Health Law and Policy Commons^™

Non-Communicable Disease And Diabetes Screening In Community Settings In Low- And Middle-Income Countries: A Case Study In Senegal, West Africa, Rhonda Belue

Saint Louis University Journal of Health Law & Policy

Sub-Saharan Africa is faced with a significant and increasing burden of non-communicable diseases such as type 2 diabetes mellitus (diabetes). In Senegal, the prevalence of diabetes has been documented to be as high as 8.1% in urban-dwelling Senegalese and is fast approaching the United States prevalence of approximately nine percent; however, insufficient resources are available for prevention efforts and disease management. As a result, many cases remain undiagnosed, leading to an increased likelihood of diabetes complications and mortality. Many of these cases remain undiagnosed or are diagnosed only after complications have developed, such as the need for amputation, kidney failure, …

Nutrition And Health Equity: The Role Of Washington, D.C.’S East Capitol Urban Farm, Tia D. Jeffery

Saint Louis University Journal of Health Law & Policy

Disenfranchised communities have yet to become full beneficiaries of the core values of the Constitution. Health inequities are rooted in the social barriers connected to racism, classism, and sexism. Furthermore, marginalized groups in Washington, District of Columbia (D.C.), reside in food deserts. Urban agriculture has gained exposure as a working solution to the epidemic of food deserts in underserved urban communities. The East Capitol Urban Farm is one of the urban food hub extensions of the University of the District of Columbia College of Agriculture, Urban Sustainability, and Environmental Sciences. It operates in a food desert in Ward 7 of …

Evidence-Based Public Health Is The Answer To Increasing American Childhood Vaccination Rates, Not Legislative Fortitude, Molly F. Anderson

Saint Louis University Journal of Health Law & Policy

After recent outbreaks of vaccine-preventable disease across the United States, some states have responded by removing non-medical exemptions. State legislatures that remove non-medical exemptions do so with the hope of increasing vaccination rates. However, there are serious concerns about this knee-jerk legislative reaction. Removing non-medical exemptions can lead to anti-vaccination sentiment and interference with parental autonomy.

This article argues that instead of removing non-medical exemptions, states should implement evidence-based public health solutions in order to increase vaccination rates. One example of an evidence-based solution is the Community Guide, a resource that contains reviews by a Task Force on a wide …

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: Competition’S Achilles Heel, Thomas L. Greaney

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Optimizing Private Antitrust Enforcement In Health Care, Anne Marie Helm

Saint Louis University Journal of Health Law & Policy

Americans are paying too much for health care services and insurance, in large part due to insufficiently competitive markets. Waves of consolidation have fortified providers and insurers with market power, resulting in higher prices and lower quality for consumers. As antidotes, advocates have proposed various legislative, regulatory, and enforcement solutions. Yet, unlike public antitrust enforcement, private antitrust enforcement is either not mentioned or criticized as sour grapes from competitors or a money grab by consumers. Instead of ignoring or bashing private litigation, those looking to address the health care pricing crisis in the United States should be looking to optimize …

The Anti-Competitive Potential Of Cross-Market Mergers In Health Care, Jaime S. King, Erin C. Fuse Brown

Saint Louis University Journal of Health Law & Policy

Health care consolidation in the United States has been widespread at all levels and across all entities. This consolidation has extended beyond horizontal mergers of hospitals or other providers to include out-of-market mergers, or cross-market mergers. Cross-market mergers include the merger or acquisition of any health care entity that does not directly compete with the acquiring entity in the same product or geographic market. Antitrust enforcers have historically had little in the way of market theory, economic models, or empirical data to inform their analyses on the potential impacts of cross-market mergers on competition. However, recent developments in economic theory …

Competition As Policy Reform: The Use Of Vigorous Antitrust Enforcement, Market-Governance Rules, And Incentives In Health Care, Emilio Varanini

Saint Louis University Journal of Health Law & Policy

In health care, the increase in market concentration on both the insurer side and the provider side has led to insurers and providers acquiring market power. Insurers and providers, in turn, have used that market power to charge higher prices to employers providing employees with medical care without corresponding increases in the quality of that care. Responding more generally to the increase in market concentration in many industries in the United States with a range of inimical effects for the nation’s economy, the Obama Administration suggested a range of policy solutions that this article groups under the term “Competition as …

Managing Medicaid, Isaac D. Buck

Saint Louis University Journal of Health Law & Policy

In a steady but rapid march, managed care has come to Medicaid. Privatization has undoubtedly rebuilt the Medicaid landscape across America over the last three decades. Now, as managed care programs administer health care to three-in-four Medicaid beneficiaries nationwide, whether or not managed care is adequately managing America’s largest public insurance program has become an increasingly important question.

Of particular note have been states’ difficulties in constructing and organizing the bidding and selection processes of the private companies tasked with overseeing the administration of private Medicaid plans. Legal challenges to various states’ bid procurement processes have been well documented. These …

When Is Competition Not Competition: The Curious Case Of Medicare Advantage, Robert A. Berenson

Saint Louis University Journal of Health Law & Policy

Policymakers routinely assume that Medicare Advantage plans and the traditional Medicare program compete for beneficiaries. Yet the District of Columbia federal district court blocked the proposed Aetna and Humana merger, finding that for purposes of antitrust analysis Medicare Advantage plans and traditional Medicare are effectively in different product markets. That is, they do not compete. This article reviews the basis for the court decision, which relied to a large extent on information that Medicare beneficiaries select their insurance coverage based on durable preferences either for the Medicare Advantage or the traditional Medicare option.

The article explores whether the apparently durable …

Taking Quality Of Health Care Seriously In Provider Merger Analysis, Kent Bernard

Saint Louis University Journal of Health Law & Policy

Traditionally, antitrust analysis had no method to quantify the benefits of better health care outcomes from a potential merger to balance them against the potential for increased costs. However, a branch of health care economics allows for that calculation. This approach has not been used in antitrust analysis to date, but United States law is flexible enough to allow such an approach, and the 2010 Horizontal Merger Guidelines contemplate it in Section 5. It enables us to use established procedures to put quality of care into health care merger analysis.

Avoiding Sticker Shock: Legislative Approaches To Protect Consumers From Surprise Medical Bills, Merlow M. Dunham

Saint Louis University Journal of Health Law & Policy

Consumers are increasingly receiving surprise medical bills, where an insured patient is unexpectedly billed directly for medical services received at an in-network health care facility from an out-of-network provider. These situations often arise in emergency rooms, operating rooms, and delivery rooms, despite the efforts of patients to receive care only from in-network providers. Surprise medical bills commonly leave consumers on the hook for thousands of dollars for out-of-network services that they had no opportunity to refuse. This article explores how the steady rise of narrow provider network health plans and the often-corresponding lack of transparency regarding which providers are included …

Working Well(Ness): The Impact Of The Ada Final Rule On Wellness Program Regulation And A Proposal For A Zero-Incentive Rule, Stefanie Brody

Saint Louis University Journal of Health Law & Policy

The Equal Employment Opportunity Commission (EEOC) recently amended wellness program regulation under 29 C.F.R. § 1630.14 of the Americans with Disabilities Act (ADA). Amidst criticism of the new rule, this article proposes the EEOC return to a zero-incentive policy for voluntary wellness programs that include disability-related inquiries or medical examinations. First, it reviews existing literature on wellness programs and the ADA, highlighting the legal and ethical challenges facing American workers with disabilities. Then, it explores the latest case law, illustrating the effects of the new rule compared to the proposal. By eliminating the thirty percent incentive limit and redefining “voluntary” …

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.

Key Issues Facing Medicaid After The Affordable Care Act, Marybeth Musumeci

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Medicaid, Managed Care, And The Mission For The Poor, John V. Jacobi

Saint Louis University Journal of Health Law & Policy

Medicaid has financed care for the poor for five decades. During that time it has balanced two important missions: providing for the particular health needs of the poor, and mainstreaming care for the poor. These roles have been consistent as all insurance payors—public and private—have shifted away from passively funding fragmented care to actively supporting patient-centered coordinated care. But the health needs of the poor go beyond medical interventions; the health status of the poor depends on the provision of social services to address social determinants of health, including housing, nutrition, and employment training services. Unlike non-poor insureds, Medicaid beneficiaries …

Pin The Tail On The Donkey: Beneficiary Enforcement Of The Medicaid Act Over Time, Jane Perkins

Saint Louis University Journal of Health Law & Policy

During the twentieth century, Congress enacted legislation designed to improve the lives of low-income Americans. A number of these laws were enacted by Congress pursuant to the Constitution’s Spending Clause, including the Medicaid Act, which entitles certain low-income individuals to publicly funded health insurance coverage. As enacted in 1965, the Medicaid Act did not include a provision authorizing the statute’s beneficiaries to bring private enforcement actions in court. Since the early 1970s, however, program beneficiaries relied upon the Constitution’s Supremacy Clause or, more frequently, 42 U.S.C. § 1983 for the cause of action allowing them to obtain relief in court. …

On The Expansion Of “Welfare” And “Health” Under Medicaid, Laura D. Hermer

Saint Louis University Journal of Health Law & Policy

Medicaid was intended from its inception to provide financial access to health care for certain categories of impoverished Americans. While rooted in historical welfare programs, it was meant to afford the “deserving” poor access to the same sort of health care that other, wealthier Americans received. Yet despite this seemingly innocuous and laudable purpose, it has become a front in the political and social battles waged over the last several decades on the issues of welfare and the safety net. The latest battleground pits competing visions of Medicaid. One vision seeks to transform Medicaid from a health care program into …

Premiums And Section 1115 Waivers: What Cost Medicaid Expansion?, Sidney D. Watson

Saint Louis University Journal of Health Law & Policy

States reluctant to adopt the Affordable Care Act’s Medicaid expansion are demanding that the U.S. Department of Health and Human Services grant them Section 1115 demonstration waivers that allow them to charge poor people premiums.

The U.S. Department of Health and Human Services has yielded to these demands, granting five states waivers of long standing federal statutory protections that limit state discretion to impose premiums for Medicaid. These premium waivers present a fundamental problem of law because the Secretary of the U.S. Department of Health and Human Services has no statutory authority to grant Section 1115 waivers that allow states …

Mergers And Monopolies: An Examination Of The Cyclical Effect Of Anti-Competition And A Lack Of Rate Regulation In Health Care, Madeline J. Bainer

Saint Louis University Journal of Health Law & Policy

Health care costs continue to rise, forcing consumers to make difficult choices between seeking expensive treatment and risking the consequences without. To combat the inflation of health care costs, the Affordable Care Act implemented a number of policies aimed at improving the quality of care while lowering the cost of that care. In order to accomplish the goals of the Affordable Care Act, health care systems began merging with one another and acquiring smaller groups to incorporate into a vast network of providers. However, many of these mergers offer little value to consumers. Instead, they ultimately drive up the cost …

A False Sense Of Safety: How The Drug Quality And Security Act Fails To Protect Patients From Harm, Tyler Dinkelaker

Saint Louis University Journal of Health Law & Policy

For many years, the art of pharmaceutical compounding in the United States has been largely an overlooked and under regulated industry providing millions of patients each year with customized medications. Only after piecemeal enforcement resulted in hundreds of injuries and deaths in an event known as the New England Compounding Center Tragedy, did legislators and regulatory agencies refocus attention on current regulations in pharmaceutical compounding. Congress passed the Drug Quality and Security Act providing clarification for state and federal agencies as to their specific regulatory authority and responsibility to ensure patient safety in pharmaceutical compounding. However, the Drug Quality and …

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, Kelly Dineen

Saint Louis University Journal of Health Law & Policy

No abstract provided.

The Medicalization Of End-Of-Life Care: The Role Of Health Professions Education, Philip Fung, Miguel Paniagua

Saint Louis University Journal of Health Law & Policy

In the past 100 years, the advances in medical science and technology have shaped the health care delivery system in remarkable ways. The side effect of these advances has been a tendency to dehumanize the dying process, and consequently it has led to the rise of a specialty focused merely on bridging this gap in care. The public’s expectations of our legal, licensing, and medical education systems have also reflected this evolution in health care.

Making Sense Of Family Communication About And At The End Of Life: Family Communication Around End-Of-Life Planning And Decision Making, April R. Trees, Jennifer E. Ohs

Saint Louis University Journal of Health Law & Policy

Families faced with end-of-life (EOL) decisions on behalf of a family member are charged with honoring a care recipient’s wishes, which may or may not be clear to them. The process of decision making is challenging for surrogate decision makers and their families, and it often results in suboptimal decisions that fail to meet the best interests of the patients, cause stress for family members, and burden the legal and medical systems. Effective family communication, something that legal representatives, medical professionals, and social workers are often in positions to influence, can enhance the quality of EOL care planning and decisions. …

Is There A Moral Obligation For Health Care Organizations To Develop Robust Advance Care Planning Programs?, Thomas D. Harter

Saint Louis University Journal of Health Law & Policy

Advance care planning (ACP) has become an integral part of patient care because of its ability to help guide treatment decision making for individuals in need of medical care but who have lost the ability to communicate—temporarily or permanently—due to illness or injury. Not all persons have the same treatment threshold; some persons value their lives above all else and will accept a high level of physical debility regardless of personal discomfort to stay alive. Others value their individual personal comfort over the length of their lives and will refuse otherwise life-sustaining treatment if they believe the treatment will cause …

Give Me Liberty To Choose (A Better) Death: Respecting Autonomy More Fully In Advance Directive Statutes, Kathy L. Cerminara, Joseph R. Kadis

Saint Louis University Journal of Health Law & Policy

In the name of state interests, advance directive statutes almost universally include language requiring that a patient be in a particular physical state as a condition precedent to operation of a directive. This article urges state legislatures to recognize and rectify the conflict they have created by imposing such triggering conditions. First, it examines states’ efforts to facilitate autonomous end-of-life decision making through advance directive statutes. Then it proposes amending those statutes to align the law with medical ethics by eliminating specified physical triggering conditions burdening the exercise of patients’ rights to refuse life-sustaining treatment. Such amendment will improve end-of-life …