Health Law and Policy Commons^™

Narrow Networks, The Very Sick, And The Patient Protection And Affordable Care Act: Recalling The Purpose Of Health Insurance And Reform, Valarie K. Blake

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Consumers purchasing health insurance on both state and federally-run exchanges are finding that affordable premiums may come at the cost of restricted provider choice. So-called narrow networks are increasingly popular in individual, small group, and large group insurance markets as a means for insurers to curb premiums and compete for business. As PPACA regulations limit medical underwriting and homogenize insurance offerings, insurers are agreeing to nudge their patients to a narrow selection of providers in exchange for better reimbursement rates and lower premiums. This may mean wider availability of health insurance for the public, increased enrollment for insurers, and cost-savings …

Overvaluing Employer-Sponsored Health Insurance, Lauren R. Roth

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Although positive and negative assessments of tying health insurance to employment abound, most scholars and policymakers have acknowledged that our long history in this area predicts our future. What they have largely ignored, however, is the extent to which individual attachment to employment-based insurance is at the root of our inability to make broader health reforms. The attachment (1) harms exchange-based insurance and (2) denies employers the ability to use Health Reimbursement Arrangements (“HRAs”) to subsidize the purchase of insurance by their employees on the exchanges.

This Article advocates reducing or eliminating workers’ overvaluation of their health insurance and increasing …

Navigating The Law Of Defense Counsel Ex Parte Interviews Of Treating Physicians, Joseph Regalia, V. Andrew Cass

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This article explores the issue of defense counsel ex parte interviews with treating physicians, and proposes a resolution to standardize the practice that is equitable for all parties involved. Courts and legal scholars have commonly recognized that treating physicians in personal injury litigation are usually fact witnesses, albeit with special expertise, and allow plaintiffs unfettered access while defendants are relegated to a formal deposition which creates a fundamental imbalance in informational power. Moreover, there are significant arguments raised by the defense bar concerning efficiency and fairness. However, allowing defense counsel unlimited and unregulated access to treating physicians creates clear risks …

Abortion And Compelled Physician Speech, David Orentlicher

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No abstract provided.

The Dsm-5: Implications For Health Law, Stacey A. Tovino

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In May 2013, the American Psychiatric Association released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (“DSM-5”). Among other changes, the DSM-5 includes new entries for hoarding disorder and premenstrual dysphoric disorder as well as a reclassified entry for gambling disorder. Using these changes as examples, this Article examines the implications of the DSM-5 for key issues in health law, including health insurance coverage, public and private disability benefit eligibility, and disability discrimination protection. As a descriptive matter, this Article illustrates how the addition of new disorders and the reclassification of existing disorders in the DSM-5 …

Medicaid At 50: No Longer Limited To The "Deserving" Poor?, David Orentlicher

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Professor David Orentlicher considers the significance of the passage of the Affordable Care Act on the Medicaid program. He discusses the expansion of the program's recipients from merely children, pregnant women, single caretakers of children, and disabled persons to all persons up to 138% of the federal poverty level. Professor Orentlicher argues that the Medicaid expansion reflects concerns about the high costs of health care rather than an evolution in societal thinking about the "deserving" poor. As a result, the expansion may not provide a stable source of health care coverage for the expansion population.

The Commerce Power And Congressional Mandates, Dan T. Coenen

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In National Federation of Independent Business v. Sebelius, a five-Justice majority concluded that the commerce power did not support enactment of the so-called “individual mandate,” which imposes a penalty on many persons who fail to buy health insurance. That ruling is sure to spark challenges to other federal laws on the theory that they likewise mandate individuals or entities to take certain actions. Federal laws founded on the commerce power, for example, require mine operators to provide workers with safety helmets and (at least as a practical matter) require mine workers to wear them. Some analysts will say that laws …

Overcoming Barriers To The Protection Of Viable Fetuses, Randy Beck

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I start this Article from the premise that the Court was correct in Roe v. Wade concerning the significance of fetal viability. I assume for the sake of argument that viability is a momentous point in pregnancy and that “logical and biological justifications” support a compelling state interest in protecting the lives of fetuses that have crossed the viability threshold. The goal of this Article is to highlight factors that individually and in concert significantly hinder legislative attempts to preserve the lives of viable fetuses, and to identify measures that, if permitted by the courts, could facilitate the pursuit of …

An Assessment Of Mayor Bloomberg's Public Health Legacy, Rodger D. Citron

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This article contains Rodger D. Citron's interview with Lawrence O. Gostin, Professor of Global Health Law at Georgetown University Law Center and the Director of the World Health Organization Collaborating Center on Public Health Law and Human Rights, regarding Gostin's article for the Hasting Center Report addressing former New York City Mayor Michael Bloomberg’s public health legacy.

Concussions And Sports: Introduction, David Orentlicher

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No abstract provided.

A Restatement Of Health Care Law, David Orentlicher

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No abstract provided.

Giving Thanks: The Ethics Of Grateful Patient Fundraising, Stacey A. Tovino

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Grateful patient fundraising, defined as the solicitation of philanthropic donations by health care providers from current and former patients, raises a number of legal and ethical issues. Elsewhere, I detailed the confidentiality issues raised by the use and disclosure of patient identifiable information by hospital development officers, major gifts officers, institutionally-related foundations, and commercial fundraisers, and proposed corrections to federal health information confidentiality regulations to better balance the competing aims of health care philanthropy and health information confidentiality. In this Article, I analyze several outstanding issues raised by physician involvement in grateful patient fundraising. That is, physicians who solicit philanthropic …

Silence Is Golden . . . Except In Health Care Philanthropy, Stacey A. Tovino

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No abstract provided.

Aging Populations And Physician Aid In Dying: The Evolution Of State Government Policy, David Orentlicher

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Professor David Orentlicher explores the evolution of physician assisted suicide from illegal taboo to the passage of Death with Dignity legislation and caselaw.

Employer-Based Health Care Insurance: Not So Exceptional After All, David Orentlicher

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No abstract provided.

The Changing Legal Climate For Physician Aid In Dying, David Orentlicher

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No abstract provided.

Health Care Reform And Efforts To Encourage Healthy Behavior By Individuals, David Orentlicher

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No abstract provided.

The Future Of The Affordable Care Act: Protecting Economic Health More Than Physical Health?, David Orentlicher

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No abstract provided.

Lost In The Shuffle: How Health And Disability Laws Hurt Disordered Gamblers, Stacey A. Tovino

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Gambling disorder is not a legally sympathetic health condition. Health insurance policies and plans have long excluded treatment for gambling disorder from health insurance coverage. Individuals with gambling disorder who seek disability income insurance benefits from public and private disability income insurers also tend not to be successful in their claims. In addition, federal and state antidiscrimination laws currently exclude individuals with gambling disorder from disability discrimination protections. This Article is the first law review article to challenge the legal treatment of individuals with gambling disorder by showing how health insurance and antidiscrimination laws hurt problem gamblers. Using neuroscience, economics, …

I Need A Doctor: A Critique Of Medicare Financing Of Graduate Medical Education, Stacey A. Tovino

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In its broadest sense, this Article examines the complex relationship between population booms, doctor shortages, and United States government financing of graduate medical education (GME). More specifically, this Article argues that current rules governing the calculation of Medicare payments to teaching hospitals for the costs of GME are based on cost, population, and other data that are no longer relevant. As applied, these formulas discriminate in favor of the nation's oldest teaching hospitals, located in New England and the Middle Atlantic, and against current and future teaching hospitals located in growing population centers, especially regions in the South and West. …

Crafting A Narrative For The Red State Option, Elizabeth Weeks Leonard

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This Article examines the current state of play following the Supreme Court's decision in NFIB v. Sebelius to allow states the option of expanding their Medicaid programs in accordance with the Patient Protection and Affordable Care Act (ACA). Holding that mandatory expansion was unconstitutionally coercive, the Court created the Red State Option. Despite the enormously generous federal financial support for Medicaid expansion, close to half of the states have declined. At the same time, at least eight Republican-led states have crossed Tea Party lines to accept federal funding for expansion. Drawing lessons from these states, including Arkansas, Arizona, Michigan, and …

The Prudential Third Party Standing Of Family-Owned Corporations, Matthew I. Hall, Benjamin Means

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On November 26, 2013, the Supreme Court agreed to decide whether for-profit corporations or their shareholders have standing to challenge federal regulations that implement the Patient Protection and Affordable Care Act (ACA). At issue in the two cases consolidated for appeal, Hobby Lobby and Conestoga Wood Specialties, are regulations mandating that employers with fifty or more employees offer health insurance that includes coverage for all contraceptives approved by the Food and Drug Administration (FDA). The plaintiffs assert that providing certain types of contraceptive care would be contrary to their religious beliefs and allege, therefore, that the mandate violates the Religious …

Ignorance, Harm, And The Regulation Of Performance-Enhancing Substances, Lisa Milot

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There is a disconnect between how legal and sporting authorities, on the one hand, and many elite athletes, on the other, view the use of performance-enhancing substances. While official and popular narratives portray the use of these substances as isolated examples of deviant behavior, to the elite athletes who daily push their bodies beyond societally normal limits of pain and risk, enhancement is oftentimes an accepted part of the job. As a result, efforts to regulate and detect athletes’ use of these substances have consistently captured only a small fraction of the use that exists.

This Article describes the ways …

Genomics Unbound: The Scientific And Legal Case Against Patents Based On Naturally Occurring Dna Sequences, Fazal Khan

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While there have been mixed opinions as to whether gene patents were dead in light of Prometheus,this Article argues that a proper understanding of patent law, genomics, and public policy concerns should lead to no other result. The primary focus of this piece is to rebut certain vested interests in the biotechnology industry and affirm the normative claim that gene patents improperly fetter genomics research and development. First, through the lens of the Myriad case, we will recount why there was such a strong public interest movement against recognizing such patents. Specifically, we will show how patents on naturally occurring …

Ovaries, Testicles, And Uteruses, Oh My! Regulating Reproductive Tissue Transplants, Valarie K. Blake

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This article will explore key regulatory and ethical challenges presented by reproductive tissue transplants (RTTs) as they are currently developing, recognizing that additional issues may reveal themselves as the technologies progress. Part I of this article will begin with a discussion of the current status of the technology, including the results and status of animal and human experiments for all three types of transplants. Part II will explore the demand for RTTs — who might consider such a transplant and why RTTS might be considered by some patients as more favorable than other reproductive options. Part III will explore the …

Deactivating Implanted Cardiac Devices: Euthanasia Or The Withdrawal Of Treatment?, David Orentlicher

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No abstract provided.

Concussion And Football: Failures To Respond By The Nfl And The Medical Profession, David Orentlicher

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No abstract provided.

The Fda’S Graphic Tobacco Warning And The First Amendment, David Orentlicher

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No abstract provided.

Nfib V. Sebelius: Proportionality In The Exercise Of Congressional Power, David Orentlicher

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With its opinion on the constitutionality of the Affordable Care Act (ACA), the U.S. Supreme Court sparked much discussion regarding the implications of the case for other federal statutes. In particular, scholars have debated the significance of the Court's recognition of an anticoercion limit to the Spending Clause power.

When it recognized an anticoercion limit for the ACA's Medicaid expansion, the Court left considerable uncertainty as to the parameters of that limit. This essay sketches out one valuable and very plausible interpretation of the Court's new anticoercion principle. It also indicates how this new principle can address a long-standing problem …

Conflicts Of Interest In Medicine, Research, And Law: A Comparison, Stacey A. Tovino

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Several of the remarks and articles presented in this symposium have addressed conflicts of interest arising during the provision of legal counsel to individuals who are elderly, including specific conflicts of interest implicated by estate planning, retirement planning, and long-term care planning. Topics examined thus far include conflicts of interest with respect to the application of rules of confidentiality within state rules of professional conduct to elderly clients with impaired decision-making capacity; conflicts of interest involving representative payees for Social Security benefits; conflicts of interest in distributions when parents enter into marriages that are unprotected by law; and conflicts of …