Health Law and Policy Commons^™

The Contraception Mandate Accomodated: Why The Rfra Claim In Zubik V. Burwell Fails, Caroline Mala Corbin

Short Works

No abstract provided.

Physician Quality Reporting System Program Updates And The Impact On Emergency Medicine Practice., Jennifer L Wiler, Michael Granovsky, Stephen V Cantrill, Richard Newell, Arjun K Venkatesh, Jeremiah D Schuur

Emergency Medicine Faculty Publications

In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician's to focus on quality of care measures and report quality performance for the first time. Initially termed "The Physician Voluntary Reporting Program," various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, …

Hospital Mergers And Economic Efficiency, Roger D. Blair, Christine Piette Durrance, D. Daniel Sokol

Washington Law Review

Consolidation via merger both from hospital-to-hospital mergers and from hospital acquisitions of physician groups is changing the competitive landscape of the provision of health care delivery in the United States. This Article undertakes a legal and economic examination of a recent Ninth Circuit case examining the hospital acquisition of a physician group. This Article explores the Saint Alphonsus Medical Center-Nampa Inc. v. St. Luke’s Health System, Ltd. (St. Luke’s) decision—proposing a type of analysis that the district court and Ninth Circuit should have undertaken and that we hope future courts undertake when analyzing mergers in the health care …

Buyers In The Baby Market: Toward A Transparent Consumerism, June Carbone, Jody Lyneé Madeira

Washington Law Review

This Article assesses the forces on the horizon remaking the fertility industry, including greater consolidation in the health care industry, the prospects for expanding (or contracting) insurance coverage, the likely sources of funding for future innovation in the industry, and the impact of globalization and fertility tourism. It concludes that concentration in the American market, in contrast with other medical services, may not necessarily raise prices, and price differentiation may proceed more from fertility tourism than from competition within a single geographic region. The largest challenge may be linking those who would fund innovation, whether innovation that produces new high …

The Law, Economics, And Medicine Of Off-Label Prescribing, William S. Comanor, Jack Needleman

Washington Law Review

There is a major dissonance in the current structure of regulating new drugs that have more than one medical indication. Physicians are authorized to prescribe these drugs for all indications including those beyond their approved purposes. However, product manufacturers are expressly prohibited from marketing or promoting their drugs for any purpose other than those which have been specifically indicated. While prescribing physicians are encouraged to gain medical information on any additional indications, they cannot obtain it from one of its most likely sources: the drug’s supplier. The Second Circuit Court of Appeals’ recent opinion in United States v. Caronia has …

A Flexible Health Care Workforce Requires A Flexible Regulatory Environment: Promoting Health Care Competition Through Regulatory Reform, Andrew I. Gavil, Tara Isa Koslov

Washington Law Review

Effective competition policy is critical to the success of U.S. health care reform, including efforts to reduce health care costs, increase quality of care, and expand access to health care services. While promoting competition is necessary at every level of the rapidly evolving health care system, it is particularly important with respect to licensed professionals who provide health care services. This Article argues that the current system of health care professional regulation, born of the last century, is in numerous respects an impediment to the kinds of changes needed to fully unleash the benefits of competition among different types of …

Navigating Through The Fog Of Vertical Merger Law: A Guide To Counselling Hospital-Physician Consolidation Under The Clayton Act, Thomas L. Greaney, Douglas Ross

Washington Law Review

Lawyers assessing legality under the antitrust laws of hospital acquisitions of physician practices face a quandary. The case law is sparse, federal enforcement guidance outdated, and academic input conflicting. Applying these muddled standards in the rapidlyevolving health care sector only magnifies the uncertainty. While most transactions will be competitively neutral or beneficial, rapidly evolving market conditions causing integration between hospitals and physicians present opportunities for consolidations that may harm consumer interests. Indeed, given the highly concentrated structure of many hospital markets in the nation, preemptive acquisitions of physician practices may be a tempting strategy for some to undermine competition. This …

Buyer Power And Healthcare Prices, John B. Kirkwood

Washington Law Review

One major reason why healthcare spending is much higher in America than in other countries is that our prices are exceptionally high. This Article addresses whether we ought to rely more heavily on buyer power to reduce those prices, as other nations do. It focuses on two sectors where greater buyer power could easily be exercised: prescription drugs covered by Medicare and hospital and physician services covered by private insurance. The Article concludes that the biggest buyer of all, the federal government, should be allowed to negotiate Medicare prescription drug prices. This would likely reduce the prices of many branded …

Hospital Mergers And Economic Efficiency, Roger D. Blair, Christine Piette Durrance, D. Daniel Sokol

UF Law Faculty Publications

Consolidation via merger both from hospital-to-hospital mergers and from hospital acquisitions of physician groups is changing the competitive landscape of the provision of health care delivery in the United States. This Article undertakes a legal and economic examination of a recent Ninth Circuit case examining the hospital acquisition of a physician group. This Article explores the Saint Alphonsus Medical Center-Nampa Inc. v. St. Luke’s Health System, Ltd. (St. Luke’s) decision—proposing a type of analysis that the district court and Ninth Circuit should have undertaken and that we hope future courts undertake when analyzing mergers in the …

Buyers In The Baby Market: Toward A Transparent Consumerism, June Carbone, Jody Lyneé Madeira

Washington Law Review

This Article assesses the forces on the horizon remaking the fertility industry, including greater consolidation in the health care industry, the prospects for expanding (or contracting) insurance coverage, the likely sources of funding for future innovation in the industry, and the impact of globalization and fertility tourism. It concludes that concentration in the American market, in contrast with other medical services, may not necessarily raise prices, and price differentiation may proceed more from fertility tourism than from competition within a single geographic region. The largest challenge may be linking those who would fund innovation, whether innovation that produces new high …

Hospital Mergers And Economic Efficiency, Roger D. Blair, Christine Piette Durrance, D. Daniel Sokol

Washington Law Review

Consolidation via merger both from hospital-to-hospital mergers and from hospital acquisitions of physician groups is changing the competitive landscape of the provision of health care delivery in the United States. This Article undertakes a legal and economic examination of a recent Ninth Circuit case examining the hospital acquisition of a physician group. This Article explores the Saint Alphonsus Medical Center-Nampa Inc. v. St. Luke’s Health System, Ltd. (St. Luke’s) decision—proposing a type of analysis that the district court and Ninth Circuit should have undertaken and that we hope future courts undertake when analyzing mergers in the health care …

The Law, Economics, And Medicine Of Off-Label Prescribing, William S. Comanor, Jack Needleman

Washington Law Review

There is a major dissonance in the current structure of regulating new drugs that have more than one medical indication. Physicians are authorized to prescribe these drugs for all indications including those beyond their approved purposes. However, product manufacturers are expressly prohibited from marketing or promoting their drugs for any purpose other than those which have been specifically indicated. While prescribing physicians are encouraged to gain medical information on any additional indications, they cannot obtain it from one of its most likely sources: the drug’s supplier. The Second Circuit Court of Appeals’ recent opinion in United States v. Caronia has …

Contraceptive Coverage Falls, No More: Using Rfra To Limit The Scope Of Religious Challenges To The Aca's Contraceptive Mandate, M. Catherine Norman

Mercer Law Review

Contraceptive coverage is a required part of all new insurance plans under the Patient Protection and Affordable Care Act (ACA), but many employers' are exempt from this requirement. Other employers have challenged the contraceptive requirement on religious grounds. In East Texas Baptist University v. Burwell, the United States Court of Appeals for the Fifth Circuit held as follows: (1) the plaintiffs are either automatically exempt from the contraceptive-coverage mandate or eligible for accommodation upon application; (2) the challenged provisions do not violate rights to religious freedom under the Religious Freedom and Restoration Act (RFRA); (3) RFRA applies only to …

Byrne: Closing The Gap Between Hipaa And Patient Privacy, Austin Rutherford

San Diego Law Review

HIPAA’s lack of an individualized remedy harmed individuals and left the law a toothless monster, but Byrne begins to fill the longstanding gap by offering greater protection for individuals and their sensitive information. Byrne will also incentivize better compliance with HIPAA by instilling in companies a fear of sizeable tort suit damage awards.

Part II of this Note introduces HIPAA and its ability to protect sensitive health information. Part III discusses the facts, holding, and reasoning of Byrne, in which a state supreme court, for the first time, recognized HIPAA requirements as a duty owed in negligence claims. Part IV …

A Liberal Dilemma: Respecting Autonomy While Also Protecting Inchoate Children From Prenatal Substance Abuse., Andrew J. Weisberg, Frank E. Vandervort

Articles

Substance abuse is a significant social problem in America. It is estimated that some eighteen million Americans have an alcohol abuse problem and that almost five million have a drug abuse problem. According to the National Institute on Drug Abuse, substance abuse costs some $700 billion per year Substance abuse is a major contributor to child maltreatment. It is estimated that between one- and two-thirds of cases in which children enter foster care are linked to parental substance abuse. Unfortunately, this may be an underestimate as recent research suggests that many cases, particularly cases in which children have been exposed …

The Fatality And Morbidity Components Of The Value Of Statistical Life, W. Kip Viscusi, Elissa Philip Gentry

Vanderbilt Law School Faculty Publications

The fatality risk–money tradeoff that is the value of a statistical life (VSL) may vary with the nature of the fatality event. While all fatalities involve loss of future life expectancy, the morbidity effects and their duration may differ. This article analyzes fatality risks accompanied by morbidity effects of different duration to disentangle the mortality and morbidity components of VSL using data from the Census of Fatal Occupational Injuries (CFOI). The VSL is comprised of the sum of the value of the fatality risk and the value of the morbidity risk. Labor market valuations of morbidity risks are positive, even …

Monitoring Hiv And Aids Related Policy Reforms: A Road Map To Strengthen Policy Monitoring And Implementation In Pepfar Partner Countries, Jeffrey Lane, Andre Verani, Mai Hijazi, Erin Hurley, Amy Hagopian, Nicole Judice, Ron Macinnis, Sallie Sanford, Sarah Zelek, Aaron Katz

Articles

Achieving an AIDS-free generation will require the adoption and implementation of critical health policy reforms. However, countries with high HIV burden often have low policy development, advocacy, and monitoring capacity. This lack of capacity may be a significant barrier to achieving the AIDS-free generation goals. This manuscript describes the increased focus on policy development and implementation by the United States President’s Emergency Plan for AIDS Relief (PEPFAR). It evaluates the curriculum and learning modalities used for two regional policy capacity building workshops organized around the PEPFAR Partnership Framework agreements and the Road Map for Monitoring and Implementing Policy Reforms. …

Pilot Perceptions On Impact Of Crew Rest Regulations On Safety And Fatigue, Lukas Rudari, Mary E. Johnson, Robert C. Geske, Lauren A. Sperlak

International Journal of Aviation, Aeronautics, and Aerospace

The risk of fatigue on pilot performance and safety is well recognized in aviation. In response to increased safety concerns, the Federal Aviation Administration addressed fatigue risk for passenger airline pilots in Title 14 Code of Federal Regulations Part 117, which included accommodations to address fatigue related risk-factors such as circadian rhythm and the phenomenon commonly described as jet-lag. The rule became effective in January 2014. A survey was conducted in March and April of 2014 to better understand pilot perceptions of the new Part 117 rule. This study analyzed survey responses from 92 self-identified pilots to determine the effect …

Why Does My Insurance Cost So Much?, Donald Roth

Faculty Work Comprehensive List

"Tthere are no easy complete solutions to the challenges we face in insurance costs, but there are many small things we can do based on the model of how insurance works."

Posting about health care issues from In All Things - an online hub committed to the claim that the life, death, and resurrection of Jesus Christ has implications for the entire world.

http://inallthings.org/why-does-my-insurance-cost-so-much/

Administrative Oversight Of State Medicaid Payment Policies:Giving Teeth To The Equal Access Provision, Julia Bienstock

Fordham Urban Law Journal

No abstract provided.

Hospital Discharge Planning In Medicare: Current Requirements And Proposed Changes, Sally Coberly

National Health Policy Forum

Medicare's specific minimum health and safety standards for hospitals, known as conditions of participation, include requirements for discharge planning for patients who need such services. Discharge planning is intended to ensure smooth transitions from hospital to home or other health care facility. This publication reviews the current discharge planning requirements for hospitals as well as changes included in a proposed rule published by the Centers for Medicare & Medicaid Services on November 3, 2015. Key proposed changes include an expanded definition of which patients must receive discharge planning services, a requirement that providers responsible for follow-up care receive timely …

King V. Burwell: What Does It Portend For Chevron’S Domain?, Leandra Lederman, Joseph C. Dugan

Pepperdine Law Review

This short Essay considers what the U.S. Supreme Court’s decision in King v. Burwell, 135 S. Ct. 2480 (2015), suggests about the future of Chevron deference. It first compares the Court’s approach in King with its approach in two other “extraordinary” nondeference cases, FDA v. Brown & Williamson Tobacco Corp. and Gonzales v. Oregon. It next situates King in a broader context of developments in the Court’s Chevron jurisprudence. The Essay concludes that, while King may simply be a sui generis case involving an important social program, it may also signal a fading appetite for deference among the Justices. - …

The (Perhaps) Unintended Consequences Of King V. Burwell, Kristin E. Hickman

Pepperdine Law Review

The Supreme Court’s decision in King v. Burwell surprised many people, not because of its outcome but because, even as the Court ultimately agreed with the IRS’s interpretation of the statute, the Court expressly denied the IRS Chevron deference. As regards that result, this Essay makes three points. First, the Chevron discussion in King was not incidental, but the IRS and taxes were not foremost on the Court’s mind. Rather, King reflects a careful effort by Chief Justice Roberts to accomplish, through alternative framing, a broader curtailment of Chevron’s scope that he advocated unsuccessfully two terms earlier in City of …

King V. Burwell: Where Were The Tax Professors?, Andy S. Grewal

Pepperdine Law Review

King v. Burwell drew unusually wide attention for a tax case. Members of the public, the mainstream media, health care professionals, Washington think tanks, and constitutional, administrative, and health law professors, to name a few groups, all debated the merits of the challengers’ arguments. Everyone, it seems, had something to say about the case — except tax professors. This contribution to Pepperdine Law Review’s Tax Law Symposium explores three potential reasons for the tax professoriate’s reticence. It concludes that none of those reasons withstand scrutiny, and going forward, tax professors should play a more active role in cases like this.

Is The Chief Justice A Tax Lawyer?, Stephanie Hoffer, Christopher J. Walker

Pepperdine Law Review

In our contribution to this symposium on King v. Burwell, we explore two aspects of the Chief Justice’s opinion where it is hard to ignore the fingerprints of a tax lawyer. First, in the Chief’s approach to statutory interpretation one sees a tax lawyer as interpreter with an approach that tracks tax law’s substance-over-form doctrine. Second, as to King’s sweeping administrative law holding, the Chief crafts a new major questions doctrine that could significantly cut back on federal agency lawmaking authority. Yet he seems to develop this doctrine against the backdrop of tax exceptionalism, and thus this development may have …

The Rise And Fall Of Chevron In Tax: From The Early Days To King And Beyond, Steve R. Johnson

Pepperdine Law Review

Chevron is receding in tax, not because of any resurgence of tax exceptionalism but because it is receding everywhere. The case will continue to be cited by courts and masticated by commentators, but the unresolved – indeed worsening — conceptual, definitional, and practical incongruities of its doctrine rob it of operational force. King, which the Supreme Court conspicuously chose to resolve without “help” from Chevron, is another mile-marker on Chevron’s downward road. This article maps that road.

King V. Burwell And Tax Court Review Of Regulations, Ellen P. Aprill

Pepperdine Law Review

In King v. Burwell, the Supreme Court did not rely on Chevron to hold valid tax regulations allowing tax credits for taxpayers who enroll in an insurance plan through a federal rather than a state exchange. It instead concluded, relying in good measure on Brown and Williamson, that Congress had not delegated the question at issue to the IRS. It thus introduced a so-called Chevron Step 0. This essay reviews the Tax Court’s use of Chevron and Brown & Williamson to conclude that the Tax Court may well make use of King v. Burwell to review and reject tax regulations …

Foreword—King V. Burwell Symposium: Comments On The Commentaries (And On Some Elephants In The Room), David Gamage

Pepperdine Law Review

As an introduction to the Symposium, this invited response essay reviews the pieces submitted for the Pepperdine Law Review symposium on the King v. Burwell case. The thrust of this essay’s response commentary is to praise the submitted essays for their excellence and insightfulness, but to suggest that the submitted essays nonetheless might benefit from focusing more on the role of the political mobilization that resulted in the King v. Burwell dispute. Ultimately, this essay suggests that what may have motivated the Supreme Court to develop and apply its new “deep economic and political significance” test in this this case …

The Affordable Care Act Is Not Tort Reform, Andrew F. Popper

Catholic University Law Review

On March 23, 2010, President Obama signed The Patient Protection and Affordable Care Act (PPACA). Prior to the enactment of the PPACA, Congress held several hearings focused on subrogation and relaxation of collateral source restrictions as well as caps on damages in an effort to promote tort reform. While the ACA included provisions on medical liability reform, the suggested tort reform was thwarted, and the ACA had no actual legal effect on limiting medical malpractice liability. This article argues that the reality is that the PPACA has done nothing to change the admissibility of collateral sources nor has it enhanced …

Obesity Regulation Under Home Rule: An Argument That Regulation By Local Governments Is Superior To Administrative Agencies, Patrick M. Steel

Cardozo Law Review

No abstract provided.