Health Law and Policy Commons^™

Avoiding Pandora’S Box: Why Federal Nondiscrimination Statutes Do Not Prohibit Health Insurance Coverage Exclusions Of Sex-Rejecting Procedures, Rachel N. Morrison

Catholic University Law Review

There is increasing litigation over whether employer-provided health insurance and state Medicaid plans can exclude coverage of procedures for “gender transitions.” Plaintiffs claim that gender-transition coverage exclusions violate the Equal Protection Clause of the Fourteenth Amendment and federal nondiscrimination statutes. While Fourteenth Amendment claims should be foreclosed by the Supreme Court’s holding in Geduldig v. Aiello, nondiscrimination claims require a separate analysis.

This article shows the proper analysis for whether coverage exclusions of transition procedures violate federal nondiscrimination statutes. Looking to the history of coverage exclusion claims, Part I traces sex and pregnancy discrimination claims challenging coverage exclusions of …

Beyond Subsidies And Mandates: Testing A Simple Behavioral Mechanism To Drive Health Insurance Coverage, Wendy Netter Epstein, Hansoo Ko, Christopher Robertson, Kevin Wilson, David Yokum

Faculty Scholarship

Uninsured individuals face reduced access to care, financial risk, and higher mortality. Although public programs and private subsidies have lowered uninsurance, these mechanisms remain incomplete and politically unstable. We evaluate whether a low-cost outreach intervention can increase health insurance enrollment without altering plan prices. Using a randomized field experiment involving 16,477 uninsured Maryland households, we assigned households to a no-contact control or to receive email and postcard outreach featuring affordability messaging alone or combined with responsibility or community framings. Outreach increased qualified health plan enrollment by 0.699 percentage points and total coverage by 0.967 percentage points relative to control. The …

Unh Healthcare Vitals: Health Insurance Premiums Are Skyrocking For 2026-- Why?, Lucy Hodder

Law Faculty Scholarship

Health insurance premiums and out-of-pocket costs in New Hampshire are projected to rise sharply in 2026 due to expiring federal subsidies, escalating prescription drug prices, hospital consolidation, workforce shortages, and policy changes. Without intervention, affordability will worsen for individuals and employers, with significant impacts on coverage and access. The report outlines policy recommendations to help mitigate these challenges for Granite Staters.

Innovative Mechanisms For Marketing Health Insurance: An Experimental Field Test (Results From Colorado), Wendy Netter Epstein, Christopher Robertson, David Yokum, Hansoo Ko, Kevin Wilson

Faculty Scholarship

We hypothesize that marketing messages using a generosity framing have the potential to draw healthy persons into the insurance pool, thereby improving access and health outcomes and lowering premiums, but without removing choice or requiring substantial government action. The dependent variable for our field experiment is whether or not recipients of the marketing campaigns enroll in health insurance via the participating exchanges or in Medicaid.

Reproductive Innovation And Reproductive Exceptionalism: How Private Health Insurance Coverage Of Fertility Treatment Complements Hostile Governmental Action And Expands Access To Assisted Reproduction In The United States, Myrisha S. Lewis

Faculty Publications

The use of fertility treatment and assisted reproductive technology (ART) in the United States and globally is increasing over time. As of April 2023, the World Health Organization estimates that approximately one in six individuals have faced infertility globally. Fertility treatment includes the use of drugs to stimulate egg production, in vitro fertilization (IVF), and, for some, the use of gestational surrogacy to aid in childbirth. Debates have abounded and continue to abound in federal legislatures, state legislatures, and society more broadly about the morality of abortion, contraception, and assisted reproduction, as well as whether governments, public insurers, and private …

Just Fix The Damn Payment System!, Frances H. Miller

Faculty Scholarship

This piece takes as a given that we are stuck with our fragmented, inefficient, multi-payor health care system for at least the short run. It then analyzes the deficiencies of three payment mechanisms whereby regulators (including Congress) have invited private sector providers to help ameliorate perceived problems. The first concerns an inadequate supply of nursing home beds in the early ‘70s, the next focuses on Medicare Advantage as a supposedly superior cost containment alternative to traditional Medicare, and the final one involves the ‘devil’s bargain’ struck with the pharmaceutical industry to get prescription drug coverage added to Medicare. All three …

Mda At Your Service: My License Expired, And I’M Overwhelmed, Kristin Johnson Dds

The Journal of the Michigan Dental Association

The Michigan Public Health Code allows a 60-day grace period for license renewal with late fees and CE requirements. For health insurance options, MDA Insurance provides assistance and quotes. Attend the MDA Health Insurance Seminar on Oct. 25 for more insights. Engage in organized dentistry via local society meetings, the MDA Leadership Forum, and the LEAD Program. MDA Insurance offers Medicare support, including educational events on Sept. 13 and 27. For more details, contact relevant MDA representatives.

Mda Services: Five Tips To Recruit, Retain Good Employees, Reva Darling

The Journal of the Michigan Dental Association

In a competitive labor market, retaining and recruiting dental staff is challenging. Key strategies include offering health insurance, pre-tax benefit options, and retirement plans, which attract long-term employees. Providing vision insurance and discounts on auto and home insurance can further enhance employee satisfaction. Updating pay scales and utilizing temporary services like Stynt can also aid in filling staff positions.

Cost Cushion Or Cash Cow? A Federal Drug-Pricing Program Called Into Question, Caleb C. Briggs

Law Student Publications

“Bon Secours turned the hospital’s poverty into an asset,” read a recent story about Richmond Community Hospital published in The New York Times. Richmond Community Hospital has been part of the Bon Secours network since 1995. Since then, the hospital has become one of the most profitable in the Bon Secours network. Yet, over time, Richmond Community Hospital has been stripped of its resources, lost medical staff, and generally seen a decrease in its ability to provide patients quality health care services. The hospital is located in Richmond’s East End, which is a predominantly low-income neighborhood, and a large …

Employers And The Privatization Of Public Health, Sharona Hoffman

Faculty Publications

This Article focuses on the role of employers in public health and argues that they constitute increasingly important actors in the U.S. public health arena. In the aftermath of the COVID-19 pandemic, a series of judicial decisions and newly enacted statutes enfeebled the public health powers of the federal and state governments. In a 2023 statement, Supreme Court Justice Neil Gorsuch clearly articulated his antagonism towards government-initiated COVID-19 interventions, describing them as “the greatest intrusions on civil liberties in the peacetime history of this country.” All too many share his views.

Employers may be highly motivated to safeguard their workers’ …

Defining Health Affordability, Govind C. Persad

Sturm College of Law: Faculty Scholarship

Affordable health care, insurance, and prescription drugs are priorities for the public and for policymakers. Yet the lack of a consensus definition of health affordability is increasingly recognized as a roadblock to health reform efforts. This Article explains how and why American health law invokes health affordability and attempts, or fails, to define the concept. It then evaluates potential affordability definitions and proposes strategies for defining affordability more clearly and consistently in health law.

Part I examines the role health affordability plays in American health policy, in part by contrasting the United States’s health system with systems elsewhere. Part II …

Medicare Advantage? If You Say So. Fraud, Waste, And Abuse In Medicare Part C, John J. Locurto

Faculty Articles

Debates about health care often emphasize distributive justice. How should society allocate finite resources? Who will get access to them, who will not? Is the allocation fair? Who decides and by what standard? Answers to these questions rarely consider health care fraud, waste, and abuse. This is a material omission. Fraud alone costs the health care system billions of dollars annually, dissipating limited funds and degrading quality of care. This paper considers how fraud, waste, and abuse occur in Medicare Part C - better known as Medicare Advantage - an increasingly popular coverage option. Medicare Advantage experiences unique challenges that …

National Federation Of Independent Business V. Sebelius, 567 U.S. 519 (2012), Elizabeth Weeks, Mary Ann Chirba, Alice A. Noble

Scholarly Works

In National Federation of Independent Business v. Sebelius, decided in 2012, twenty-six states as well as private individuals and an organization of independent businesses challenged the constitutionality of two key components of the Affordable Care Act. The Court upheld the individual mandate but converted the Medicaid eligibility expansion from mandatory to optional for states. Elizabeth Weeks’ feminist rewrite breaks down the public law-private law distinction to get beyond the traditional view of health insurance as a commercial product providing individual financial protection against risk and instead to view it as effecting a risk pool premised on cross-subsidization of the health-care …

Long-Term Care In The United States: History, Financing, And Directions For Reform, George A. (Sandy) Mackenzie

Upjohn Press

This book is a concise survey of the development of U.S. long-term care and its financing, with comparisons with other rich countries. It also includes a brief comparative account of the impact of the COVID-19 pandemic in the United States and several other countries. The study finds much that is amiss with American long-term care and proposes three sets of progressively more ambitious reforms.

Can Moral Framing Drive Insurance Enrollment In The Us?, Wendy Netter Epstein, Christopher Robertson, David Yokum, Hansoo Ko, Kevin Wilson, Monica Ramos, Katherine Kettering, Margaret Houtz

Faculty Scholarship

To encourage health insurance uptake, marketers and policymakers have focused on consumers' economic self-interest, attempting to show that insurance is a good deal or to sweeten the deal, with subsidies or penalties. Still, some consumers see insurance as a bad deal, either because they rationally exploit private risk information (“adverse selection”), or irrationally misperceive the value due to cognitive biases (e.g., optimism). As a result, about 30 million Americans remain uninsured, including many who could afford it. At the same time, polling suggests that Americans view health insurance through a moral lens, seeking to protect those with pre-existing conditions especially. …

Addressing Stigma And False Beliefs About Mental Health: A New Direction For Mental Health Parity Advocacy, Claire Sontheimer, Michael Ulrich

Faculty Scholarship

Despite laws designed to protect mental health and substance use parity in the United States, real parity remains an aspiration. Under the current system, insurance companies use multiple tactics to deny coverage for or delay the provision of mental health and substance use disorder (MH/SUD) treatment. The difficulty of enforcing parity creates a barrier to achieving the goal of accessible behavioral health services. Rather than a continued effort to legislate our way out of this conundrum, it may be useful to look further upstream. Critical impediments to achieving such parity include the basic attitudes and beliefs about mental and behavioral …

Non-Elderly Adults On Disability In The Cf Population, Lea Nolan, Semret Seyoum, Julanne Wilson, Marsha Regenstein

Health Policy and Management Issue Briefs

No abstract provided.

The Opioid Crisis: Lessons For Health Reform, Valarie K. Blake

Law Faculty Scholarship

No abstract provided.

Who Bears The Cost Of An Emergency: Balancing Billing's Effects On Health Care Providers, And Solutions Through Alternative Dispute Resolution, Hayden Tavoda

Pepperdine Dispute Resolution Law Journal

Arbitration, as well as other forms of alternative dispute resolution, provide many benefits for all parties when a dispute arises, such as faster results and less expense and time than litigation, and the potential for more qualified finders of fact on a specific topic rather than a jury of peers. In the following case note, Part II will focus on the background of different types of health insurance carriers in the United States, the Knox-Keene Act, and the California Assembly Bill 1611.20 Part III will discuss more specifically the issues that stem from balance billing through explicit cases. Part IV …

Risk Indicators Of Food Insecurity In The Cf Population, Semret Seyoum, Marsha Regenstein, Lea Nolan

Health Policy and Management Issue Briefs

No abstract provided.

The Reincorporation Of Prisoners Into The Body Politic: Eliminating The Medicaid Inmate Exclusion Policy, Mira K. Edmonds

Articles

Incarcerated people are excluded from Medicaid coverage due to a provision in the Social Security Act Amendments of 1965 known as the Medicaid Inmate Exclusion Policy (“MIEP”). This Article argues for the elimination of the MIEP as an anachronistic remnant of an earlier era prior to the massive growth of the U.S. incarcerated population and the expansion of Medicaid eligibility under the Patient Protection and Affordable Care Act of 2010. It explores three reasons for eliminating the MIEP. First, the inclusion of incarcerated populations in Medicaid coverage would signify the final erasure from the Medicaid regime of the istinction between …

Little Sisters Of The Poor V. Pennsylvania: The Not So Little Effect Of Interfering With The Aca's Contraceptive Mandate, Sabrina Rubis

Women, Leadership & Equality

No abstract provided.

An Update On Gambling Disorder, Neuroscience, And The Law, Stacey A. Tovino

Faculty Articles

No abstract provided.

Cost, Coverage, And The Underuse Of Medications Among People With Cf, Semret Seyoum, Marsha Regenstein, Lea Nolan

Health Policy and Management Issue Briefs

No abstract provided.

Laboratories Of Exclusion: Medicaid, Federalism & Immigrants, Medha D. Makhlouf

Faculty Scholarly Works

Medicaid’s cooperative federalism structure gives states significant discretion to include or exclude various categories of immigrants. This has created extreme geographic variability in immigrants’ access to health coverage. This Article describes federalism’s role in influencing state policies on immigrant eligibility for Medicaid and its implications for national health policy. Although there are disagreements over the extent to which public funds should be used to subsidize immigrant health coverage, this Article reveals that decentralized policymaking on immigrant access to Medicaid has weakened national health policy. It has failed to incentivize the type of state policy experimentation and replication that justifies federalism …

Mhpaea & Marble Cake: Parity & The Forgotten Frame Of Federalism, Taleed El-Sabawi

Dickinson Law Review (2017-Present)

No abstract provided.

Distinguishing Moral Hazard From Access For High-Cost Healthcare Under Insurance, Christopher Robertson, Andy Yuan, Wendan Zhang, Keith Joiner

Faculty Scholarship

Health policy has long been preoccupied with the problem that health insurance stimulates spending (“moral hazard”). However, much health spending is costly healthcare that uninsured individuals could not otherwise access. Field studies comparing those with more or less insurance cannot disaggregate moral hazard versus access. Moreover, studies of patients consuming routine low-dollar healthcare are not informative for the high-dollar healthcare that drives most of aggregate healthcare spending in the United States.
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/="/">We test indemnities as an alternative theory-driven counterfactual. Such conditional cash transfers would maintain an opportunity cost for patients, unlike standard insurance, but also guarantee access to …

J Mich Dent Assoc February 2020

The Journal of the Michigan Dental Association

Every month,The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• A cover story on the 2020 MDA Annual Session
• A feature covering student perspectives on the Opioid Crisis
• News you need, Editorial and regular department articles on MDA Foundation activities, Dentistry and the Law, Staff Matters, Headquarters Report, and component news

This issue also includes articles reprinted with permission:

• “Muscle Deprogramming: A Source of Confusion”, …

Is Obamacare Really Unconstitutional?, Nicholas Bagley

Articles

On December 18, 2019, just 3 days after the close of open enrollment on the exchanges and on the same day the House of Representatives impeached President Donald Trump, a conservative appeals court handed the President a major victory in his crusade against the Affordable Care Act (ACA). Over a stern dissent, the U.S. Court of Appeals for the Fifth Circuit declared that the law’s individual mandate is unconstitutional and that the entire rest of the law might therefore be invalid.

Ensuring An Underclass: Stigma In Insurance, Valarie K. Blake

Scholarly Works

In our country, access to insurance can be a matter of life and death, as well as financial security. Despite these great stakes, the ability to get affordable insurance is often influenced by social factors like sexual orientation, age, gender, and race. Insurers defend these practices, and regulators frequently agree, on the basis of actuarial fairness. That is, some groups are costlier to insure and others shouldn’t have to offset their expenses. This article advances a stigma-based critique to challenge this conception of lawful discrimination and fairness in insurance. The sociological stigma literature tells us that it is a natural …