Health Law and Policy Commons^™

Legislation And Genetic Discrimination, Sharona Hoffman

Journal of Law and Health

State legislation addresses genetic discrimination in both employment and health insurance. Thirty-one states have passed laws that address genetic discrimination in employment. Approximately thirteen states prohibit employers from requiring applicants to undergo genetic testing as a condition of employment. Some states have more limited restrictions. Florida prohibits only the screening of applicants for the sickle-cell trait. Wisconsin requires employers to obtain written and informed consent from applicants prior to administering genetic tests, but does not preclude their utilization altogether. Some states establish exceptions that permit genetic testing that is job-related or that is conducted, with the employee's written and informed …

Breaking Through The Erisa Blockade: The Ability Of States To Access Employer Health Plan Information In Medicaid Expansion Initiatives, Barbara Zabawa

Faculty Works

The article discusses the challenges and potential solutions for states to access employer health plan information under the constraints of the Employment Retirement Income Security Act (ERISA) of 1974. It focuses on the importance of such access in supporting Medicaid expansion programs, using Wisconsin’s BadgerCare initiative as a case study. The article highlights the growing concern about "crowd out," where public health programs may displace employer-sponsored insurance, and argues for balanced public-private health coverage. It examines legal avenues for circumventing ERISA preemption, including federal law exceptions, Qualified Medical Child Support Orders (QMCSOs), and provisions under Title XIX of Medicaid. By …

The "Access" Problem: How Employee And Employer Issues May Increase Badgercare Participation By Impeding The Verification Process, Barbara Zabawa

Faculty Works

In its effort to be a welfare reform pioneer, Wisconsin has led the nation in adopting one of the most expansive public health insurance programs, "BadgerCare," to address the health care needs of working families in the post-welfare reform era. One year after BadgerCare implementation, Wisconsin is experiencing the fiscal impact of the program due to unexpectedly high enrollment in BadgerCare. While some Wisconsin leaders praise this growth rate for reducing the number of uninsured, others raise a concern that the enrollment figures may be rising due to employees opting for BadgerCare rather than employer-sponsored insurance. Consequently, this "crowd-out" effect …

Doctors, Hmos, Erisa, And The Public Interest After Pegram V. Herdrich, Jeffrey W. Stempel, Nadia Von Magdenko

Scholarly Works

The Employee Retirement Income Security Act of 1974 was enacted in the wake of highly publicized pension disasters in order to protect employee pension rights. Born as a piece of pro-worker legislation, it initially was criticized by business groups as a cause of bureaucratic arteriosclerosis that was worse than the disease of pension failures. Even worse, it prompted many employers to consider dispensing with pension plans altogether rather than struggle with the administrative and financial obligations of ERISA. Business, labor, and the public all complained about the law's complexity. It even became something of a national joke as regulators took …

Pink Slip Introduction, Dena S. Davis

Journal of Law and Health

What has changed however, is the degree of worry and concern that people feel about the uses to which their genetic information can be put. When the HGP (Human Genome Project) began, a number of pundits were convinced that the "future knowledge" that genetic information can deliver to consumers and insurers alike would completely undermine the practice of private health insurance, and send our current system crashing to the ground. Needless to say, that has not happened; but with 42 million Americans currently without health insurance, and with insurance tightly entwined with employment, many people fear that genetic information will …

Cardiovascular Genetics: Case Studies, Kenneth G. Zahka

Journal of Law and Health

What I'd like to do in the next 10 or 15 minutes is use a case approach which we all use in medicine as you use in law to give you a flavor for how we as clinicians think about things that are oftentimes obviously genetic. But I want to stress to you that probably a day does not go by or a patient does not go by where I don't think in terms of genetic issues for their cardiovascular health.

Can Employers Put Genetic Information To Good Use, Kathleen C. Engel

Journal of Law and Health

In my talk today I am going to try to answer the question: Can employers put genetic information to good use? Preparing this talk was a challenge because it required me to switch sides of the table. Having represented plaintiffs in employment discrimination cases for ten years, my inclination is to focus on the ways that employers can use genetic information to the detriment of their workers. I chose to talk about the value of genetic information from the employers' perspective because I wanted to force myself to engage in a disciplined study of the issues, rather than simply don …

Is There A Pink Slip In Your Genes?, J. B. Silvers

Journal of Law and Health

On the insurance company side, it's clear that insurance companies are not well loved by folks. They're not even supposed to do that. At one point after a company had approached QualChoice and told us not to tell the enrollees something that, in fact, had been a policy decision by the company, I was suggesting that perhaps we should change the name to the company to the "Scapegoat Insurance Company," since that really was what we were being paid for, and I think in this argument that may be part of the issue here.

Genetic Testing And Employment Litigation, Harry Zanville

Journal of Law and Health

I have only a couple of comments to make that relate to litigation hurdles and how to achieve this balance, and the first thing I want to talk about, following the wonderful presentation is, in fact, we probably don't in some ways even need a new cause of action.

Unraveling The Lining Of Erisa Health Insurer Pockets-A Vote For National Federal Common Law Adoption Of The Make Whole Doctrine, David M. Kono

BYU Law Review

No abstract provided.

., Administrative Channeling Under The Medicare Act Clarified: Illinois Council, Section 45(H), And The Application Of Congressional Intent, John Aloysius Cogan, Jr., Rodney A. Johnson

Faculty Articles and Papers

In non-legal terms, subject matter jurisdiction is much like your American Express card. You cannot "leave home without it." This is especially true if you represent a Medicare provider or supplier and intend to sue on a Medicare claim. To be sure, your well-pleaded complaint alleges several bases for the federal district court's subject matter jurisdiction, including, but not limited to, 28 U.S.C. § 1331 (federal question jurisdiction), 28 U.S.C. § 1346 (federal defendant jurisdiction), 28 U.S.C. § 1361 (mandamus), and 5 U.S.C. § 702 (the Administrative Procedures Act). Perhaps, your complaint is brought in the context of an adversary …

Recent Case Developments, Jeffrey W. Stempel

Scholarly Works

Recent case developments in Insurance Law in the years 1999 and 2000.

University Of Richmond Law Review

University of Richmond Law Review

No abstract provided.

Increasing Consumer Power In The Grievance And Appeal Process For Medicare Hmo Enrollees, Kenneth J. Pippin

University of Michigan Journal of Law Reform

Federal law requires that Health Maintenance Organizations (HMOs) and Managed Care Organizations (MCOs) provide Medicare beneficiaries with specific grievance and appeal rights for challenging adverse decisions of these organizations. The Health Care Financing Administration (HCFA) is charged with enforcing these regulations. Currently, however, HCFA contracts with HMOs, allowing them to enroll Medicare beneficiaries despite the fact that many of the statutory and regulatory requirements are ignored by the Medicare HMOs. This is problematic because the elderly Medicare population may not be able to independently and adequately challenge the HMO's denial of care or reimbursement. Because HCFA has been reluctant and …

The Governmental Composition Of The Insurance Costs Of Smoking, W. Kip Viscusi

Vanderbilt Law School Faculty Publications

The estimated health risks from smoking have significant external financial consequences for society. Studies at the national level indicate that cigarettes are self-financing since external costs such as those due to illnesses are offset by cost savings associated with premature death, chiefly pension costs. This paper extends this analysis to all 50 states and considers the costs considered in the state attorneys general suits against the cigarette industry. Cigarettes are always self-financing from the standpoint of costs to each state. The extent of the cost savings is less than at the federal level. However, smokers' higher medical costs are outweighed …

Managed Care Regulation: Can We Learn From Others? The Chilean Experience, Timothy Stoltzfus Jost

University of Michigan Journal of Law Reform

Because the United States relies on private insurance for financing health care to a much greater degree than do other nations, and because managed care as a form of private insurance is further developed in the United States than elsewhere, it is arguable that we have little to learn from other nations about managed care regulation. This Article tests this hypothesis with respect to Chile, a country where private insurance is widespread and managed care is emerging. It concludes that by studying the experience of other nations we might gain a larger perspective on the context of our concerns in …

Managed Care- The First Chapter Comes To A Close, Sallyanne Payton

University of Michigan Journal of Law Reform

Introduction to the symposium, Managed Care: What's the Prognosis: Managing Care in the Next Century.

Clearing The Way For An Effective Federal-State Partnership In Health Reform, Eleanor D. Kinney

University of Michigan Journal of Law Reform

At century's end, states have assumed a very different role in the design, implementation, and operation of health service programs than they did twenty-five years ago. In the current volatile political atmosphere particularly at the federal level, states have taken up the mantle of healthcare reform in the final years of the 1990s. Yet there remain problems and difficulties with the current federal-state relationship in health reform. The critical question is whether states can successfully accomplish genuine reform given its politically charged, complex and costly nature. This question takes on particular significance for the most important reform-expanding coverage to the …

The Competitive Impact Of Small Group Health Insurance Reform Laws, Mark A. Hall

University of Michigan Journal of Law Reform

This Article reports on findings from an extensive study of small group health insurance market reforms in seven states, enacted during the early 1990s. After summarizing the content and purpose of these reforms, this evaluation focuses on the impact these reforms have had on the nature and degree of market competition. The principal findings are: (1) small group health insurance markets are highly competitive, both in price and in product innovation and diversity; (2) although some insurers have left some or all of these states in part because of these reforms, an ample number of active competitors remain, even in …

Gender Discrimination Within The Reproductive Health Care System: Viagra V. Birth Control, Lisa A. Hayden

Journal of Law and Health

This Article begins with an examination of the prescription drug, Viagra and the medical condition it is intended to aid. Additionally, this Article evaluates the five most common, and FDA approved forms of contraceptives: contraceptive pills, intrauterine devices (IUD's), Depo-Provera shots, Norplant inserts and diaphragms. A basic understanding of the above prescriptions is necessary to determine if health care inequity exists between men and women in the area of prescriptive coverage, or if there is such a difference between the medical conditions involved that insurance companies are justified in excluding contraceptive coverage while including Viagra coverage. Part III of this …

Patient Safety, Risk Reduction, And The Law, Larry I. Palmer

Faculty Publications

No abstract provided.

Chicago Hope Meets The Chicago School, Gail B. Agrawal

Michigan Law Review

Twenty-five years after the enactment of the Federal Health Maintenance Organization Act and nearly five years after the failure of proposed federal health care reform, managed care has come to dominate the medical marketplace. As a result, the relationships among patients, payers, and physicians have changed fundamentally and dramatically. In this market-driven environment, health care - how much it costs, who receives treatment, and who pays for it - may have surpassed the weather as a topic of everyday conversation at dinner tables and water coolers across the country. In the popular press, reports concerning managed care, usually derogatory, are …

Symposium, The Florida Tobacco Litigation -- Fact, Law, Policy, And Significance, Jeffrey W. Stempel

Scholarly Works

This is the transcript of the Florida tobacco litigation symposium, discussing the s$11.3 billion settlement concerning tobacco in the state of Florida. Jeffrey W. Stempel served as co-chair and moderator of the symposium.

Rights And Efficiency In American Health Law, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

During the 1960s and 1970s, the individual rights revolution that swept through American society remade much of the nation's health law in its image. Sick people acquired the right to be told of the risks and benefits of proposed treatments and then to give thumbs-up or thumbs-down to their doctors' decisions. Successful suits for medical negligence went from rare to commonplace. Elderly and poor Americans achieved statutory rights of access to publicly funded healthcare, and courts burnished these rights with myriad procedural protections. The critically ill and their families won the right to refuse aggressive, life-sustaining treatments. Psychiatric patients acquired …

Judicial Opinions Involving Health Insurance Coverage: Trompe L'Oeil Or Window On The World?, William M. Sage

Faculty Scholarship

This essay offers a few thoughts about using judicial decisions as the dataset for research into health insurance coverage. Part I offers a general overview of insurance coverage law. Part II considers why students of health insurance coverage gravitate toward studying published opinions. Part III then discusses what is wrong with the approach, and suggests alternatives. Finally, Part IV turns to what may be right with the approach, concluding that judicial opinions in coverage litigation may reveal the functionality (or dysfunctionality) of the coverage process in managed care. Although the basic critique which the essay presents applies to areas other …

Emergency Care And Managed Care - A Dangerous Combination, Diane E. Hoffmann

Faculty Scholarship

No abstract provided.

Enterprise Liability And The Emerging Managed Health Care System, William M. Sage

Faculty Scholarship

“Enterprise medical liability” is a term used to describe a system in which health care organizations bear responsibility for medical malpractice in addition to or instead of individual health professionals. Enterprise liability is in many senses a natural outgrowth of the increasing dependence of medical practice on institutional resources and expertise. Proposals for enterprise liability surfaced briefly from the academic literature into the political spotlight during the 1993-94 health care reform debate. At that time, objections to the concept as a basis for medical malpractice liability, even in a restructured health care system, were nearly universal.

Just five years later, …

Legal Attack On Cost Containment Mechanisms: The Expansion Of Liability For Physicians And Managed Care Orgainizations, 31 J. Marshall L. Rev. 207 (1997), Allison Faber Walsh

UIC Law Review

No abstract provided.

Physician Employment Under Managed Care: Toward A Retaliatory Discharge Cause Of Action For Hmo-Affiliated Physicians, Peter B. Jurgeleit

Indiana Law Journal

No abstract provided.

Democratizing Hmo Regulation To Enforce The "Rule Of Rescue", Kent G. Rutter

University of Michigan Journal of Law Reform

Despite heightened public concern about HMOs, misguided regulatory measures have not guaranteed HMO patients access to the treatment options many consider vital. This Note recommends four changes to the current regulatory system that would preserve HMOs' ability to control health care costs while allowing patients and doctors, rather than lawmakers or HMO administrators, to set health care priorities.