Health Law and Policy Commons^™

Painfully Prescribed: Could Taking Opioids As Legal Treatment Result In Discrimination Uncovered By The Ada?, Rachael Elyse Palmer

Saint Louis University Journal of Health Law & Policy

Amended in 2008, the Americans with Disabilities Act (ADA), with its sole mission to protect individuals with disabilities, is still gaping with holes in coverage due to recent court interpretations. One such interpretation is the lack of protection for patients being treated with legally prescribed medications. With widespread misconceptions about opioid use and its effects, employers take adverse action upon their employees seeking necessary treatment. This paper will discuss the harmful consequences of courts narrowly interpreting the ADA against coverage of these patients, as well as the potential revitalization of the ADA’s mission in pending actions.

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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.

Could We Pass The Ada Today?: Disability Rights In An Age Of Partisan Polarization, Michael Waterstone

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Could We Pass The Ada Today? Disability Rights In An Age Of Partisan Polarization, Tony Coelho

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Would The Ada Pass Today?: Disability Rights In An Age Of Partisan Polarization, Laura Rothstein

Saint Louis University Journal of Health Law & Policy

The Americans with Disabilities Act of 1990 (ADA) was the most significant civil rights legislation enacted since the Civil Rights Act of 1964. It provided comprehensive protection against discrimination for individuals with disabilities in employment, public accommodations, and public services. It built on § 504 of the Rehabilitation Act that provided these protections only to programs receiving federal financial assistance. It afforded broad access to those individuals who had benefitted from the 1975 Individuals with Disabilities Education Act. This complex and far-reaching legislation was made possible by a confluence of timing and the right people at the right place at …

Threats To Medicaid And Health Equity Intersection, Mary Crossley

Saint Louis University Journal of Health Law & Policy

The year 2017 proved politically tumultuous in the U.S. on many fronts, but perhaps none more so than health care. For enrollees in the Medicaid program, it was a “year of living precariously.” Long-promised Republican efforts to repeal the Affordable Care Act also took aim at Medicaid, with proposals to fundamentally restructure the program and drastically cut its federal funding. These proposals provoked pushback from multiple fronts, including formal opposition from groups representing people with disabilities and people of color and individual protesters. Opposition by these groups should not have surprised the proponents of “reforming” Medicaid. Both people of color …

The Costs Of Uncertainty: The Doj’S Stalled Progress On Accessible Medical Equipment Under The Americans With Disabilities Act, Elizabeth Pendo

Saint Louis University Journal of Health Law & Policy

No abstract provided.

A State’S Effort To Enhance Health Care: Empowering Pharmacists With Prescribing Authority, Madhav Y. Bhatt

Saint Louis University Journal of Health Law & Policy

High rates of unintended pregnancies and costs associated with them have been a concern for the health care system in the U.S. The State of Oregon took a unique approach to reduce unintended pregnancy rates within its borders. Oregon enacted a statute that authorized pharmacists to prescribe hormonal contraceptives, which expanded the scope of practice of pharmacists. This Article explores whether states, instead of the Food and Drug Administration (FDA), should regulate the scope of practice of health care professionals. This Article further explores the impact of Oregon’s law on access to hormonal contraceptives, safety of women’s health, and costs …

Medical Marijuana And The Ada: Following The Path Blazed By State Courts To Extend Protection, Stephen M. Scannell

Saint Louis University Journal of Health Law & Policy

Thirty-three states across the country have legalized the use of medical marijuana for disabled individuals. Nevertheless, medical marijuana’s status in the workplace still faces significant uncertainty, because the current understanding of the Americans with Disabilities Act (ADA) categorizes medical marijuana use as an “illegal use of drugs.” Thus, the ADA provides no protection for disabled employees seeking to treat their condition with medical marijuana. In recent years, courts deciding cases involving state medical marijuana and anti-discrimination statutes have brought a more patient-centered and pragmatic approach to the issue. These courts have offered an interpretation of the “illegal use of drugs” …

The Vaccine Race In The 21st Century, Ana Santos Rutschman

All Faculty Scholarship

In a world in which infectious diseases are spreading increasingly faster, the development of new human vaccines remains a priority in biopharmaceutical innovation. Legal scholars have addressed different aspects of vaccine regulation and administration, but less attention has been paid to the role of laws governing innovation during the stages of research and development (R&D) of vaccines.

This Article explores the race to develop new vaccines from its beginnings through the early 21st century, with a particular focus on the progressively pervasive role of intellectual property in governing vaccine innovation. It describes the insufficiencies of current innovation regimes in promoting …

On The Judicialization Of Health, Ana Santos Rutschman

All Faculty Scholarship

The provision of health care has long been at the forefront of domestic and international debates, philosophical inquiries, and political agendas. A growing body of legal scholarship has added to the debate by examining the role of judicial review in the context of health-related litigation. What role, if any, should courts play in compelling the provision of health care or in furthering access to potentially life-saving medicines?

This question intersects with multiple strands of the law. For instance, it has an institutional component that interrogates the function(s) of courts within systems of checks and balances. It ties into constitutional design …

Permitted Incentives For Workplace Wellness Plans Under The Ada And Gina: The Regulatory Gap, Elizabeth Pendo, Brandon Hall

All Faculty Scholarship

Although workplace wellness plans have been around for decades, they have flourished under the Patient Protection and Affordable Care Act (“PPACA”) into a $6 billion-dollar industry. Under PPACA, a “wellness plan” is a program of health promotion or disease prevention offered by an employer that is designed to promote health or prevent disease and which meets the other applicable requirements of that subsection. Employers look to these programs to promote healthy lifestyles, improve the overall health of employees and beneficiaries, and reduce rising healthcare costs. PPACA’s amendments to the Health Insurance Portability and Accountability Act (“HIPAA”) permit employers to offer …

Knowledge Of Practicing Physicians About Their Legal Obligations When Caring For Patients With Disability, Nicole Agaronnik, Elizabeth Pendo, Julie Ressalam, Eric G. Campbell, Lisa Iezzoni

All Faculty Scholarship

doi: 10.1377/hlthaff.2018.05060 HEALTH AFFAIRS 38, NO. 4 (2019): 545–553

Medical Malpractice Cuts Not The Answer, Ruqaiijah A. Yearby

All Faculty Scholarship

Tort reform--legislation that aims to reduce medical malpractice suits --will not cut medical costs and improve health care unless the government addresses the proliferation of unnecessary medical errors that victimize hundreds of thousands of patients every year.

Yearby's research considers how laws enacted to grant equal access to quality health care actually can pose barriers to the disenfranchised, and she is critical of health care reform efforts that do not address the far-reaching problem of medical errors. Finding ways to curb what she calls the "alarming rate of these medical errors," not only will reduce medical malpractice suits, but save …

Vaccine Licensure In The Public Interest: Lessons From The Development Of The U.S. Army Zika Vaccine, Ana Santos Rutschman

All Faculty Scholarship

Vaccines developed by the public sector are key to preventing future outbreaks of infectious diseases. However, the licensure of these vaccines to private-sector companies under terms that do not ensure both their availability and affordability compromises their development. This Essay analyzes the recent attempted licensing deal for a Zika vaccine between the U.S. Army and Sanofi, a French pharmaceutical company. The proposed grant of an exclusive license to Sanofi triggered widespread concern because none of its substantive terms were disclosed. While § 209 of the Patent Act imposes limitations on exclusive licensure, the Army released no information supporting its finding …

Macra And Medicare’S Elusive Quest For Fairness And Value With Physician Payment Policy: Speeding Up The Transition To “Big Med”, Rick Mayes, Soleil Shah

Saint Louis University Journal of Health Law & Policy

This article traces the evolution of Medicare physician payment policy from the program’s beginning to the passage of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA). Based on interviews, primary data sources, and an extensive review of the secondary literature, the authors provide an analysis of: (1) some of the most significant events, trends and factors that led to the Act’s passage, (2) MACRA’s basic design and the primary options it gives to physicians, and (3) the major concerns many physician representatives and health policy experts have about MACRA. As the majority of physicians will likely feel the need …

Law Enforcement And Executive Order: Duplication In Missouri’S Prescription Drug Monitoring Program, Colleen A. Kinsey

Saint Louis University Journal of Health Law & Policy

Missouri had long been scrutinized as the only state operating without a prescription drug monitoring program. These programs are seen as an effective way to monitor prescription opioids as opioid-related deaths have risen in the past decade. The opioid crisis has gained significant media attention and cast scrutiny on pharmaceutical companies, physicians, and state and federal governments. This comment explores the history of the opioid crisis and details Missouri’s struggle to implement a prescription drug monitoring program legislatively. In 2017, former Governor Eric Greitens signed an Executive Order directing the Missouri Department of Health and Senior Services to implement one …

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Saint Louis University Journal of Health Law & Policy

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Saint Louis University Journal of Health Law & Policy

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Regulatory Implications Of The Comprehensive Care For Joint Replacement Demonstration Project, Thomas W. Brewer

Saint Louis University Journal of Health Law & Policy

An often overlooked provision in the Patient Protection and Affordable Care Act is the authorization of demonstration projects which incentivize providers to develop, implement, and test novel, cost-cutting approaches to care delivery. One such project, the Comprehensive Care for Joint Replacement demonstration project, encourages providers across the continuum of care to collaborate on strategies that improve the quality of and lower the cost of complete joint replacements. The project allows providers to share the benefits of cost savings, and liabilities for cost overruns, across the surgeons performing procedures, acute care facilities, and post-acute care facilities. Arrangements of this type, outside …

Putting The Brakes On Consumer Driven Medicaid: The Failures And Harms Of Healthy Indiana Plan (Hip) 2.0, Sidney D. Watson

Saint Louis University Journal of Health Law & Policy

In January 2015, the U.S. Department of Health and Human Services (HHS) granted Indiana a Section 1115 Demonstration Waiver to experiment with consumer driven Medicaid. The Healthy Indiana Plan (HIP) 2.0 combines a $2,500 high deductible with a Personal Responsibility and Wellness (POWER) Account, premiums, and copays. Described as “the most significant departure from traditional Medicaid ever approved,” Indiana claims that the POWER Account, the signature feature of HIP 2.0, is “similar to a health savings account (HSA)” and encourages members to be more cost-conscious consumers, helps familiarize members with how commercial health insurance works, and encourages continuous Medicaid enrollment. …

The Body Politic: Federalism As Feminism In Health Reform, Elizabeth Y. Mccuskey

Saint Louis University Journal of Health Law & Policy

This essay illuminates how modern health law has been mainstreaming feminism under the auspices of health equity and social determinants research. Feminism shares with public health and health policy both the empirical impulse to identify inequality and the normative value of pursing equity in treatment. Using the Affordable Care Act’s federal health insurance reforms as a case study of health equity in action, the essay exposes the feminist undercurrents of health insurance reform and the impulse toward mutuality in a body politic. The essay concludes by revisiting—from a feminist perspective—scholars’ arguments that equity in health insurance is essential for human …

Finding An Unlikely Combatant In The War Against Ransomware: Opportunities For Providers To Utilize Off-Site Data Backup Within The Hipaa Omnibus And Hitech Amendments, Jordan Butler

Saint Louis University Journal of Health Law & Policy

Each day the health care sector is subjected to an onslaught of thousands of ransomware virus attacks which attempt to capture a provider’s IT operations until a ransom is paid to the hacker. Apart from monetary, functional, and civil liability considerations, compromised health systems that contain electronic patient health information could expose a provider to legal liability under multiple HIPAA laws. This article will explore how recent amendments made to HIPAA, particularly under the Omnibus and HITECH Acts, incentivize providers to obtain legal, functional, and policy-based benefits by utilizing off-site data backup business associates as part of their cybersecurity defense …

Overlapping And Concurrent Surgeries: An Analysis Of Informed Consent When There Is Incomplete Risk Information, Caitlan E. Grombka-Murphy

Saint Louis University Journal of Health Law & Policy

The practice of overlapping and concurrent surgeries—where a single surgeon runs two or more operations at once—is not new. However, it was not until 2015, through the Boston Globe’s investigation, that the general public learned the details of such practices. Lack of transparency surrounding these practices regrettably has created a culture of distrust within the surgeon-patient relationship. The core concern of overlapping and concurrent surgeries is the potential for patient risk. Scientific research on how much additional risk overlapping or concurrent surgeries place on the patient is still in its early stages. This article explores current scientific research, noting …

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Saint Louis University Journal of Health Law & Policy

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Saint Louis University Journal of Health Law & Policy

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Foreword, Robert Gatter

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Independence Is The New Health, Laura D. Hermer

Saint Louis University Journal of Health Law & Policy

Medicaid plays key roles in supporting our nation’s health. Under the Affordable Care Act, Medicaid took an even more central position in public health endeavors by extending coverage in all interested states to millions of adults who typically fell through the health care cracks. Nevertheless, the Trump administration is now undoing these gains by actively encouraging states to curtail access to Medicaid in key respects while using the rhetoric of health.

This article examines Trump administration efforts in two contexts: (1) state § 1115 waiver applications seeking to better align their Medicaid programs with cash welfare and food stamp programs, …

Health Justice In The Age Of Alternative Facts And Tax Cuts: Value-Based Care, Medicaid Reform, And The Social Determinants Of Health, Elizabeth Tobin-Tyler

Saint Louis University Journal of Health Law & Policy

Some provisions of the Patient Protection and Affordable Care Act of 2010 (ACA) as well as regulatory policies under the Obama administration reflected the overwhelming evidence that to reduce health care costs, and to improve quality of care and population health, the social determinants of health (SDOH) must be addressed. These policies included funding for partnerships between public health agencies, community organizations, and health care institutions, promotion of value-based payment models that incentivize integrated health and social care delivery, and support for Medicaid program innovations that directly address social needs as part of health care. The Trump administration, through a …