Health Law and Policy Commons^™

Disparities In Private Health Insurance Coverage Of Skilled Care, Stacey A. Tovino

Scholarly Works

This article compares and contrasts public and private health insurance coverage of skilled medical rehabilitation, including cognitive rehabilitation, physical therapy, occupational therapy, speech-language pathology, and skilled nursing services (collectively, skilled care). As background, prior scholars writing in this area have focused on Medicare coverage of skilled care and have challenged coverage determinations limiting Medicare coverage to beneficiaries who are able to demonstrate improvement in their conditions within a specific period of time (the Improvement Standard). By and large, these scholars have applauded the settlement agreement approved on 24 January 2013, by the U.S. District Court for the District of Vermont …

On Health, Law, And Religion, Stacey A. Tovino

Scholarly Works

The Supreme Court recently decided a number of cases involving health, law, and religion, including Whole Woman's Health v. Hellerstedt, Zubik v. Burwell, and Burwell v. Hobby Lobby Stores, Inc. These cases were important for understanding constitutional undue burden limitations and the boundaries of religious exercise during the Obama Administration. Unfortunately, the Supreme Court's recent opinions addressing health, law, and religion have little value for many health law professors and most practicing health care attorneys. These individuals, tasked with teaching and applying the thousands of federal and state statutes, regulations, and government guidance documents that address a wide …

The Post-Production Costs Issue In Texas And Louisiana: Implications For The Fate Of Implied Covenants And Pro-Lessor Clauses In The Shale Era Oil And Gas Lease., Laura H. Burney

St. Mary's Law Journal

This Article discusses the implications of Heritage Resources, Hyder, and several Louisiana cases on the “post-production costs” issue in gas royalty clauses, as well as the fate of implied covenants in the shale era. To better understand that issue, this Article first provides a background on the interaction of express lease clauses and the doctrine of implied covenants. This discussion reveals that implied covenants are relegated to a minor role in light of extensive express clauses in Shale Era leases because courts frequently view express or “plain” terms as barring implied covenants. The problem, however, as commentators have noted—particularly regarding …

The Executive Right To Lease After Kcm Financial Llc V. Bradshaw And A Louisiana Solution To A Texas Problem., Christopher S. Kulander

St. Mary's Law Journal

Abstract Forthcoming.

Beyond Canterbury: Can Medicine And Law Agree About Informed Consent? And Does It Matter?, 45 J.L. Med. & Ethics 106 (2017), Marc Ginsberg

UIC Law Open Access Faculty Scholarship

For those of us whose scholarship focuses on medico-legal jurisprudence, the law of informed consent is a gift. It has been a fertile topic of discussion for decades, with no end in sight. Although it is not difficult to acknowledge that patient autonomy is at the core of informed consent, the doctrine is not static - it has evolved in scope and continues to engage courts in thought provoking analysis.

Coverage In Transition: Considerations When Expanding Employer-Provided Health Coverage To Lgbti Employees And Beneficiaries, 24 Cardozo J. Equal Rts. & Soc. Just. 3 (2017), Kathryn J. Kennedy

UIC Law Open Access Faculty Scholarship

The rights of transgender individuals has been in the headlines during 2017 - ranging from President Trump's tweet to announce a ban on transgender individuals from serving in the military due to the "tremendous medical costs" to a nationwide injunction imposed by a federal district court on the HHS regulations that prohibit health-care discrimination against transgender individuals under the Affordable Care Act (ACA). There are three important reasons why transgender rights are in the news. First, the Human Rights Campaign Foundation, designed to promote the lives of lesbian, gay, bisexual, and transgender (LGBT) people, scores employers in its Corporate Equality …

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.

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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 …

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” …

The Abortion Closet (With A Note On Rules And Standards), David E. Pozen

Faculty Scholarship

An enormous amount of information and insight is packed into Carol Sanger's About Abortion: Terminating Pregnancy in Twenty-First Century America. The book is anchored in post-1973 American case law. Yet it repeatedly incorporates examples and ideas from popular culture, prior historical periods, moral philosophy, feminist theory, medicine, literature and the visual arts, and more.

The Limits Of Reading Law In The Affordable Care Act Cases, Kevin C. Walsh

Law Faculty Publications

One of the most highly lauded legacies of Justice Scalia's decades-long tenure on the Supreme Court was his leadership of a movement to tether statutory interpretation more closely to statutory text. His dissents in the Affordable Care Act cases- National Federation of Independent Business v. Sebelius and King v. Burwell- demonstrate both the nature and the limits of his success in that effort.

These were two legal challenges, one constitutional and the other statutory, that threatened to bring down President Obama's signature legislative achievement, the Patient Protection and Affordable Care Act. Both times the Court swerved away from a direct …

Closets, Standards, Abortion: A Reply To Professor Pozen, Carol Sanger

Faculty Scholarship

I am grateful for David Pozen's thoughtful observations regarding About Abortion. They have sharpened my understanding of how to think about the problem of abortion – or more accurately, about how abortion is kept problematic – as a matter of law and of social practice. I invoke the word "problematic" to describe the cultural setting in which abortion sits: although the procedure is legal, common, and safe, it is often treated as though it were not legal, or barely so; not common, except perhaps for women and girls who have nothing to do with you; and not at all …

Police Contact And Mental Health, Amanda Geller, Jeffrey Fagan, Tom R. Tyler

Faculty Scholarship

Although an effective police presence is widely regarded as critical to public safety, less is known about the effects of police practices on mental health and community wellbeing. Adolescents and young adults in specific neighborhoods of urban areas are likely to experience assertive contemporary police practices. This study goes beyond research on policing effects on legal socialization to assess the effects of police contact on the mental health of those stopped by the police. We collected and analyzed data in a two wave survey of young men in New York City (N=717) clustered in the neighborhoods with the highest rates …

Regulatory Obstacles To Harm Reduction: The Case Of Smoking, Jonathan H. Adler

Faculty Publications

The inability of many smokers to quit is a significant public health problem. The demand for a product that can help smokers kick the habit is an entrepreneurial opportunity. In surveys, a majority of smokers express concern for their health and a desire to kick the habit.

Electronic cigarettes (“e-cigarettes” or “e-cigs”) appear to be the most promising smoking alternative to enter the market to date. E-cigarettes have the potential to satisfy smokers’ craving for nicotine in a less dangerous way. The available evidence suggests e-cigarettes expose smokers (and others) to a fraction of the health risks posed by combustible …

The Process Of Reclaiming Tribal Sovereignty Through Healthcare Autonomy, Karolina A. Serhan

Honors Theses

This honors thesis explores the complex interplay between health status, healthcare, and tribal sovereignty among native communities in the United States. These relationships are explored through analyzing the paradoxical and condescending nature of the Federal Trust Responsibility in relation to government-organized healthcare programs for natives. In establishing this relationship, the thesis goes on to illustrate how native communities have effectively fought to regain sovereignty through reclaiming autonomy of their healthcare systems through the use of the 1975 Indian Self-Determination and Education Assistance Act. The impact of tribal-led healthcare systems is further explored through an in-depth case study conducted regarding the …