Health Law and Policy Commons^™

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” …

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

No abstract provided.

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Saint Louis University Journal of Health Law & Policy

No abstract provided.

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

No abstract provided.

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Saint Louis University Journal of Health Law & Policy

No abstract provided.

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 …

What Hope For Health In All Policies’ Addition And Multiplication Of Equity In An Age Of Subtraction And Division At The Federal Level?: The Memphis Experience, Amy T. Campbell

Saint Louis University Journal of Health Law & Policy

Increasingly, people recognize that social factors, such as poverty, the living environment, and educational status, substantially affect health outcomes. A “health in all policies approach” (HiAP) seeks structural reform of policymaking to require purposeful consideration, across an interconnected range of public sector actors, of the health equity and justice policy-level considerations of these factors. With the election of Donald J. Trump as 45th President in the United States, however, the U.S. entered a world where the math of the day is division and subtraction, rather than addition or multiplication. And yet, hope in HiAP remains through examples of innovative approaches …

Political Rhetoric And Minority Health: Introducing The Rhetoric-Policy-Health Paradigm, Kimberly Cogdell Grainger

Saint Louis University Journal of Health Law & Policy

Rhetoric is a persuasive device that has been studied for centuries by philosophers, thinkers, and teachers. In the political sphere of the Trump era, the bombastic, social media driven dissemination of rhetoric creates the perfect space to increase its effect. Today, there are clear examples of how rhetoric influences policy. This Article explores the link between divisive political rhetoric and policies that negatively affect minority health in the U.S. The rhetoric-policy-health (RPH) paradigm illustrates the connection between rhetoric and health. Existing public health policy research related to Health in All Policies and the social determinants of health combined with rhetorical …

The Faltering Promise Of Fda Tobacco Regulation, Micah L. Berman

Saint Louis University Journal of Health Law & Policy

Congress passed the Tobacco Control Act (TCA) in 2009, giving the FDA the authority to regulate tobacco products for the first time. Ten years later, the promise that the TCA’s enactment would be a transformative moment for public health has not materialized. To the contrary, the FDA’s most notable regulatory effort—requiring graphic warnings on cigarette packages and advertisements—has been struck down in court, and the FDA is now scrambling to address a youth e-cigarette epidemic that caught it off guard. This Article provides a brief review of TCA implementation during the Obama administration, and it reviews the Trump administration’s “comprehensive …

“I Walk In, Sign. I Don’T Have To Go Through Congress.” President Trump’S Use Of Executive Orders To Unravel The Patient Protection And Affordable Care Act, Elizabeth Van Nostrand, Tina Batra Hershey

Saint Louis University Journal of Health Law & Policy

Executive orders, used by presidents to advance their administrations’ agendas, have changed history. These powerful written instruments were used to confine Japanese Americans during World War II, desegregate public schools, and create NASA. On the day of his inauguration, President Donald J. Trump issued his first Executive Order which directed secretaries of executive branch agencies to begin dismantling President Barack Obama’s flagship initiative—the Patient Protection and Affordable Care Act (ACA). This action, along with subsequent executive orders, precipitated a flurry of regulatory change and judicial challenges. Whether President Trump will ultimately be successful in crippling the ACA is still to …

Three Lost Ebola Facts And Public Health Legal Preparedness, Robert Gatter

Saint Louis University Journal of Health Law & Policy

Three key facts about Ebola Transmission should drive policy designed to control the risk of transmission during a crisis.

• Ebola—like HIV—is not easily transmissible human-to-human.
• Ebola has “dry” and “wet” symptoms, and only the wet symptoms threaten public health.
• A fever is Ebola’s canary in a coal mine; it provides timely warning of a coming threat.

Yet, during the U.S. Ebola scare in 2014, these three facts were lost. Unnecessary quarantine, stigma, and burden on those exposed to Ebola resulted, including especially for those who volunteered to fight the disease at its source abroad. Tragically, the law permitted these injustices …

Stretching Armstrong: How The Eighth Circuit Incorrectly Applied Supreme Court Precedent In Does V. Gillespie, Lauren E. Pair

Saint Louis University Journal of Health Law & Policy

Medicaid serves as an important source of health insurance for millions of Americans. One of the Act’s core tenants is the patient’s freedom to choose from any qualified and willing provider. This “freedom of choice” provision was eventually codified, and subsequent protections were put in place to protect a patient’s choice regarding family planning services. However, as states attempt to limit access to family planning services by severing their Medicaid contracts with Planned Parenthood, patients must rely on § 1983 to pursue relief in federal courts. Section 1983 provides a right of action for the violation of any federal right …

Addressing Urban Health And Food Policy Through Resiliency Food Hubs: A Case Study From Washington, D.C., Dwane Jones

Saint Louis University Journal of Health Law & Policy

By 2050, the world’s population is projected to exceed nine billion people. Most of this growth is expected to materialize in urban and urbanizing areas, potentially further increasing disparities amongst populations in these environments. Historically, urban environments have lacked ample opportunities for providing locally grown, community-operated, small-scale urban farms that help to minimize food insecurity. Similarly, urban environments have lacked resiliency respective to small-scale farm operations. As a result, many public health issues and related policies are either antiquated or non-existent when it comes to providing opportunities for food security and resiliency in urban environments.

This article suggests several key …

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.

Belling The Cat: Implementation Of A Prospective Payment Reimbursement System For Critical Access Hospitals, Its Likely Success, And Political Implications Of This Policy Move, Erin E. Grant

Saint Louis University Journal of Health Law & Policy

Health care is plagued by inefficient reimbursement policies which encourage expensive financial waste with little incentive to maintain care quality. Though no perfect solution exists, effective remedies may require a hard look at programs so far untouched by policy changes. This article discusses the application of a prospective payment system of reimbursement for critical access hospitals, as well as how this policy change would affect rural health care access, costs, and quality of care. Though some fear prospective payment systems of reimbursement would cripple rural health care, evidence shows it would likely promote more cost-efficient care without diminishing quality or …