Law Commons^™

Inefficacy Of The Transparency In Coverage Final Rule In Promoting Cost-Effective Choices, Abigail Jaeger

Saint Louis University Journal of Health Law & Policy

The Transparency in Coverage Final Rule requires health plans to provide beneficiaries with financial information such as estimates of their personalized cost-sharing liabilities for items and services offered by different providers, the plan’s negotiated in-network rates with these providers, and the plan’s allowed out-of-network amounts. The Final Rule is designed to enhance consumers’ access to pricing information under their health plan so they have the ability to make well-informed and cost-effective decisions regarding their health care. However, empirical evidence suggests that the Final Rule will not effectuate its intended purpose. Many consumers lack the high level of health insurance comprehension …

Cost-Effectiveness Comes To America: The Promise And Perils Of Cost-Effective Analysis In Medication Coverage Decisions, Carl Coleman

Georgia State University Law Review

In an effort to control rising drug costs, some health insurers have begun experimenting with methods to link decisions about coverage to the value added by medicines, including through the use of formal cost-effectiveness analysis (CEA). Increased interest in subjecting new drugs to rigorous economic analysis is a welcome development, as it offers the potential to minimize wasteful spending on drugs whose high prices are not justified by evidence of additional benefits produced. At the same time, CEA raises significant ethical issues, particularly when payers use it to limit access to drugs deemed to provide insufficient value for money. For …

Sb 338: Amendments Relating To Medicaid Postpartum Coverage, Ivona Relja, Meredith Elkin

Georgia State University Law Review

This Act amends Medicaid postpartum coverage for mothers from a period of six months to one year. The Department of Human Services will provide postpartum care Medicaid coverage to mothers for a period of one year following the date pregnancy ends.

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 …

Twelve Injured Men: Why Injured Jurors Should Not Receive Workers' Compensation Coverage From The Courts, Corey Baron

St. John's Law Review

(Excerpt)

This Note argues that the legislature should add a provision to New York’s Workers’ Compensation Act that expressly precludes jurors from coverage. Such a provision would comport with the policy underlying the statute, the statute’s structure, and the statute’s language. Moreover, that legislative provision would prevent the court from wasting the considerable time and expense of grappling with other courts’ inconsistent interpretations of workers’ compensation statutes and their underlying policies. First, Part I of this Note provides an overview of the workers’ compensation law and explores the policies underlying the advent of workers’ compensation statutes. Then, Part II surveys …

Finding A Right To Abortion Coverage: The Ppaca, Intersectionality, And Positive Rights, Courtney Olson

Seattle University Law Review

During a floor debate in 1976, Representative Henry Hyde explained, “I would certainly like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle class woman, or a poor woman. Unfortunately, the only vehicle available is the [Medicaid] bill.” For a short time after the Supreme Court of the United States established the right to abortion in Roe v. Wade, Medicaid did not distinguish between coverage for abortion and other medical services. That all changed when Congress passed the Hyde Amendment to the Medicaid Act in 1976. This Note will argue that a right to …

The Aca’S 2017 State Innovation Waiver: Is Erisa A Roadblock To Meaningful Healthcare Reform?, Marea B. Tumber

University of Massachusetts Law Review

In 2017, the Affordable Care Act’s (ACA) State Innovation Waiver (§1332) will enable states to waive many of the ACA’s provisions and to develop their own creative solutions to reign in healthcare spending. The Employee Retirement Income Security Act of 1974 (ERISA) was enacted to encourage employers to sponsor benefit plans and minimize potential conflicts with existing state laws. Because of ERISA, the regulation of employee benefit plans, including health plans, falls primarily under federal jurisdiction for about 131 million people. This Note explores the ways in which ERISA presents significant roadblocks to meaningful state level healthcare reform under §1332. …

Appellate Division, First Department, Courtroom Television Network Llc V. New York, Paula Gilbert

Touro Law Review

No abstract provided.

Maria’S Law: Extending Insurance Coverage For Fertility Preservation To Cancer Patients In Massachusetts, Brittany Raposa

University of Massachusetts Law Review

This Note addresses the issues related to fertility preservation treatments for cancer patients in the context of insurance coverage. As cancer survival rates improve, the ability to bear children after therapy is increasingly difficult and a concern for most patients. Currently, no states have laws requiring insurance coverage for fertility preservation treatments for cancer patients. Because it is not currently covered by either private or public insurance, only those who can pay for it on their own can use fertility preservation treatments. This note proposes that Massachusetts, as having one of the most inclusive infertility health insurance mandates, should expand …

Court Of Appeals Of New York, Consumers Union Of United States, Inc. V. New York, Daphne Vlcek

Touro Law Review

No abstract provided.

Insurance At The Energy-Water Nexus, Donald T. Hornstein

University of Richmond Law Review

No abstract provided.

Modernizing Underinsured Motorist Coverage In Missouri: Removing The Insurance Paradox Between Uninsured And Underinsured Coverage Via Legislative Action, David W. Reynolds

Saint Louis University Law Journal

No abstract provided.

Health Care Providers Meet Erisa: Are Provider Claims For Misrepresentation Of Coverage Preempted, Jeffrey A. Brauch

Pepperdine Law Review

No abstract provided.

Exposure, Manifestation Of Loss, Injury-In-Fact, Continuous Trigger: The Insurance Coverage Quagmire , Nicolas R. Andrea

Pepperdine Law Review

No abstract provided.

Nursing Facility Coverage Under Medicare, Edward Dale, Cheryldiane Feuerman

Marquette Elder's Advisor

Many beneficiaries believe that Medicare provides substantial coverage for nursing home care. The coverage actually available is of short duration, incomplete, and riddled with limitations. This article discusses the various requirements to receive Medicare benefits for skilled nursing facility admissions, and it also discusses the appeals process for denied benefit claims.

The Medicare Managed Care Choice

Marquette Elder's Advisor

Medicare managed care still has problems and careful evaluation is critical when choosing a program. Government attempts at providing information have created further confusion and drawn criticism from the professionals. This overview highlights some of the most important issues.

Medicare Handbook, Jane M.R. Mulcahy

Marquette Elder's Advisor

No abstract provided.

Medicare Reasonable And Medically Necessary Care: Skirmishes At The Front

Marquette Elder's Advisor

Medicare covers costs for health care deemed "reasonable and necessary" and excludes care classified as "experimental, investigative, or unproven." This article discusses coverage limits and the exceptions for which Medicare will authorize payment.

Defined Contribution Health Plans: Ready Or Not, Here They Come, Caryn Cucuta

Marquette Elder's Advisor

Defined contribution health coverage has been discussed for a number of years no response from the market. Now however, it looks as though employers may be ready to make the move to such plans. This article discusses the market and legislative influences that are making this switch more attractive to employers, and outlines various defined contribution plan models.

Why Virginia's Challenges To The Patient Protection And Affordable Care Act Did Not Invoke Nullification, Robert S. Claiborne Jr.

University of Richmond Law Review

No abstract provided.

The Consequences Of Repealing Health Care Reform In Early 2013 , J. Angelo Desantis, Gabriel Ravel

Cleveland State Law Review

This Article evaluates the consequences of an early 2013 repeal of the enacted Health Care Reform. We consider the Act's significant provisions that will have taken effect by 2013. For implemented provisions, we review their current effect on coverage, costs, and care. We then evaluate the practical consequence of the loss of those provisions. For provisions that have not yet taken effect, but will before 2013, we evaluate their projected effects in considering the consequences of repeal. Finally, for provisions that will not take effect before 2014, but where significant funds and effort will be expended prior to 2014, we …

Form & Reform: The Economic Realities Of The United States Healthcare System, Mark Votruba

Journal of Law and Health

Good afternoon, everybody. My name is Eric Steiger, I'm one of the editors-in-chief from the Journal of Law and Health. And I'm happy to welcome all of you to the second speaker event in the 2009/2010 Journal of Law and Health Speaker Series. Thank you all for coming. Now, I know that the news last week was dominated by the story of Sandra Bullock's breakup; however, some of you might have noticed that a small piece of minor legislation also got passed through Congress last week. And you also might have noticed that it wasn't quite as full of bipartisan …

News Coverage, The Expansion Of Discourse, And Conflict, Philip Seib

Journal of Dispute Resolution

The universe of news cultures--comprising providers and consumers-has never been static. It perpetually evolves, sometimes in small increments, sometimes with dazzling leaps. We are now in one of the latter phases, with new technologies driving change at high speed. This alteration of the news universe is a mix of reshaping and expansion, and it has a profound effect on social and political life throughout much of the world. It has particular impact on how policy makers and the public evaluate and respond to conflict.

Beyond Drug Coverage: The Cumulative Effect Of Privatization Reforms In The Medicare Modernization Act, Robert I. Field, Richard G. Stefanacci

Saint Louis University Journal of Health Law & Policy

No abstract provided.

The Federally Supported Health Center Assistance Act: National Malpractice Insurance And How It Works, Don A. Dennis

Georgia State University Law Review

No abstract provided.

The Supreme Court Opens Its Mind, And Medical Books, And Refuses ‘You Can Walk, You Can Talk, You Don’T Seem Sick Enough’ Approach To Asymptomatic Hiv Coverage Under The Americans With Disabilities Act, Rebecca Walker Embry

Saint Louis University Public Law Review

No abstract provided.

A Theory Of Insurance Policy Interpretation, Kenneth S. Abraham

Michigan Law Review

The first principle of insurance law is captured by the maxim contra proferentem, which directs that ambiguities in a contract be interpreted "against the drafter," who is almost always the insurer. Yet given the modern recognition that language is an inherently imperfect instrument for communicating meaning, insurance policy provisions are in a sense always ambiguous. Moreover, in addition to contra proferentem, policyholders may invoke such allied doctrines as waiver, estoppel, and the rule that the reasonable expectations of the insured should be honored even if those expectations are unambiguously contradicted by fine-print provisions in the policy. Contra proferentem and these …

A Crisis In Insurance, Benjamin Lipson

New England Journal of Public Policy

As the life and health insurance industry evaluates its long-term financial goals, the cloud of Black Monday — October 19, 1987, the day the stock market collapsed — blurs its cherished investment income projections. With investment portfolios under siege, mutual life insurance companies and stock companies alike are wary of making policy-pricing miscalculations that could prove to be disastrous. As if that weren't enough, one single disease — acquired immunodeficiency syndrome — looms as the most serious threat to life and health insurers for the remainder of this century. The spread of the new disease has caused insurers to adjust …

Florida Statutes Section 627.727: Is The Statutory Right To Reject Uninsured Motorist Coverage Really A "Right" At All?, Karen E. Roselli

Nova Law Review

In 1961, Florida joined the ranks of the growing majority of states

to mandate uninsured motorist coverage. This legislation resulted from

consumer outcry over the numerous hardships befalling accident victims

injured by uninsured motorists.

1977 Workmen's Compensation Legislation, Stanley James Brainerd

Florida State University Law Review

No abstract provided.