Health Law and Policy Commons^™

Fracking Health Care: How To Safely De-Medicalize America And Recover Trapped Value For Its People, William M. Sage

Faculty Scholarship

The wealth trapped within American health care is simultaneously a tragedy and a miracle. It is a tragedy because stagnating wages, widening disparities in income, ballooning deficits, and stunted investments in education and social services make such medical profligacy shameful. It is a miracle because it still exists, whereas other U.S. economic resources of similar magnitude have already been dissipated by global market forces without addressing any of the aforementioned failings – indeed, sometimes having contributed to them. It therefore can be released and used.

It is time to “frack the health care system” and innovate the de-medicalization of America. …

Medical Malpractice And The Mind-Blowing Hypocrisy Of Obamacare Repeal, Joanne Doroshow

Other Publications

No abstract provided.

Teaching The Law Of American Health Care, Elizabeth Weeks, Nicole Huberfeld, Kevin Outterson

Scholarly Works

In writing our casebook, The Law of American Health Care, we started from scratch, rethinking the topics to include and themes around which to organize them. Like many health law professors, we were schooled in and continued to propound the traditional themes of cost, quality, access, and choice. While those concerns certainly pervade many areas of health care law, our casebook's overarching themes emphasize different issues, namely: federalism, individual rights, fiduciary relationships, the modem administrative state, and market regulation. These new themes, we believe, better capture the range of issues and topics essential for the new generation of health lawyers. …

Teaching The Law Of American Health Care, Elizabeth Weeks, Nicole Huberfeld, Kevin Outterson

Faculty Scholarship

In writing our casebook, The Law of American Health Care, we started from scratch, rethinking the topics to include and themes around which to organize them. Like many health law professors, we were schooled in and continued to propound the traditional themes of cost, quality, access, and choice. While those concerns certainly pervade many areas of health care law, our casebook's overarching themes emphasize different issues, namely: federalism, individual rights, fiduciary relationships, the modem administrative state, and market regulation. These new themes, we believe, better capture the range of issues and topics essential forthe new generation of health lawyers. When …

When Religious Belief Becomes Scientific Opinion: Burwell V. Hobby Lobby And The Unraveling Of Federal Rule 702, Meredith Rachel Mandell

Northwestern Journal of Law & Social Policy

No abstract provided.

A Promise Realized? A Critical Review Of Accountable Care Organizations Since The Enactment Of The Affordable Care Act, Jean Phillip Shami

University of Miami Law Review

As the six-year anniversary of the passage of the Affordable Care Act (“ACA”) comes to a close, a critical review of one of the key inventions of the ACA—Accountable Care Organizations (“ACOs”)—is timely as part of the greater narrative around affordable, quality health care in America. This Comment begins with a discussion of the statutory creation, philosophy and vision, and organizational structure of ACOs in the context of the passage of the ACA in 2010. Then, it will critically review ACOs from three perspectives based on the ACO model’s mission to provide better care for more people at a lower …

Community Health Centers And Medicaid Payment Reform: Emerging Lessons From Medicaid Expansion States, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent a major source of primary health care for the nation’s Medicaid beneficiaries. Because the Federally Qualified Health Center (FQHC) payment system is encounter-based, health centers and Medicaid agencies in ACA expansion states are actively pursuing payment reforms that will enable health centers to adopt strategies that can more effectively respond to the considerable and complex health and social needs of people served by health centers, and more efficiently address the surging volume of patient care. In five expansion states whose alternative payment experiments are underway, health centers and Medicaid agencies are testing payment alternatives, such as …

Surviving The Storm 2016: Employee Benefit Compliance & Employment Law Update, George Thompson, Brooks R. Magratten, Mark A. Pogue, Kelli Viera, Cecily Banks, Roger Williams University School Of Law

School of Law Conferences, Lectures & Events

No abstract provided.

Implementation Of The Affordable Care Act In Physical Therapy, Greg Austin

Mahurin Honors College Capstone Experience/Thesis Projects

Introduction: With the implementation of the Affordable Care Act (ACA) in 2010, many medical specialties prepared to see reimbursement rates altered. Not impervious to this trend was the field of physical therapy (PT). This change in reimbursement structure could impact the effectiveness of PT treatment. Under this model, a patient may not be able to receive the appropriate number of visits to a physical therapist, resulting in a loss of utilization in the injured area and, possibly, a loss of independence. Methods: A literature review was performed to determine reimbursement rate impact on PT. A seven-item open-ended survey regarding various …

Nfib V. Sebelius And The Individual Mandate: Thoughts On The Tax/Regulation Distinction, Kyle D. Logue

Michigan Business & Entrepreneurial Law Review

When Chief Justice John Roberts wrote the opinion of the Court in National Federation of Independent Businesses v. Sebelius (NFIB) explaining the constitutionality of the Affordable Care Act’s (ACA) minimum essential coverage provision (sometimes referred to as the individual mandate), he reasoned that the mandate—or, more precisely, the enforcement provision that accompanied the mandate (the Shared Responsibility Payment or SRP)—could be understood as a tax on the failure to purchase health insurance. According to this view, the enactment of the mandate and its accompanying enforcement provisions fell within Congress’s virtually unlimited power to “lay and collect taxes.” This tax-based interpretation …

The Relationship Between The Markets For Health Insurance And Medical Malpractice Insurance, W. Kip Viscusi, J. Bradley Karl, Patricia H. Born

Vanderbilt Law School Faculty Publications

This article evaluates the interdependence of medical malpractice insurance markets and health insurance markets. Prior research has addressed the performance of these markets, individually, without specifically quantifying the extent to which they are linked. Increasing levels of health insurance losses could increase the scale of potential malpractice claims, boosting medical malpractice losses, or could embody an improvement in medical care quality, which will reduce malpractice losses. Our results for a state panel data set from 2002 to 2009 demonstrate that health insurance losses are negatively related to medical malpractice insurance losses. An additional dollar of health insurance losses is associated …

Regulating Employment-Based Anything, Brendan S. Maher

Faculty Scholarship

Benefit regulation has been called “the most consequential subject to which no one pays enough attention.” It exhausts judges, intimidates legislators, and scares off theorists. That need not be so. Reality is less complicated than advertised.

Governments often consider intervention if markets fail to make some socially desirable Good X — such as education, health care, home mortgages, or pensions, for example — sufficiently available. One obvious fix is for the government to provide the good itself. A less obvious intervention is for the government to regulate employment-based (EB) arrangements that provide Good X as a benefit to employees and …

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/

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. - …

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 …

Health Care And The Myth Of Self-Reliance, Nicole Huberfeld, Jessica L. Roberts

Faculty Scholarship

Both pillars of the Affordable Care Act that are designed to facilitate universal coverage — the low-income tax subsidy and Medicaid expansion — have been subject to high-profile Supreme Court cases. While in King v. Burwell the Court saved the ACA’s low-income subsidy, in NFIB v. Sebelius the Court frustrated Medicaid expansion, at least temporarily. We argue that there is a deeper story about health care access for the poor. Drawing from the history of the American health care system, vulnerability theory, and demographic data, we demonstrate that all Americans lead subsidized lives and could find themselves quickly moving from …

Brief For Catholics For Choice Et Al. As Amici Curiae Supporting Respondents, Zubik V. Burwell, Leslie C. Griffin

Supreme Court Briefs

No abstract provided.

Sufficiency, Comprehensiveness Of Healthcare Coverage And Cost-Sharing Arrangements In The Realpolitik Of Health Policy, Govind Persad, Harald Schmidt

Sturm College of Law: Faculty Scholarship

This chapter explores two questions in detail: How should we determine the threshold for costs that individuals are asked to bear through insurance premiums or care-related out-of-pocket costs, including user fees and copayments? and What is an adequate relationship between costs and benefits? This chapter argues that preventing impoverishment is a morally more urgent priority than protecting households against income fluctuations, and that many health insurance plans may not adequately protect individuals from health care costs that threaten to drop their financial status below a decent minimum. A design that places greater emphasis on preventing impoverishment and finances the achievement …

A Feuding House: An Examination Of The Causes And Effects Of The Decline Of Bipartisanship In The United States Congress, Aaron Jackson Horner

Undergraduate Honors Theses

Excerpt from Introduction

In October of 2016, a Gallup poll reported that Congress had an approval rating of 18%.[1] Compared to the President’s approval rating, Congress is seen as ineffective and too bipartisan for many Americans. While there has always been a natural tension between the opposing parties, it has magnified within recent years. Within Congress itself, many members are seeing their political opposition even more unfavorably today than their counterparts did two decades ago. Carol Doherty of the Pew Research Center claims that it is the “intensity of negativity that’s increased.”[2] The 2008 election marked a new …

Instrumental And Transformative Medical Technology, Nicole Huberfeld Professor Of Law

Vanderbilt Journal of Entertainment & Technology Law

This Article considers how medical technologies impact universality in health care. The universality principle, as embodied in the Patient Protection and Affordable Care Act (ACA), eliminated widespread discriminatory practices and provided financial assistance to those otherwise unable to become insured--a democratizing federal act that was intended to stabilize health care policy nationwide. This Article posits that medical technology, as with all of medicine, can be universalizing or exclusionary and that this status roughly correlates to its being "instrumental technology" or "transformative technology." Instrumental technology acts as a tool of medicine and often serves an existing aspect of health care; in …

The Patient Protection And Affordable Care Act And Choice In Childbirth: How The Aca's Nondiscrimination Provisions May Change The Legal Landscape Of Childbirth, Caitlin Mccartney

American University Journal of Gender, Social Policy & the Law

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.

The Double-Edged Sword Of Health Care Integration: Consolidation And Cost Control, Erin C. Fuse Brown, Jaime S. King

Indiana Law Journal

The average family of four in the United States spends $25,826 per year on health care. American health care costs so much because we both overuse and overpay for health care goods and services. The Affordable Care Act’s cost control policies focus on curbing overutilization by encouraging health care providers to integrate to pro-mote efficiency and eliminate waste, but the cost control policies largely ignore prices. This article examines this overlooked half of health care cost control policy: rising prices and the policy levers held by the states to address them. We challenge the conventional wisdom that reducing overutilization through …

Collecting New Data On Disability Health Inequities, Elizabeth Pendo

All Faculty Scholarship

Prior to the Affordable Care Act, disability was marginalized in data collection efforts, limiting our ability to understand and address significant health inequities experienced by millions of Americans. Now, for the first time, we can use these tools to collect valuable new data on the nature and extent of health inequities experienced by people with disabilities across the country.

This article argues that standardized health collection data is critical to health equity, and because of the ACA’s groundbreaking requirements for data collection of disability status and treatment of patients with disabilities, we now have the potential to identify, track, and …

The Future Of The Cadillac Tax, Kathryn L. Moore

Law Faculty Scholarly Articles

The Affordable Care Act includes a 40 percent excise tax on high-cost employer-sponsored health care coverage. Often referred to as the “Cadillac tax,” this excise tax is one of the most controversial elements of the Affordable Care Act.

Currently scheduled to go into effect in 2020, the Cadillac tax poses serious challenges and uncertainty for employers. On the one hand, recent estimates suggest that the Cadillac tax may hit as many as 20 percent of employers with health care plans in 2020. On the other hand, there is a serious question as to whether the tax will be repealed before …

Irresponsibly Taxing Irresponsibility: The Individual Tax Penalty Under The Affordable Care Act, Francine J. Lipman, James Owens

Scholarly Works

In recent decades, Congress has used the federal income tax system increasingly to administer and deliver social benefits. This transition is consistent with the evolution of the American welfare system into workfare over the last several decades. As more and more social welfare benefits are conditioned upon work, family composition, and means-tested by income levels, the income tax system where this data is already systematically aggregated, authenticated, and processed has become the go-to administrative agency.

Nevertheless, as the National Taxpayer Advocate Nina Olson has noted there are “substantial differences between benefits agencies and enforcement agencies in terms of culture, mindset, …