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Articles 61 - 90 of 140
Full-Text Articles in Insurance Law
Overbilling And Informed Financial Consent — A Contractual Solution, Barak D. Richman, Mark A. Hall, Kevin A. Schulman
Overbilling And Informed Financial Consent — A Contractual Solution, Barak D. Richman, Mark A. Hall, Kevin A. Schulman
Faculty Scholarship
U.S. hospitals and physicians regularly charge uninsured patients and patients receiving care outside their health-plan networks far more what most health insurers pay and far more than their actual costs. Such practices have triggered over 100 lawsuits and prompted calls for pricing transparency in Congress and price regulation in several states. This Perspective argues that the theory of implied contracts, a foundation in most first-year courses in contract law, offers a useful legal and ethical mechanism for handling these troubling problems in health care billing.
All Illnesses Are (Not) Created Equal: Reforming Federal Mental Health Insurance Law, Stacey A. Tovino
All Illnesses Are (Not) Created Equal: Reforming Federal Mental Health Insurance Law, Stacey A. Tovino
Scholarly Works
This Article is the second, and most important, installment in a three-part series that presents a comprehensive challenge to lingering legal distinctions between physical and mental illness. The basic impetus for this historical, medical, and legal project is a belief that there exists no rational or consistent method of distinguishing physical and mental illness in the context of health insurance law. The first installment in this series narrowly inquired as to whether a particular set of disorders, the postpartum mood disorders, are or should be classified as physical or mental illnesses in a range of health law contexts.* This second …
It’S An Art Not A Science: State-Mandated Insurance Coverage Of Assisted Reproductive Technologies And Legal Implications For Gay And Unmarried Persons, Valarie K. Blake
It’S An Art Not A Science: State-Mandated Insurance Coverage Of Assisted Reproductive Technologies And Legal Implications For Gay And Unmarried Persons, Valarie K. Blake
Scholarly Works
Assisted reproductive technology (ART) has made it possible for a wealth of individuals, who would otherwise be unable, to create families and become parents. Traditionally, most people think of infertile couples as the beneficiaries of such technology, but ART has special and important implications for gay and/or unmarried persons as well. Dubbed the “structurally infertile,” this latter group is highly dependent on ART for their family planning needs. Despite the growth in popularity of ART for both the medically and structurally infertile, ART continues to be a mainly private-payer enterprise, reserved for those individuals who have the expendable income to …
Why It's Called The Affordable Care Act, Nicholas Bagley, Jill R. Horwitz
Why It's Called The Affordable Care Act, Nicholas Bagley, Jill R. Horwitz
Articles
The Patient Protection and Affordable Care Act of 2010 (“ACA”) raises numerous policy and legal issues, but none have attracted as much attention from lawyers as Section 1501. This provision, titled “Maintenance of Mini-mum Essential Coverage,” but better known as the “individual mandate,” requires most Americans to obtain health insurance for themselves and their dependents by 2014. We are dismayed that the narrow issue of the mandate and the narrower issue of free riding have garnered so much attention when our nation’s health-care system suffers from countless problems. By improving quality, controlling costs, and extending coverage to the uninsured, the …
A Cautious Path Forward On Accountable Care Organizations, Barak D. Richman, Kevin A. Schulman
A Cautious Path Forward On Accountable Care Organizations, Barak D. Richman, Kevin A. Schulman
Faculty Scholarship
The wave of new Accountable Care Organizations (ACOs), spurred by financial incentives in the Affordable Care Act, could become the latest chapter in the steady accumulation of market power by hospitals, health care systems, and physician groups. The main purpose behind forming many ACOs may not be to achieve cost savings but instead to strengthen negotiating power over purchasers in the private sector. This would be an unfortunate sequel to the waves of mergers in the 1990s when health care entities sought to counter market pressure from managed care organizations. The possibility that ACOs might further concentrate health care markets …
The Provider-Monopoly Problem In Health Care, Clark C. Havighurst, Barak D. Richman
The Provider-Monopoly Problem In Health Care, Clark C. Havighurst, Barak D. Richman
Faculty Scholarship
Although federal judges have resisted giving due effect to standard antitrust principles in scrutinizing mergers of nonprofit hospitals, the presence of health insurance makes it especially important to oppose monopoly in health services markets. U.S.-style health insurance gives monopolist providers extraordinary pricing freedom, thus exacerbating monopoly’s usual redistributive effects. Significant allocative inefficiencies - albeit not the kind generally associated with monopoly - also result when the monopolist is a nonprofit hospital. Because it is probably impossible to undo past hospital mergers creating undue market power, we suggest some alternative remedies. One is to apply antitrust rules against "tying" arrangements so …
Reforming State Mental Health Parity Law, Stacey A. Tovino
Reforming State Mental Health Parity Law, Stacey A. Tovino
Scholarly Works
This Article is the final installment in a three-part project that presents a comprehensive challenge to lingering legal distinctions between physical and mental illness in the context of health insurance. The first installment in this series narrowly inquired as to whether the postpartum mood disorders should be classified as physical or mental illnesses in a range of health law contexts, including the context of health insurance. The second installment was broader in scope and challenged a number of federal provisions that allow publicly- and privately-funded health care programs and plans to provide mental health insurance benefits that are less comprehensive …
Free Rider: A Justification For Mandatory Medical Insurance Under Health Care Reform?, Douglas A. Kahn, Jeffrey H. Kahn
Free Rider: A Justification For Mandatory Medical Insurance Under Health Care Reform?, Douglas A. Kahn, Jeffrey H. Kahn
Articles
Section 1501 of the Patient Protection and Affordable Care Act added section 5000A to the Internal Revenue Code to require most individuals in the United States, beginning in the year 2014, to purchase an established minimum level of medical insurance. This requirement, which is enforced by a penalty imposed on those who fail to comply, is sometimes referred to as the “individual mandate.” The individual mandate is one element of a vast change to the provision of medical care that Congress implemented in 2010. The individual mandate has proved to be controversial and has been the subject of a number …
The Unaffordable Health Care Act - A Reponse To Professors Bagley And Horwitz, Douglas A. Kahn, Jeffrey H. Kahn
The Unaffordable Health Care Act - A Reponse To Professors Bagley And Horwitz, Douglas A. Kahn, Jeffrey H. Kahn
Articles
The Patient Protection and Affordable Care Act of 2010 has stirred considerable controversy. In the public debate over the program, many of its proponents have defended it by focusing on what is sometimes called the “free-rider” problem. In a prior article, we contended that the free-rider problem has been greatly exaggerated and was not a significant factor in the congressional decision to adopt the Act. We maintained that the free-rider issue is a red herring advanced to trigger an emotional attraction to the Act and distract attention from the actual issues that favor and disfavor its adoption. In a recently …
Four Constitutional Limits That The Minimum Coverage Provision Respects, Neil S. Siegel
Four Constitutional Limits That The Minimum Coverage Provision Respects, Neil S. Siegel
Faculty Scholarship
Opponents of the minimum coverage provision in the Affordable Care Act charge that if Congress can require most people to obtain health insurance or pay a certain amount of money, then Congress can impose whatever mandates it wishes—or, at least, whatever purchase mandates it wishes. This Essay refutes that claim by identifying four limits on the Commerce Clause that the minimum coverage provision honors. Congress may not use its commerce power: (1) to regulate noneconomic subject matter; (2) to impose a regulation that violates constitutional rights, including the right to bodily integrity; (3) to regulate at all, including by imposing …
Who Pays? Who Benefits? Unfairness In American Health Care, Clark C. Havighurst, Barak D. Richman
Who Pays? Who Benefits? Unfairness In American Health Care, Clark C. Havighurst, Barak D. Richman
Faculty Scholarship
American-style health insurance greatly amplifies price-gouging opportunities for health care providers, who inflate prices both to enrich themselves and to subsidize and expand the nation’s health care enterprise. To the extent that lower- and middle-income Americans with private health coverage pay premiums that go to support and expand the system, they are subject to an unfair (regressive) “head tax” levied by unaccountable entities for ostensibly public but also private purposes. Lower-income premium payers also often pay for costly health coverage designed to suit the economic interests and values of professional and other elites rather than their own. They also appear …
Using Payroll Deduction To Shelter Individual Health Insurance From Income Tax, David Orentlicher
Using Payroll Deduction To Shelter Individual Health Insurance From Income Tax, David Orentlicher
Scholarly Works
In this article, Professor Orentlicher and his colleagues assess the impact of state laws requiring or encouraging employers to establish ‘‘section 125’’ cafeteria plans that shelter employees’ premium contributions from tax.
Crisis On Campus: Student Access To Health Care, Bryan A. Liang
Crisis On Campus: Student Access To Health Care, Bryan A. Liang
University of Michigan Journal of Law Reform
College-aged adults are an overrepresented group in the uninsured population of the United States, and traditionally underserved minorities are disproportionately affected. Students with private health insurance are often functionally uninsured as well, since most schools refuse to accept this traditionally elite calling card on campus. Consequently, the large uninsured and functionally uninsured populations often rely on school-sponsored health insurance plans for access to care. These plans have uneven coverage, limited benefits, exclusions and high co-pays and deductibles, and provide little health care security for their beneficiaries. Further, schools and insurance companies have profited substantially from these student plans, raising the …
Reconstructing The Individual Mandate As An Escrow Account, Gregg D. Polsky
Reconstructing The Individual Mandate As An Escrow Account, Gregg D. Polsky
Michigan Law Review First Impressions
The recent health care reform law's most controversial provision is the individual mandate, which imposes a fine on individuals who fail to obtain a minimum level of health insurance coverage. Many object to this policy, arguing that the government shouldn't force individuals to purchase health insurance. Others believe that the mandate is a necessary component to health care reform. What has been missed in the discussion is that Congress could restructure the individual mandate to avoid the requirement that individuals purchase health insurance while still fulfilling its principal function. The principal purpose of the mandate is not to require individuals …
Form & Reform: The Economic Realities Of The United States Healthcare System, Mark Votruba
Form & Reform: The Economic Realities Of The United States Healthcare System, Mark Votruba
Journal of Law and Health
Good afternoon, everybody. My name is Eric Steiger, I'm one of the editors-in-chief from the Journal of Law and Health. And I'm happy to welcome all of you to the second speaker event in the 2009/2010 Journal of Law and Health Speaker Series. Thank you all for coming. Now, I know that the news last week was dominated by the story of Sandra Bullock's breakup; however, some of you might have noticed that a small piece of minor legislation also got passed through Congress last week. And you also might have noticed that it wasn't quite as full of bipartisan …
Desperate Doctors And Antitrust Laws: The Best Ways For Lawmakers To Simulate Physician Collective Bargaining, Cristina Olson
Desperate Doctors And Antitrust Laws: The Best Ways For Lawmakers To Simulate Physician Collective Bargaining, Cristina Olson
Nevada Law Journal
This Note will examine the legality of bills that open up physician collective bargaining—and what kind of provisions lawmakers should include to ensure legality and good policy. Given the current economic downturn, states must look for ways to make health insurance more affordable; a low-cost adjustment of collective bargaining rules may be a good solution. Such an adjustment would not be the only, or necessarily the best, solution to the healthcare cost crisis that exists in America, but it would be worthwhile for legislators to consider. Furthermore, if lawmakers craft legislation that puts state governments in charge of actively supervising …
On The Constitutionality Of Health Care Reform, Barak D. Richman
On The Constitutionality Of Health Care Reform, Barak D. Richman
Faculty Scholarship
This commentary describes the legal challenges to the Patient Protection and Affordable Care Act.
The "Discretionary Clause" In Erisa Health Insurance Plans, Greg Munro
The "Discretionary Clause" In Erisa Health Insurance Plans, Greg Munro
Faculty Journal Articles & Other Writings
This article reviews the issue of the power of state insurance commissioners to regulate the use of the discretionary clause under ERISA. The article questions the remarkable power imbalance between insureds and insurers noting the courts' deference to decisions made under discretionary clauses and the abuse of discretion standard.
Whom Would Jesus Cover - A Biblical, Ethical Lens For The Contemporary American Health Care Debate, Jeffrey R. Baker
Whom Would Jesus Cover - A Biblical, Ethical Lens For The Contemporary American Health Care Debate, Jeffrey R. Baker
Journal of Law and Health
This paper attempts a view of the contemporary health care debate in America through the prism of Biblical scripture and proposes that people of faith should recognize the current state of the American health care system as a moral crisis of justice and charity. First, I provide a survey of the current state of American health care for the uninsured, describing the demographic and economic circumstances of the uninsured and the resources available to them when they need medical care. Second, I ask whether, in light of scripture, this state of affairs presents a moral question that should drive our …
Health Reform: What's Insurance Got To Do With It? Recognizing Health Insurance As A Separate Species Of Insurance, Wendy K. Mariner
Health Reform: What's Insurance Got To Do With It? Recognizing Health Insurance As A Separate Species Of Insurance, Wendy K. Mariner
Faculty Scholarship
Health insurance can be, and to a large extent already is, a separate species of insurance. This article describes the different views of insurance that made health reform contentious. It argues that the goals of health reform are incompatible with conventional views of insurance. Nonetheless, reforming health insurance to achieve those goals does not require as dramatic shift as some might think, because health insurance has already become primarily a means of paying for health care, rather than a simple risk spreading device for specified losses.
Health Insurance Exchanges: Legal Issues, Timothy S. Jost
Health Insurance Exchanges: Legal Issues, Timothy S. Jost
O'Neill Institute Papers
Health insurance exchanges (HIE) are entities that organize the market for health insurance by connecting small businesses and individuals into larger pools that spread the risk for insurance companies, while facilitating the availability, choice and purchase of private health insurance for the uninsured. While there are legal issues that warrant consideration under a federal, state, or private exchange framework, those issues are not insurmountable barriers to implementation.
Universal Health Care, American Pragmatism, And The Ethics Of Health Policy: Questioning Political Efficacy, Daniel S. Goldberg
Universal Health Care, American Pragmatism, And The Ethics Of Health Policy: Questioning Political Efficacy, Daniel S. Goldberg
The University of New Hampshire Law Review
[Excerpt] “This article will explore the conceptual implications of applying ethical critique and analysis to health policy. This is not to imply any reductionist conception of health policy in which ethics is absent. As Deborah Stone and John W. Kingdon both note, policy is fraught with ethical implications, and value prioritization is a sine qua non for health policy. Nevertheless, I wish to suggest that there are some conceptually significant distinctions in thinking of the ethics of health policy as opposed to thinking separately about ethics and about health policy. Moreover, these distinctions themselves are of value, both in thinking …
When Patients Say No (To Save Money): An Essay On The Tectonics Of Health Law., Mark A. Hall, Carl E. Schneider
When Patients Say No (To Save Money): An Essay On The Tectonics Of Health Law., Mark A. Hall, Carl E. Schneider
Articles
The ultimate aim of health care public policy is good care at good prices. Managed care stalled at achieving this goal by trying to influence providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy are now pressuring patients to spend their own money when they select health plans, providers, and treatments. Expecting patients to choose what they need at the price they want, consumerists believe that market competition will constrain costs while optimizing quality. This classic form of consumerism is today's watchword. This Article evaluates this ideal type …
The Patient Life: Can Consumers Direct Health Care?, Carl E. Schneider, Mark A. Hall
The Patient Life: Can Consumers Direct Health Care?, Carl E. Schneider, Mark A. Hall
Articles
The ultimate aim of health care policy is good care at good prices. Managed care failed to achieve this goal through influencing providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy now pressure patients to spend their own money when they select health plans, providers, and treatments. Expecting patients to choose what they need at the price they want, consumerists believe that market competition will constrain costs while optimizing quality. This classic form of consumerism is today's health policy watchword. This article evaluates consumerism and the regulatory mechanism …
Review Of Reforming Medicare: Options, Tradeoffs, And Opportunities, Jill R. Horwitz
Review Of Reforming Medicare: Options, Tradeoffs, And Opportunities, Jill R. Horwitz
Reviews
Medicare needs fixing. The program has its strengths; it is popular among beneficiaries, has very low administrative costs (maybe too low), and, since its inception, has greatly reduced financial risk exposure among beneficiaries. Nevertheless, it is unaffordable and inefficient. Jeanne Lambrew and Henry Aaron take up both of these challenges for Medicare reform in great detail in Reforming Medicare.
A Delphi Study Of Hipaa Compliance To Battlefield Medical Evacuation, John A. Chessman
A Delphi Study Of Hipaa Compliance To Battlefield Medical Evacuation, John A. Chessman
Theses and Dissertations
The purpose of this research was to examine the impact of HIPAA compliance on the Battlefield Medical Evacuation process. Specifically, this thesis sought to answer three research questions addressing the current Battlefield Medical Evacuation process and current HIPAA considerations for each step of the process. The research questions were answered through the use of the Delphi Technique. Eight experts, representing Air Force, Army and Civilian medical communities participated in two rounds of the Delphi Technique. The research identified how HIPAA compliance is handled now and identified suggested improvements. An original model of the battlefield medical evacuation process was developed, and …
(Debate) Medicare: Did The Devil Make Us Do It?, D. A. Hyman, Jill R. Horwitz
(Debate) Medicare: Did The Devil Make Us Do It?, D. A. Hyman, Jill R. Horwitz
Articles
In this lively and creative debate, Professors David Hyman and Jill Horwitz argue about the virtues and vices of the federal Medicare program. As some predict a bleak future for the American’s government’s ability (or inability) to continue paying for Medicare as the population ages, this debate shows that there is genuine disagreement about the severity of the problem. In his Opening Statement, Professor Hyman offers a satirical letter to the Devil from one of his demonic servants, describes the Medicare program through the lens of the seven deadly sins. Arguing that Medicare’s faults are represented in each sin, the …
The Virtues Of Medicare, Jill R. Horwitz
The Virtues Of Medicare, Jill R. Horwitz
Reviews
Most of us look forward to a heaven where people don't get sick. But if they do, health care would be traded among fully informed patients and providers in perfectly competitive and frictionless markets. In that perfect world, sick citizens simply shop for doctors the way they shop for other consumer goods. The better doctors, like the most elegant hotel rooms and fanciest cars, would cost more than inferior doctors. Patients would consult their utility meters and, with appropriate attention to discounting over an infinite lifetime, choose accordingly. After each treatment, the patients would know the quality of their outcome …
Life, Health, And Disability Insurance: Understanding The Relationships, Robert H. Jerry Ii
Life, Health, And Disability Insurance: Understanding The Relationships, Robert H. Jerry Ii
Faculty Publications
This project focuses on the extent to which dis-ability insurers should be allowed to use genetic information in underwriting and rate-setting, but this subject cannot be completely isolated from the related questions of whether life and health insurers should also have this discretion. Federal and state laws place significant restrictions on insurers' use of genetic information in health insurance, but regulation of such use in life and disability insurance is considerably more modest. This essay examines the reasons for this disparity and discusses the implications for future proposals to regulate disability insurers' use of genetic information in underwriting and rate-set-ting. …
Same Injury, Different Coverage: How Privatized Insurance Policies Affect Injured Elite And Non-Elite Professional Athletes, Diana P. Cortes
Same Injury, Different Coverage: How Privatized Insurance Policies Affect Injured Elite And Non-Elite Professional Athletes, Diana P. Cortes
Jeffrey S. Moorad Sports Law Journal (1994 - )
No abstract provided.