Health Law and Policy Commons^™

Post-Pandemic, But Not Post-Racial, Courtney Lauren Anderson

Saint Louis University Journal of Health Law & Policy

The Fair Housing Rights Act and the Voting Rights Act have had measurable success in providing opportunities to address intentional discrimination in housing and voting contexts. Plaintiffs with evidence of direct illegalities have clear frameworks under which justice may be sought, and both Acts provide a path for relief upon violations of housing and voting rights because of one’s membership in a protected class. However, the disparate impact theories that are cognizable under both Acts have been scrutinized for lackluster results. Practitioners and academicians have written about and experienced the difficulties plaintiffs face in successfully proving that a particular housing …

Developing A Health Care Workforce That Supports Team-Based Care Models That Integrate Health And Social Services, Jessica Mantel, Mcclain Sampson, David S. Buck, Winston Liaw, Lechauncy Woodard, Jasmine Singh

Saint Louis University Journal of Health Law & Policy

Across the country, health care professionals are joining forces to improve the health care of populations with complex social, financial, and behavioral health needs. One promising approach relies on community-based integrated health teams (CIHTs), or interprofessional teams that integrate a broad range of medical, behavioral health, and social services, offer intensive case management, and link patients to available community resources. Yet whether CIHTs fulfill their potential depends in part on policymakers enacting policies that support CIHTs delivering comprehensive, high-value care to their patients. Drawing on the insights of CIHT professionals shared with the authors, this Article highlights several factors that …

Immigration Reforms As Health Policy, Medha D. Makhlouf, Patrick J. Glen

Saint Louis University Journal of Health Law & Policy

The 2020 election, uniting control of the political branches in the Democratic party, opened up a realistic possibility of immigration reform. Reform of the immigration system is long overdue, but in pursuing such reform, Congress should cast a broad net and recognize the health policies embedded in immigration laws. Some immigration laws undermine health policies designed to improve individual and population health. For example, immigration inadmissibility and deportability laws that chill noncitizens from enrolling in health-promoting public benefits contribute to health inequities in immigrant communities that spill over into the broader population—a fact highlighted by the still-raging COVID-19 pandemic. Restrictions …

Insurer Accountability In The Next Generation Of Health Reform, Katie Keith

Saint Louis University Journal of Health Law & Policy

Democrats continue to debate how to extend health insurance coverage to the remaining uninsured and improve the affordability and quality of coverage and care. Prior intraparty debates—over whether to build upon the Affordable Care Act, create a public option, or expand the Medicare program to all (or more)—have centered on how to best accomplish these goals and whether health care delivery should be mediated through public versus private payers. These are worthwhile debates, but the history of health reform suggests that private health insurers are here to stay. This Article accepts the premise that future coverage expansions will likely rely …

Revisiting Health Care Fraud In The Biden Administration, Joan H. Krause

Saint Louis University Journal of Health Law & Policy

Although not one of the Biden administration’s initial priorities, health care fraud inevitably will be a major concern. First, the federal government’s response to the COVID-19 pandemic—including the disbursement of more than $175 billion in provider relief funds and the loosening of traditionally strict rules on Medicare reimbursement for telehealth services—has created new opportunities to divert health care funds for fraudulent purposes. Second, President Joseph Biden took office in the midst of the incomplete transition from volume-based to value-based payment in the federal health care programs, which will allow fraud to flourish in the gaps between multiple reimbursement systems. Third, …

Beyond Disability Rights: A Way Forward After The 2020 Election, Robyn M. Powell

Saint Louis University Journal of Health Law & Policy

Throughout Donald Trump’s presidency, people with disabilities and other historically marginalized communities experienced incessant attacks on their rights. From continuous attempts to repeal the Affordable Care Act, to decreased enforcement of federal disability rights laws, to reductions to social safety net programs, to the intentional disregard of the COVID-19 pandemic, Trump’s presidency threatened nearly every facet of disabled people’s lives. However, even before the Trump administration, people with disabilities experienced a range of pervasive and persistent social, economic, and health inequities. Moreover, many of these injustices endure today—nearly two years since President Trump left office.

The disability rights movement originated …

Access To Court Cases From The Supreme Court’S 2020–2021 Term: The New Majority’S Debut, Sarah Somers, Jane Perkins, Abigail Coursolle, Sarah Grusin

Saint Louis University Journal of Health Law & Policy

Throughout the Supreme Court’s first term without Justice Ruth Bader Ginsburg, the Court issued only a few major opinions with respect to access to the Court for civil litigants, and it issued none that discarded major precedents. Yet, in several areas, the Court demonstrated an increasingly conservative bent and began to lay the groundwork for major changes. In this Article, we discuss selected opinions from the Court’s 2020–2021 term that may have an impact on access to the courts for individuals seeking to vindicate civil and constitutional rights. In particular, it focuses on cases that may affect access for low-income …

The Impact Of Bostock V. Clayton County On Access To Health Care For Lgbtq Persons, Hiba B. Al-Ramahi

Saint Louis University Journal of Health Law & Policy

LGBTQ individuals face countless acts of discrimination in health care insurance and delivery. In spite of this inequality, there are zero LGBTQ-inclusive health insurance protections in over half of the United States. Title VII of the Civil Rights Act (Title VII) and Section 1557 of the Patient Protection and Affordable Care Act (ACA) are two federal statutes that prohibit discrimination, in relevant part, on the basis of sex. Both federal statutes have been greatly impacted by the Supreme Court decision in Bostock v. Clayton County, which interpreted “sex” in Title VII to include gender identity and sexual orientation. This …

“Woman Enough” To Win? An Analysis Of Sex Testing In College Athletics, Brenna M. Moreno

Saint Louis University Journal of Health Law & Policy

In recent years, dozens of bills restricting the rights of transgender, or trans, individuals have been introduced in state legislatures throughout the country. To date, ten states have successfully passed laws prohibiting trans athletes from competing on teams in accordance with their gender identities. For its athletes, the National Collegiate Athletic Association (NCAA), the United States’ largest intercollegiate athletic organization, has pursued a compromise to balance trans inclusion and fair competition. Established in 2011, the NCAA’s conditionally inclusive policy permits trans women—meaning those who were assigned the sex of male but identify as women—to compete on a women’s team only …

Table Of Contents

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Masthead

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Foreword: Probing The Intersection Of Climate Change And Public Health, Ana Santos Rutschman

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Pursuing Climate Justice: Learning The Lessons Of The Covid-19 Response, Lance Gable

Saint Louis University Journal of Health Law & Policy

The COVID-19 pandemic and the climate crisis have many parallels. Both are large disruptive events that pose foundational threats to humanity through the capacity to cause substantial harm and death to humans. Both pose complex and multifaceted challenges perpetuated by multiple factors that are difficult to interrupt or mitigate. Both are subject to evolving scientific understandings of their underlying causes and potential interventions. Both are novel challenges not previously faced by most humans alive today that comprise potential threats to human society over an extended time period. These similarities allow scholars and policymakers to extrapolate and understand how the responses …

Tribal Water Rights And Tribal Health: The Klamath Tribes And The Navajo Nation During The Covid-19 Pandemic, Robin Kundis Craig

Saint Louis University Journal of Health Law & Policy

Public health measures to combat COVID-19, especially in the first year before vaccines became widely available, required individuals to be able to access fresh water while remaining isolated from most of their fellow human beings. For the approximately 500,000 households in the United States and over two million Americans who lacked access to reliable indoor running water, these COVID-19 measures presented a considerable added challenge on top of the existing risks to their health from an insecure water supply.

Many of these people were Native Americans, whose Tribes often lack fully adjudicated, quantified, and deliverable rights to fresh water. To …

Meeting Water Affordability Challenges In The Era Of The Unexpected, Amy Hardberger

Saint Louis University Journal of Health Law & Policy

The vast majority of Americans depend on a public water supply for the procurement and delivery of their water. Water providers are tasked with securing water supplies for the future, building and maintaining the infrastructure needed for delivery, and ensuring service is available for new customers. This system has worked for many decades in part because the costs of water and construction were relatively low; however, in the past twenty years, water rates have increased at twice the rate of inflation. At the same time, income has remained stagnant. Water services now require a larger percentage of household budgets than …

Preventing Maternal Deaths: A Critical Feminist Approach To Maternal Mortality In The United States, Jemalyn Harvey

Saint Louis University Journal of Health Law & Policy

With roughly 700 women dying each year as a result of pregnancy and/or delivery complications, the United States has the highest rate of maternal deaths in the developed world. As each year passes, the maternal death rate continues to increase, despite the fact that sixty percent of these deaths are preventable. Factors such as quality care, receiving accurate and timely medical diagnoses, and recognizing urgent maternal warning signs all contribute to the preventability of deaths and why women, particularly women of color, so often fall victim to this tragic phenomenon. As an effort to address maternal death in the United …

Making Rights Meaningful: Advocating For Simple Changes In Federal Agency Practice To Promote Health Equity, Mary Quandt

Saint Louis University Journal of Health Law & Policy

Despite federal protections afforded by Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act, Americans still experience prohibited discrimination in health care on the basis of race, color, and national origin. The Department of Health and Human Services’ Office for Civil Rights (“HHS OCR”) investigates complaints and enforces protections when alleged discrimination occurs in health care covered entities receiving federal funding. The legal analyses produced in these investigations can be valuable tools for covered entities to utilize in their efforts to remain in compliance with civil rights laws, yet few are ever made public …

Protecting Patients From Physicians Who Inflict Harm: New Legal Resources For State Medical Boards, Elizabeth Pendo, Tristan Mcintosh, Heidi Walsh, Kari Baldwin, James M. Dubois

All Faculty Scholarship

State medical boards (SMBs) protect the public by ensuring that physicians uphold appropriate standards of care and ethical practice. Despite this clear purpose, egregious types of wrongdoing by physicians are alarmingly frequent, harmful, and under-reported. Even when egregious wrongdoing is reported to SMBs, it is unclear why SMBs sometimes fail to promptly remove seriously offending physicians from practice. Legal and policy tools that are targeted, well-informed, and actionable are urgently needed to help SMBs more effectively protect patients from egregious wrongdoing by physicians.

Past reviews of SMB performance have identified features of SMBs associated with higher rates of severe disciplinary …

What Covid-19 Laid Bare: Adventures In Workers’ Compensation Causation, Michael C. Duff

All Faculty Scholarship

This essay performs a close analysis of workers’ compensation coverage of COVID-19 and arrives at the conclusion that it should not be “impossible” to prove in a legal sense that an employee’s COVID-19 was caused by work. Scientific proof is not the same as legal proof: workers’ compensation law has never required that claims must be supported by irrefutable scientific proof of workplace causation. Yet repeatedly one heard this suggestion during public discussion on workers’ compensation coverage of employees.

Still, there is good evidence that even when workers’ compensation undisputedly covers work-related disease employers seldom pay benefits (and states do …

The Effects Of Missouri's Medicaid Expansion, Chandni Challa

SLU Law Journal Online

A Missouri Supreme Court ordered the Missouri legislature to implement a state constitutional amendment to expand Medicaid. In this article, Chandni Challa argues that this decision will undoubtedly affect the state economy, and based on empirical evidence from Michigan, provide a net benefit.

Barriers To Medical Board Discipline: Cultural And Organizational Constraints, Elizabeth Chiarello

Saint Louis University Journal of Health Law & Policy

Medical boards are responsible for disciplining physicians who inflict egregious harm on their patients, yet they often fail to do so. This Article develops a cultural and organizational framework for explaining why boards so often fail to discipline physicians. The framework highlights three types of barriers that impede board action: (1) input barriers that prevent hospitals and clinics from reporting harm to boards, (2) processing barriers that prevent boards from taking sufficient action against physicians who do harm, and (3) output barriers that prevent boards from sharing information about physicians who do harm with other disciplinary agencies like other medical …

Protecting The Rights And Wellbeing Of People With Disabilities During The Covid-19 Pandemic, Elizabeth Pendo

All Faculty Scholarship

The COVID-19 pandemic has exposed and exacerbated significant inequities experienced by people with disabilities. It has also emphasized the value of legal protections against discrimination based on disability. The Americans with Disabilities Act was enacted 30 years ago to eliminate discrimination against people with disabilities and ensure equal opportunity across major areas of American life (ADA, 2008). Together with an earlier law, the Rehabilitation Act of 1973 Rehabilitation Act, 2012), this landmark civil rights law impacts a broad range of issues raised by the COVID-19 pandemic and protects a large and growing number of Americans. This Chapter focuses on application …

Disparities In Health Care: The Pandemic’S Lessons For Health Lawyers, Danielle Pelfrey Duryea, Nicole Huberfeld, Ruqaiijah Yearby

All Faculty Scholarship

Population-level disparities in health and health care came to the forefront of U.S. public consciousness in 2020. As the racial, ethnic, and socioeconomic stratification of COVID-19 infection and death rates emerged with chilling clarity, the Black Lives Matter protests of the summer focused millions of Americans on the complex, structural nature of inequity and its long-lasting effects.

Access to quality health care is a “social determinant of health,” meaning that it is one of the “non-medical factors that influence health outcomes . . . the conditions in which people are born, grow, work, live, and age, and the wider set …

Table Of Contents

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Masthead

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Introduction, Alexander Williams

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Racism, Health Equity, And Crisis Standards Of Care In The Covid-19 Pandemic, Charlene Galarneau, Ruqaiijah Yearby

Saint Louis University Journal of Health Law & Policy

Long-standing and deeply embedded institutional racism, notably anti-Black racism in U.S. health care, has provided a solid footing for the health inequities by race evident in the COVID-19 pandemic. Inequities in susceptibility, exposure, infection, hospitalization, and treatment reflect and reinforce this racism and cause incalculable and preventable suffering in and loss of Black lives. This Article identifies multiple expressions of racism evident in the crisis standards of care (CSC) created by states and health care institutions to guide the ethical allocation of scarce critical care resources including ventilators. Contextualized within the broad landscape of health inequities pre-COVID-19 as well as …

Centering Racial Equity: Disparities Task Forces As A Strategy To Ensure An Equitable Pandemic Response, Dawn M. Hunter, Betsy Lawton

Saint Louis University Journal of Health Law & Policy

COVID-19 has had a stark and severe impact on health, economic stability, housing, and education in communities of color in the United States. As the pandemic has unfolded, the disproportionate number of cases, hospitalizations, and deaths due to COVID-19 among Black, Hispanic and Latinx, and Indigenous people has served as a stark reminder that the systems and structures that lead to these disparities need to be changed in order to achieve equitable outcomes.

This Article assesses efforts by cities, counties, states, and organizations to address the impact of COVID-19 on communities of color through formal task forces or working groups …

Seeking Safety While Giving Birth During The Pandemic, Elizabeth Kukura

Saint Louis University Journal of Health Law & Policy

As COVID-19 spread throughout the United States in early 2020, many pregnant people sought alternatives to delivering in a hospital. Midwifery practices offering services at home or in a freestanding birth center reported record numbers of inquiries, including from people looking to transfer care near the end of pregnancy. Whether due to fear of COVID-19 exposure in health care settings or out of a desire to avoid restrictive hospital policies regarding support people and newborn separation, people who had not previously considered home birth were newly drawn to midwifery care and others who had considered a midwife-attended birth redoubled their …

Policies Of Exclusion: The Impact Of Covid-19 On People With Disabilities, Amanda M. Caleb, Stacy Gallin

Saint Louis University Journal of Health Law & Policy

COVID-19 has had a significant impact on marginalized groups and has amplified the social and health inequalities in society, particularly for people with disabilities (PwDs), who are at higher risk of dying from the coronavirus. As such, it is vital that policies and practices include and protect PwDs, yet that is not the case across the United States. In this article, we examine policies related to COVID-19 that have further othered PwDs and that have created practical and theoretical inequity. In looking at public health strategies that are meant to protect the public, we argue that measures such as social …