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Full-Text Articles in Health Law and Policy

State Benchmark Plan Coverage Of Opioid Use Disorder Treatments And Services: Trends And Limitations, Stacey A. Tovino Jan 2019

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

Faculty Articles

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 requirement of …


Substance Use Disorder Insurance Benefits: A Survey Of State Benchmark Plans, Stacey A. Tovino Jan 2019

Substance Use Disorder Insurance Benefits: A Survey Of State Benchmark Plans, Stacey A. Tovino

Faculty Articles

Professor Tovino presents the results of a survey of state benchmark health plan coverage of substance use disorder treatments and services, including treatments and services for opioid use disorder.


Purchasing Health? The Promise And Limits Of Public Health Insurance, Kristen Underhill Jan 2019

Purchasing Health? The Promise And Limits Of Public Health Insurance, Kristen Underhill

Faculty Scholarship

The 2010s have been a momentous decade for Medicaid. With enrollment of over seventy-two million people (19% of the country’s population), Medicaid is the nation’s largest public health insurance program, and it is the primary or sole source of health insurance for vulnerable groups such as low-income children and pregnant women, adults with disabilities, and people in need of long-term care. Since 2014, the pendulum of Medicaid policy has swung from an unprecedented expansion of coverage under the Affordable Care Act (ACA), toward more recent federal regulations and state policy innovations that are instead predicted to limit uptake of benefits. …


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

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 deliver …


The Duality Of Provider And Payer In The Current Healthcare Landscape And Related Antitrust Implications, Julia Kapchinskiy Oct 2018

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.


If You Would Not Criminalize Poverty, Do Not Medicalize It, William M. Sage, Jennifer E. Laurin Oct 2018

If You Would Not Criminalize Poverty, Do Not Medicalize It, William M. Sage, Jennifer E. Laurin

Faculty Scholarship

American society tends to medicalize or criminalize social problems. Criminal justice reformers have made arguments for a positive role in the relief of poverty that are similar to those aired in healthcare today. The consequences of criminalizing poverty caution against its continued medicalization.


Reform At Risk — Mandating Participation In Alternative Payment Plans, Scott Levy, Nicholas Bagley, Rahul Rajkumar May 2018

Reform At Risk — Mandating Participation In Alternative Payment Plans, Scott Levy, Nicholas Bagley, Rahul Rajkumar

Articles

In an ambitious effort to slow the growth of health care costs, the Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI) and armed it with broad authority to test new approaches to reimbursement for health care (payment models) and delivery-system reforms. CMMI was meant to be the government’s innovation laboratory for health care: an entity with the independence to break with past practices and the power to experiment with bold new approaches. Over the past year, however, the Department of Health and Human Services (HHS) has quietly hobbled CMMI, imperiling its ability to generate meaningful data …


Does Small Group Health Insurance Deliver Group Benefits: An Argument In Favor Of Allowing The Small Group Market To Die, John Aloysius Cogan, Jr. Jan 2018

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

Faculty Articles and Papers

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 deliver …


A Right To Care, Stacey A. Tovino Jan 2018

A Right To Care, Stacey A. Tovino

Faculty Articles

In this Article, Professor Stacey Tovino examines the right to care through a personal and historical lens, then attempts to fill a scholarly gap in legal literature surrounding the right to skilled care and rehabilitation for patients with group or commercial insurance. Professor Tovino first recounts the history of Medicare coverage for skilled care and rehabilitation, then she examines the limitations of group and commercial insurance, finally concluding by asserting a right to care.


Remarks On Patient Privacy: Problems, Perspectives, And Opportunities, Stacey A. Tovino Jan 2018

Remarks On Patient Privacy: Problems, Perspectives, And Opportunities, Stacey A. Tovino

Faculty Articles

No abstract provided.


Modernizing Disability Income For Cancer Survivors, Ann C. Hodges Jan 2018

Modernizing Disability Income For Cancer Survivors, Ann C. Hodges

Law Faculty Publications

The medical progress in cancer treatment is worthy of celebration, as survivors of many cancers are living longer. This good news, however, comes with challenges for those survivors. Empirical evidence from researchers at cancer centers demonstrates the devastating impact that cancer has on employment, resulting in serious financial stress for survivors and their families. My previous research used this empirical data to recommend changes in employment laws to meet the need of survivors to maintain employment. This article builds on the prior research by using the empirical evidence of the employment effects of cancer to recommend changes in the disability …


Medicaid For All?: State-Level Single-Payer Health Care, Lindsay Wiley Jan 2018

Medicaid For All?: State-Level Single-Payer Health Care, Lindsay Wiley

Scholarly Articles in Law Reviews & Journals

If single-payer health care is ever to become a reality in the United States, it will very likely be pioneered by a state government, much like Canada’s single-payer system was first adopted in the provinces. Canada’s system operates more like U.S. Medicaid — financed nationally but administered largely by the provinces — than U.S. Medicare. This article describes three basic strategies progressive U.S. state governments are exploring for achieving universal access to high-quality health care and better health outcomes for their residents. First, maximizing eligibility for the existing Medicaid program using matching federal funds. Second, taking up the mantle of …


Ideology Meets Reality: What Works And What Doesn't In Patient Exposure To Health Care Costs, Victor Laurion, Christopher Robertson Jan 2018

Ideology Meets Reality: What Works And What Doesn't In Patient Exposure To Health Care Costs, Victor Laurion, Christopher Robertson

Faculty Scholarship

U.S. policymakers, scholars, and advocates have long displayed an ideological commitment to exposing insured patients to substantial out-of-pocket expenses. These commitments derive from both overt political ideologies, which favor individual responsibility and oppose redistribution of wealth and risks, as well as more-subtle ideological commitments of academic economists, which link observed patterns of consumption to value-claims about welfare. In this symposium contribution, we document those ideological commitments and juxtapose them with a review of the scientific evidence about the actual effects of patient cost-sharing. We find, as economic theory predicts, that patients exposed to healthcare costs consume less healthcare. However, a …


Reading Alexander V. Choate Rightly: Now Is The Time, Leslie Francis, Anita Silvers Oct 2017

Reading Alexander V. Choate Rightly: Now Is The Time, Leslie Francis, Anita Silvers

Utah Law Faculty Scholarship

Whatever happens to the Affordable Care Act (ACA) over the next few years, it is fair to assume that state Medicaid programs will be subjected to cost control measures. Despite the recent deployment of substantial arguments to the contrary, the belief still persists that the Supreme Court’s decision in Alexander v. Choate over thirty years ago stands for the proposition that disability anti-discrimination law does not impose requirements on the structure of Medicaid benefits. This belief is misleading at best. In this article, we challenge the access/content distinction and the straitened interpretation of Alexander v. Choate that has resulted from …


Anthem Health Plans Of Maine, Inc. V. Superintendent Of Insurance: Judicial Restraint Or Judicial Abdication?, David E. Sorensen Oct 2017

Anthem Health Plans Of Maine, Inc. V. Superintendent Of Insurance: Judicial Restraint Or Judicial Abdication?, David E. Sorensen

Maine Law Review

When Maine’s Superintendent of Insurance told the state’s largest health insurer that it could not profit in 2009, her decision ended up on appeal before the Maine Supreme Judicial Court, sitting as the Law Court, in Anthem Health Plans of Maine, Inc. v. Superintendent of Insurance. As part of its annual rate approval process, Anthem had requested a 3% profit and risk margin on its individual lines of health insurance in Maine. Superintendent Mila Kofman denied this request under her statutory authority to deny any rate increase proposals that are “excessive, inadequate or unfairly discriminatory.” The Superintendent held that a …


Key New Hampshire And Federal Statutes Regulating Health Care Delivery And Payment, Lucy Hodder Oct 2017

Key New Hampshire And Federal Statutes Regulating Health Care Delivery And Payment, Lucy Hodder

Law Faculty Scholarship

A summary of New Hampshire and federal regulations by subject matter, chart of New Hampshire state agency responsibilities, federal laws and regulation: An index


Table Of Contents Oct 2017

Table Of Contents

Marquette Benefits and Social Welfare Law Review

No abstract provided.


Activation Measures In Social Security: Lessons From The Dutch Case Oct 2017

Activation Measures In Social Security: Lessons From The Dutch Case

Marquette Benefits and Social Welfare Law Review

Dutch social security has undergone important changes since the 1990s, in that the focus shifted from predominantly compensating the loss of income into giving incentives for claimants and benefits recipients to stay in or get back to work. While still providing a relatively high level of benefit if there is no chance to work (to the full extent), the legislature has been quite creative in adopting conditions that stimulate persons to do their best to be in work. For this purpose, this is interesting for an American audience, since the USA system is far less generous out of fear that …


Erisa And Graham-Cassidy: A Disaster In Waiting For Employee Health Benefits And For Dependents Under 26 On Their Parents’ Plans, Leslie Francis Sep 2017

Erisa And Graham-Cassidy: A Disaster In Waiting For Employee Health Benefits And For Dependents Under 26 On Their Parents’ Plans, Leslie Francis

Utah Law Faculty Scholarship

Graham Cassidy § 105 would repeal the ACA “employer mandate”. Although its sponsors claim that the bill will give states a great deal of flexibility, it will do nothing to help states ensure that employers provide their employees with decent health insurance; quite the reverse. It will also give employers the freedom to ignore the popular ACA requirement that allows children up to age 26 to receive coverage through their parent’ plans, at least when their parents get health insurance from their employers. Here’s why.


Small Change, Big Consequences — Partial Medicaid Expansions Under The Aca, Adrianna Mcintyre, Allan M. Joseph, Nicholas Bagley Sep 2017

Small Change, Big Consequences — Partial Medicaid Expansions Under The Aca, Adrianna Mcintyre, Allan M. Joseph, Nicholas Bagley

Articles

Though congressional efforts to repeal and replace the Affordable Care Act (ACA) seem to have stalled, the Trump administration retains broad executive authority to reshape the health care landscape. Perhaps the most consequential choices that the administration will make pertain to Medicaid, which today covers more than 1 in 5 Americans. Much has been made of proposals to introduce work requirements or cost sharing to the program. But another decision of arguably greater long-term significance has been overlooked: whether to allow “partial expansions” pursuant to a state Medicaid waiver. Arkansas has already submitted a waiver request for a partial expansion, …


Covering The Care: Cost Sharing Reductions In Nh, Jo Porter, Lucy C. Hodder Jun 2017

Covering The Care: Cost Sharing Reductions In Nh, Jo Porter, Lucy C. Hodder

Law Faculty Scholarship

This brief uses national data to describe the NH population who received Cost Sharing Reductions for coverage on the NH Marketplace.


Covering The Care: A Focus On The Nh Marketplace, Jo Porter, Lucy C. Hodder Jun 2017

Covering The Care: A Focus On The Nh Marketplace, Jo Porter, Lucy C. Hodder

Law Faculty Scholarship

The second brief uses national and state data to describe the NH population enrolled in the health insurance plans through the NH Marketplace.


Covering The Care: Health Insurance Coverage In New Hampshire, Jo Porter, Lucy Hodder Jun 2017

Covering The Care: Health Insurance Coverage In New Hampshire, Jo Porter, Lucy Hodder

Law Faculty Scholarship

the first in a series of data and policy briefs that seek to inform the current conversations about health reform happening across the state. The first brief uses data from the American Community Survey to provide information about the health insurance coverage landscape in NH.


Can You Keep It? An Examination Of The Individual Health Insurance Market, Rachael Carnale May 2017

Can You Keep It? An Examination Of The Individual Health Insurance Market, Rachael Carnale

Honors Scholar Theses

The passage of the Patient Protection and Affordable Care Act (PPACA, ACA, or Obamacare) in 2010 significantly altered the structure of the individual health insurance market. The new regulatory environment and establishment of the health insurance exchanges forced insurers to adopt to be successful in the reformed individual market. However, the complexity of the law and uncertainty surrounding both the law itself and the newly insured have threatened the stability of the individual market. This thesis will explore the history of the individual health insurance market, the issues that current afflict the exchanges, and viability of possible solutions. Special attention …


Dinner For Two: Employer Mandate, Meet Erisa; How Dave & Buster’S Response To The Affordable Care Act’S Employer Mandate May Open The Door For Employees To Seek Erisa Relief, Kendall Victoria Dacey Mar 2017

Dinner For Two: Employer Mandate, Meet Erisa; How Dave & Buster’S Response To The Affordable Care Act’S Employer Mandate May Open The Door For Employees To Seek Erisa Relief, Kendall Victoria Dacey

Pepperdine Law Review

When the Affordable Care Act (ACA) became law in late March, 2010, Dave & Buster’s (D&B) had a choice: it could either comply and offer its full-time employees the minimum health insurance coverage required by the new “employer mandate” or it could ignore the new requirements and incur a penalty. Dissatisfied with either option, D&B made the drastic decision to circumvent the ACA entirely, and reduced its full-time staff below the ACA’s employee threshold so as to avoid triggering any penalty or having to pay increased health care costs. However, by dodging the employer mandate, D&B may have come in …


"A Nuanced Approach": How Washington Courts Should Apply The Filed Rate Doctrine, Kaleigh Powell Mar 2017

"A Nuanced Approach": How Washington Courts Should Apply The Filed Rate Doctrine, Kaleigh Powell

Washington Law Review

As of 2015, the vast majority of the American public had some form of health insurance, mostly provided by private companies. While some customers might, at some point, contemplate suing their insurance provider—for breach of contract, consumer protection statute violation, or some other cause—these potential plaintiffs are not likely to get far in many cases. The reason is the little-known “filed rate doctrine,” a court-created rule that bars lawsuits against many agency-regulated entities. The filed rate doctrine is based on the fact that many states, including Washington, require health insurers to file their rates with a regulatory agency—and have those …


Opinion: The Mental Health Parity And Addiction Equity Act: What Parity Means For New Hampshire, Lucy C. Hodder Jan 2017

Opinion: The Mental Health Parity And Addiction Equity Act: What Parity Means For New Hampshire, Lucy C. Hodder

Law Faculty Scholarship

[Excerpt] "New Hampshire lawyers can help clients and colleagues with mental health or substance use disorders by advising individuals how to overcome barriers to insurance coverage for treatment, and encouraging them to pursue state and federally mandated internal, external and expedited appeal opportunities when denied coverage."


Engaging Health Insurers In The War On Prescription Painkillers, Valarie K. Blake Jan 2017

Engaging Health Insurers In The War On Prescription Painkillers, Valarie K. Blake

Scholarly Works

While insurers have both the power and the motivation to curb the practice of harmful opioid prescribing, they may go about it in ways that could be counter-productive to larger public health goals. After all, insurers have historically discriminated against addiction like any other condition that leads to costly healthcare consumption. In the past, insurers have avoided enrolling addicted insureds and have limited rehabilitation services. To address this epidemic, insurers might engage in ways that could harm third parties. For example, to the extent they are permitted, insurers might avoid addicted enrollees altogether, or might limit coverage of addiction treatments …


Rethinking The Americans With Disabilities Act’S Insurance Safe Harbor, Valarie K. Blake Jan 2017

Rethinking The Americans With Disabilities Act’S Insurance Safe Harbor, Valarie K. Blake

Scholarly Works

Despite the importance of access to healthcare for the disabled, the Americans with Disabilities Act (ADA) has made little inroads in reducing disability-based discrimination by health insurers in the United States. One reason is undoubtedly the ADA’s insurance safe harbor, which explicitly permits insurers to discriminate on the basis of disability in health insurance so long as the differential treatment is supported by actuarial data and is not just intended to disadvantage the disabled. While the safe harbor’s harms are somewhat limited by the advent of the Affordable Care Act (ACA), they are not entirely neutralized. This article argues that …


Coverage In Transition: Considerations When Expanding Employer-Provided Health Coverage To Lgbti Employees And Beneficiaries, 24 Cardozo J. Equal Rts. & Soc. Just. 3 (2017), Kathryn J. Kennedy Jan 2017

Coverage In Transition: Considerations When Expanding Employer-Provided Health Coverage To Lgbti Employees And Beneficiaries, 24 Cardozo J. Equal Rts. & Soc. Just. 3 (2017), Kathryn J. Kennedy

UIC Law Open Access Faculty Scholarship

The rights of transgender individuals has been in the headlines during 2017 - ranging from President Trump's tweet to announce a ban on transgender individuals from serving in the military due to the "tremendous medical costs" to a nationwide injunction imposed by a federal district court on the HHS regulations that prohibit health-care discrimination against transgender individuals under the Affordable Care Act (ACA). There are three important reasons why transgender rights are in the news. First, the Human Rights Campaign Foundation, designed to promote the lives of lesbian, gay, bisexual, and transgender (LGBT) people, scores employers in its Corporate Equality …