Urban Farm, Tia D. Jeffery

Saint Louis University Journal of Health Law & Policy

Disenfranchised communities have yet to become full beneficiaries of the core values of the Constitution. Health inequities are rooted in the social barriers connected to racism, classism, and sexism. Furthermore, marginalized groups in Washington, District of Columbia (D.C.), reside in food deserts. Urban agriculture has gained exposure as a working solution to the epidemic of food deserts in underserved urban communities. The East Capitol Urban Farm is one of the urban food hub extensions of the University of the District of Columbia College of Agriculture, Urban Sustainability, and Environmental Sciences. It operates in a food desert in Ward 7 of …

Evidence-Based Public Health Is The Answer To Increasing American Childhood Vaccination Rates, Not Legislative Fortitude, Molly F. Anderson

Saint Louis University Journal of Health Law & Policy

After recent outbreaks of vaccine-preventable disease across the United States, some states have responded by removing non-medical exemptions. State legislatures that remove non-medical exemptions do so with the hope of increasing vaccination rates. However, there are serious concerns about this knee-jerk legislative reaction. Removing non-medical exemptions can lead to anti-vaccination sentiment and interference with parental autonomy.

This article argues that instead of removing non-medical exemptions, states should implement evidence-based public health solutions in order to increase vaccination rates. One example of an evidence-based solution is the Community Guide, a resource that contains reviews by a Task Force on a wide …

Belling The Cat: Implementation Of A Prospective Payment Reimbursement System For Critical Access Hospitals, Its Likely Success, And Political Implications Of This Policy Move, Erin E. Grant

Saint Louis University Journal of Health Law & Policy

Health care is plagued by inefficient reimbursement policies which encourage expensive financial waste with little incentive to maintain care quality. Though no perfect solution exists, effective remedies may require a hard look at programs so far untouched by policy changes. This article discusses the application of a prospective payment system of reimbursement for critical access hospitals, as well as how this policy change would affect rural health care access, costs, and quality of care. Though some fear prospective payment systems of reimbursement would cripple rural health care, evidence shows it would likely promote more cost-efficient care without diminishing quality or …

Non-Communicable Disease And Diabetes Screening In Community Settings In Low- And Middle-Income Countries: A Case Study In Senegal, West Africa, Rhonda Belue

Saint Louis University Journal of Health Law & Policy

Sub-Saharan Africa is faced with a significant and increasing burden of non-communicable diseases such as type 2 diabetes mellitus (diabetes). In Senegal, the prevalence of diabetes has been documented to be as high as 8.1% in urban-dwelling Senegalese and is fast approaching the United States prevalence of approximately nine percent; however, insufficient resources are available for prevention efforts and disease management. As a result, many cases remain undiagnosed, leading to an increased likelihood of diabetes complications and mortality. Many of these cases remain undiagnosed or are diagnosed only after complications have developed, such as the need for amputation, kidney failure, …

Masthead

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Table Of Contents

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Foreword: Competition’S Achilles Heel, Thomas L. Greaney

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Optimizing Private Antitrust Enforcement In Health Care, Anne Marie Helm

Saint Louis University Journal of Health Law & Policy

Americans are paying too much for health care services and insurance, in large part due to insufficiently competitive markets. Waves of consolidation have fortified providers and insurers with market power, resulting in higher prices and lower quality for consumers. As antidotes, advocates have proposed various legislative, regulatory, and enforcement solutions. Yet, unlike public antitrust enforcement, private antitrust enforcement is either not mentioned or criticized as sour grapes from competitors or a money grab by consumers. Instead of ignoring or bashing private litigation, those looking to address the health care pricing crisis in the United States should be looking to optimize …

The Anti-Competitive Potential Of Cross-Market Mergers In Health Care, Jaime S. King, Erin C. Fuse Brown

Saint Louis University Journal of Health Law & Policy

Health care consolidation in the United States has been widespread at all levels and across all entities. This consolidation has extended beyond horizontal mergers of hospitals or other providers to include out-of-market mergers, or cross-market mergers. Cross-market mergers include the merger or acquisition of any health care entity that does not directly compete with the acquiring entity in the same product or geographic market. Antitrust enforcers have historically had little in the way of market theory, economic models, or empirical data to inform their analyses on the potential impacts of cross-market mergers on competition. However, recent developments in economic theory …

Competition As Policy Reform: The Use Of Vigorous Antitrust Enforcement, Market-Governance Rules, And Incentives In Health Care, Emilio Varanini

Saint Louis University Journal of Health Law & Policy

In health care, the increase in market concentration on both the insurer side and the provider side has led to insurers and providers acquiring market power. Insurers and providers, in turn, have used that market power to charge higher prices to employers providing employees with medical care without corresponding increases in the quality of that care. Responding more generally to the increase in market concentration in many industries in the United States with a range of inimical effects for the nation’s economy, the Obama Administration suggested a range of policy solutions that this article groups under the term “Competition as …

When Is Competition Not Competition: The Curious Case Of Medicare Advantage, Robert A. Berenson

Saint Louis University Journal of Health Law & Policy

Policymakers routinely assume that Medicare Advantage plans and the traditional Medicare program compete for beneficiaries. Yet the District of Columbia federal district court blocked the proposed Aetna and Humana merger, finding that for purposes of antitrust analysis Medicare Advantage plans and traditional Medicare are effectively in different product markets. That is, they do not compete. This article reviews the basis for the court decision, which relied to a large extent on information that Medicare beneficiaries select their insurance coverage based on durable preferences either for the Medicare Advantage or the traditional Medicare option.

The article explores whether the apparently durable …

Avoiding Sticker Shock: Legislative Approaches To Protect Consumers From Surprise Medical Bills, Merlow M. Dunham

Saint Louis University Journal of Health Law & Policy

Consumers are increasingly receiving surprise medical bills, where an insured patient is unexpectedly billed directly for medical services received at an in-network health care facility from an out-of-network provider. These situations often arise in emergency rooms, operating rooms, and delivery rooms, despite the efforts of patients to receive care only from in-network providers. Surprise medical bills commonly leave consumers on the hook for thousands of dollars for out-of-network services that they had no opportunity to refuse. This article explores how the steady rise of narrow provider network health plans and the often-corresponding lack of transparency regarding which providers are included …

Taking Quality Of Health Care Seriously In Provider Merger Analysis, Kent Bernard

Saint Louis University Journal of Health Law & Policy

Traditionally, antitrust analysis had no method to quantify the benefits of better health care outcomes from a potential merger to balance them against the potential for increased costs. However, a branch of health care economics allows for that calculation. This approach has not been used in antitrust analysis to date, but United States law is flexible enough to allow such an approach, and the 2010 Horizontal Merger Guidelines contemplate it in Section 5. It enables us to use established procedures to put quality of care into health care merger analysis.

Working Well(Ness): The Impact Of The Ada Final Rule On Wellness Program Regulation And A Proposal For A Zero-Incentive Rule, Stefanie Brody

Saint Louis University Journal of Health Law & Policy

The Equal Employment Opportunity Commission (EEOC) recently amended wellness program regulation under 29 C.F.R. § 1630.14 of the Americans with Disabilities Act (ADA). Amidst criticism of the new rule, this article proposes the EEOC return to a zero-incentive policy for voluntary wellness programs that include disability-related inquiries or medical examinations. First, it reviews existing literature on wellness programs and the ADA, highlighting the legal and ethical challenges facing American workers with disabilities. Then, it explores the latest case law, illustrating the effects of the new rule compared to the proposal. By eliminating the thirty percent incentive limit and redefining “voluntary” …

Managing Medicaid, Isaac D. Buck

Saint Louis University Journal of Health Law & Policy

In a steady but rapid march, managed care has come to Medicaid. Privatization has undoubtedly rebuilt the Medicaid landscape across America over the last three decades. Now, as managed care programs administer health care to three-in-four Medicaid beneficiaries nationwide, whether or not managed care is adequately managing America’s largest public insurance program has become an increasingly important question.

Of particular note have been states’ difficulties in constructing and organizing the bidding and selection processes of the private companies tasked with overseeing the administration of private Medicaid plans. Legal challenges to various states’ bid procurement processes have been well documented. These …

Health Law, Public Law, And Social Justice, Sidney D. Watson

Saint Louis University Law Journal

I have taught Health Law for almost three decades. In the early years, the course was primarily about private law, the application of contract and tort principles in the context of health insurance coverage and medical care. Federal law of Medicare, Medicaid, EMTALA, and federal civil rights laws always made an appearance. Other federal statutes were added as they came along: HIPAA, the Americans with Disabilities Act, and GINA. Over the years, the course focused more and more on federal statutes until the passage of the Affordable Care Act (“ACA”) in 2010 completed the transition

Health law is now a …

Editor, "Health Care Law And The Rights Of Individuals With Disabilities", Elizabeth Pendo

All Faculty Scholarship

People with disabilities are vulnerable. They carry high risk for poor health and health outcomes. As a group, they experience social disadvantages such as poverty, underemployment and unemployment, isolation, and discrimination at a higher rate than the general population. They also face multiple barriers to quality health care and report poorer health status than people without disabilities. This Special Issue will explore the key health disparities and barriers to health care experienced by people with disabilities, and explore the legal, ethical, and social issues they raise. It will investigate the legal requirements of the Americans with Disabilities and other antidiscrimination …

Exploitation In Medical Research: The Enduring Legacy Of The Tuskegee Syphilis Study, Ruqaiijah A. Yearby

All Faculty Scholarship

For forty years, the United States government allowed economically disadvantaged African American men to be exploited in the name of research, although the research could not generate any benefit to society. Specifically, from 1932 until 1972, government funded researchers enrolled economically disadvantaged African American men in the Tuskegee Syphilis Study to document the already known course of syphilis, which led to the men suffering sores, fever, hair loss, weight loss, headaches, paralysis, blindness, dementia, and death. In exchange for free meals, medical exams, and burial insurance, the researchers promised the men that they would provide treatment for their “bad blood,” …

Preventing Neonatal Abstinence Syndrome Within The Opioid Epidemic: A Uniform Facilitative Policy, Jeremiah A. Ho, Alexander Rovzar

All Faculty Scholarship

The United States is currently in the midst of an opioid epidemic that has hit states in the southern New England regions particularly hard — with Massachusetts as one primary example. One of the many unfortunate results of the epidemic is a dramatic upsurge in cases of opioid dependency by expectant women that result in children born with Neonatal Abstinence Syndrome (NAS). NAS is a clinical syndrome that occurs when a newborn suffers withdrawal symptoms as a consequence of abrupt discontinuation of prenatal substance exposure. The expenses of treating and rehabilitating these drug-dependent newborns, predominantly shouldered by state taxpayers, are …

Special Issue "Health Care Law And The Rights Of Individuals With Disabilities", Elizabeth Pendo, Guest Editor

All Faculty Scholarship

People with disabilities are vulnerable. They carry high risk for poor health and health outcomes. As a group, they experience social disadvantages such as poverty, underemployment and unemployment, isolation, and discrimination at a higher rate than the general population. They also face multiple barriers to quality health care and report poorer health status than people without disabilities. This Special Issue will explore the key health disparities and barriers to health care experienced by people with disabilities, and explore the legal, ethical, and social issues they raise. It will investigate the legal requirements of the Americans with Disabilities and other antidiscrimination …

The Priority Review Voucher Program At The Fda: From Neglected Tropical Diseases To The 21st Century Cures Act, Ana Santos Rutschman

All Faculty Scholarship

The priority review voucher program at the Food and Drug Administration (FDA) was established in 2007 to incentivize research and development (R&D) in traditionally underfunded diseases.1 While shrouded in controversy and criticism, the program has recently been bolstered by the passage of the 21st Century Cures Act,2 which prevented the vouchers from sunsetting in late 2016 and furthered the overall scope of the program.3 As it reaches the end of its first decade, this Article discusses the impact of the program, with a focus on recent developments. The Article builds on literature suggesting that the voucher program has been ineffective …

Lessons From Ferguson And Beyond: Bias, Health, And Justice, Sidney D. Watson

All Faculty Scholarship

August 9, 2014, Michael Brown, an 18-year-old African American teen, killed by police in Ferguson, Missouri.

November 22, 2014, Tamir Rice, a 12-year-old African American child, killed by police in Cleveland, Ohio.

April 4, 2015, Walter Scott, a 50-year-old African American man, killed by police in Charlotte, North Carolina.

November 15, 2015, Jamar Clark, a 24-year-old African American man, killed by police in Minneapolis, Minnesota.

July 6, 2016, Philando Castile, a 32-year-old African American man, killed by police in Falcon Heights, Minnesota.

The list of Black men and women killed by police goes on and seems to grow by the …