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Articles 91 - 120 of 140
Full-Text Articles in Insurance Law
Consumer-Directed Health Care And The Chronically Ill, John V. Jacobi
Consumer-Directed Health Care And The Chronically Ill, John V. Jacobi
University of Michigan Journal of Law Reform
Insurance plans with consumer-controlled spending accounts are advocated as tools for reducing health costs and empowering consumers. This Article describes their recent development and argues that they are likely to fail. Instead of focusing on the small number of consumers with chronic illnesses who account for the bulk of health spending they focus on the majority of relatively well consumers. This Article proposes market-based and regulatory changes focused on high-cost patients. To best serve cost and quality goals, health finance responsibility should be divided between consumers and their employers for predictable and routine costs, and government for chronic and catastrophic …
The Supreme Court's Limitation Of Managed-Care Liability, Wendy K. Mariner
The Supreme Court's Limitation Of Managed-Care Liability, Wendy K. Mariner
Faculty Scholarship
This article summarizes and critiques the U.S. Supreme Court's decision in Aetna Health Inc. v. Davila, which limited managed care organizations' liability for negligent decisions about the care of patients in private employer-sponsored health plans governed by ERISA. It contrasts the Court's dichotomous view of health benefit plans, in which insurers administer contracts and treating physicians make medical judgments, with the more complicated relationships that affect decisions about both coverage and treatment.
The Insurance Aspects Of Damages, Robert H. Jerry Ii, Douglas R. Richmond
The Insurance Aspects Of Damages, Robert H. Jerry Ii, Douglas R. Richmond
UF Law Faculty Publications
"[I]t is difficult ... to imagine an event or transaction that does not involve insurance in some way." So it is with the most salient event in the lives of Tony and Donna Sabia, whose son Tony John Sabia, or "Little Tony," was born with profound disabilities. In the final analysis, the ability of Tony and Donna to pay for the future medical care and living expenses needed by their son depends on whether they can reach the liability insurance coverage possessed by the health care providers who attended Donna and Little Tony at the time of his birth. It …
Images Of Health Insurance In Popular Film: The Dissolving Critique, Elizabeth Pendo
Images Of Health Insurance In Popular Film: The Dissolving Critique, Elizabeth Pendo
Articles
Several recent films have villainized the health insurance industry as central elements of their plots. This Article examines three of those films: Critical Care, The Rainmaker, and John Q. It analyzes these films through the context of the consumer backlash against managed care that began in the 1990s and shows how these films reflect the consumer sentiment regarding health insurance companies and the cost controlling strategies they employ. In addition, the Article identifies three key premises about health insurance in the films that, although exaggerated and incomplete, have significant factual support. Ultimately, the author argues that, despite their passionately critical …
Insurance Binders Revisited, Peter N. Swisher
Insurance Binders Revisited, Peter N. Swisher
Law Faculty Publications
Temporary contracts of insurance-binders-protect the insured during the time between completion of the application and issuance of the policy. They are an accepted and necessary part of the insurance business, used in connection with a wide variety of insurance P7:oducts. But when alleged coverage under a binder is the subject of litigation, the results are often inconsistent and, sometimes, indefensible. This article provides a comprehensive discussion of binders, including the differences between standard form and manuscript binders, binding receipts in property and casualty insurance and conditional receipts in life insurance policies, the various kinds of conditional receipts, and otherwise. The …
Simple Fairness: Ending Discrimination In Health Insurance Coverage Of Addiction Treatment, Sonja Starr
Simple Fairness: Ending Discrimination In Health Insurance Coverage Of Addiction Treatment, Sonja Starr
Faculty Scholarship
No abstract provided.
Cockle: Importing Health Benefits Into Wages—An Invitation For Legislative Review Of The Wage Definition Under Washington's Industrial Insurance Act, Matthew H. Adams
Cockle: Importing Health Benefits Into Wages—An Invitation For Legislative Review Of The Wage Definition Under Washington's Industrial Insurance Act, Matthew H. Adams
Seattle University Law Review
This Note addresses the efficacy of construing the term "wages" RCW 51.08.178 to include employer-provided health insurance, hoping to serve as a resource for the Legislature to reevaluate IIA's wage definition in light of Cockle. First, this Note gives a general background of IIA and the Act's time-loss compensation scheme. Next, this Note discusses how Washington and other jurisdictions treat fringe benefits in defining "wages." This Note then examines the Washington Supreme Court's ground-breaking decision in Cockle, in which the court held that the value of employer-provided medical and dental benefits are part of the basis used to …
Fundamental Mismatch: The Improper Integration Of Individual Liberty Rights Into Commerce Clause Analysis Of The Patient Protection And Affordable Care Act, Arthur J.R. Baker
Fundamental Mismatch: The Improper Integration Of Individual Liberty Rights Into Commerce Clause Analysis Of The Patient Protection And Affordable Care Act, Arthur J.R. Baker
University of Miami Law Review
No abstract provided.
Genomic Medicine: The Human Genome Project From A Healthcare Provider's Perspective, Georgia Wiesner
Genomic Medicine: The Human Genome Project From A Healthcare Provider's Perspective, Georgia Wiesner
Journal of Law and Health
But the Human Genome Project from my point of view as a healthcare provider has really been on what advantages and what advances can we be able to provide from that. So we really learned a lot about how genes work, how they talk together and how we actually have both health and disease as a consequence of the Human Genome Project. So really understanding this complex interaction is one of the most exciting things as well. What this really has done for healthcare is allowed us to individualize our healthcare. To be able to say for one person against …
Legislation And Genetic Discrimination, Sharona Hoffman
Legislation And Genetic Discrimination, Sharona Hoffman
Journal of Law and Health
State legislation addresses genetic discrimination in both employment and health insurance. Thirty-one states have passed laws that address genetic discrimination in employment. Approximately thirteen states prohibit employers from requiring applicants to undergo genetic testing as a condition of employment. Some states have more limited restrictions. Florida prohibits only the screening of applicants for the sickle-cell trait. Wisconsin requires employers to obtain written and informed consent from applicants prior to administering genetic tests, but does not preclude their utilization altogether. Some states establish exceptions that permit genetic testing that is job-related or that is conducted, with the employee's written and informed …
Pink Slip Introduction, Dena S. Davis
Pink Slip Introduction, Dena S. Davis
Journal of Law and Health
What has changed however, is the degree of worry and concern that people feel about the uses to which their genetic information can be put. When the HGP (Human Genome Project) began, a number of pundits were convinced that the "future knowledge" that genetic information can deliver to consumers and insurers alike would completely undermine the practice of private health insurance, and send our current system crashing to the ground. Needless to say, that has not happened; but with 42 million Americans currently without health insurance, and with insurance tightly entwined with employment, many people fear that genetic information will …
Can Employers Put Genetic Information To Good Use, Kathleen C. Engel
Can Employers Put Genetic Information To Good Use, Kathleen C. Engel
Journal of Law and Health
In my talk today I am going to try to answer the question: Can employers put genetic information to good use? Preparing this talk was a challenge because it required me to switch sides of the table. Having represented plaintiffs in employment discrimination cases for ten years, my inclination is to focus on the ways that employers can use genetic information to the detriment of their workers. I chose to talk about the value of genetic information from the employers' perspective because I wanted to force myself to engage in a disciplined study of the issues, rather than simply don …
Increasing Consumer Power In The Grievance And Appeal Process For Medicare Hmo Enrollees, Kenneth J. Pippin
Increasing Consumer Power In The Grievance And Appeal Process For Medicare Hmo Enrollees, Kenneth J. Pippin
University of Michigan Journal of Law Reform
Federal law requires that Health Maintenance Organizations (HMOs) and Managed Care Organizations (MCOs) provide Medicare beneficiaries with specific grievance and appeal rights for challenging adverse decisions of these organizations. The Health Care Financing Administration (HCFA) is charged with enforcing these regulations. Currently, however, HCFA contracts with HMOs, allowing them to enroll Medicare beneficiaries despite the fact that many of the statutory and regulatory requirements are ignored by the Medicare HMOs. This is problematic because the elderly Medicare population may not be able to independently and adequately challenge the HMO's denial of care or reimbursement. Because HCFA has been reluctant and …
The Governmental Composition Of The Insurance Costs Of Smoking, W. Kip Viscusi
The Governmental Composition Of The Insurance Costs Of Smoking, W. Kip Viscusi
Vanderbilt Law School Faculty Publications
The estimated health risks from smoking have significant external financial consequences for society. Studies at the national level indicate that cigarettes are self-financing since external costs such as those due to illnesses are offset by cost savings associated with premature death, chiefly pension costs. This paper extends this analysis to all 50 states and considers the costs considered in the state attorneys general suits against the cigarette industry. Cigarettes are always self-financing from the standpoint of costs to each state. The extent of the cost savings is less than at the federal level. However, smokers' higher medical costs are outweighed …
Managed Care Regulation: Can We Learn From Others? The Chilean Experience, Timothy Stoltzfus Jost
Managed Care Regulation: Can We Learn From Others? The Chilean Experience, Timothy Stoltzfus Jost
University of Michigan Journal of Law Reform
Because the United States relies on private insurance for financing health care to a much greater degree than do other nations, and because managed care as a form of private insurance is further developed in the United States than elsewhere, it is arguable that we have little to learn from other nations about managed care regulation. This Article tests this hypothesis with respect to Chile, a country where private insurance is widespread and managed care is emerging. It concludes that by studying the experience of other nations we might gain a larger perspective on the context of our concerns in …
Managed Care- The First Chapter Comes To A Close, Sallyanne Payton
Managed Care- The First Chapter Comes To A Close, Sallyanne Payton
University of Michigan Journal of Law Reform
Introduction to the symposium, Managed Care: What's the Prognosis: Managing Care in the Next Century.
Clearing The Way For An Effective Federal-State Partnership In Health Reform, Eleanor D. Kinney
Clearing The Way For An Effective Federal-State Partnership In Health Reform, Eleanor D. Kinney
University of Michigan Journal of Law Reform
At century's end, states have assumed a very different role in the design, implementation, and operation of health service programs than they did twenty-five years ago. In the current volatile political atmosphere particularly at the federal level, states have taken up the mantle of healthcare reform in the final years of the 1990s. Yet there remain problems and difficulties with the current federal-state relationship in health reform. The critical question is whether states can successfully accomplish genuine reform given its politically charged, complex and costly nature. This question takes on particular significance for the most important reform-expanding coverage to the …
The Competitive Impact Of Small Group Health Insurance Reform Laws, Mark A. Hall
The Competitive Impact Of Small Group Health Insurance Reform Laws, Mark A. Hall
University of Michigan Journal of Law Reform
This Article reports on findings from an extensive study of small group health insurance market reforms in seven states, enacted during the early 1990s. After summarizing the content and purpose of these reforms, this evaluation focuses on the impact these reforms have had on the nature and degree of market competition. The principal findings are: (1) small group health insurance markets are highly competitive, both in price and in product innovation and diversity; (2) although some insurers have left some or all of these states in part because of these reforms, an ample number of active competitors remain, even in …
The Impact Of Title Iii Of The Americans With Disabilities Act On Employer-Provided Insurance Plans: Is The Insurance Company Subject To Liability?, Jill L. Schultz
The Impact Of Title Iii Of The Americans With Disabilities Act On Employer-Provided Insurance Plans: Is The Insurance Company Subject To Liability?, Jill L. Schultz
Washington and Lee Law Review
No abstract provided.
Massachusetts' Domestic Partnership Challenge: Hope For A Better Future, Jennifer Levi
Massachusetts' Domestic Partnership Challenge: Hope For A Better Future, Jennifer Levi
Faculty Scholarship
Acknowledging that its decision means that "some household members" may be without a "critical social necessity," the Massachusetts Supreme Iudicial Court (SJC) ruled in Connors v. City of Boston that Boston Mayor Thomas M. Menino's executive order granting health insurance benefits to the domestic partners of city employees could not stand in the face of a Massachusetts state insurance law. In Connors, the SJC simultaneously recognized that although the demographics of Massachusetts households have changed within the more than forty years since the state insurance law, G.L. c. 32B (Chapter 32B), was adopted, that law nevertheless constrains municipalities from extending …
Chicago Hope Meets The Chicago School, Gail B. Agrawal
Chicago Hope Meets The Chicago School, Gail B. Agrawal
Michigan Law Review
Twenty-five years after the enactment of the Federal Health Maintenance Organization Act and nearly five years after the failure of proposed federal health care reform, managed care has come to dominate the medical marketplace. As a result, the relationships among patients, payers, and physicians have changed fundamentally and dramatically. In this market-driven environment, health care - how much it costs, who receives treatment, and who pays for it - may have surpassed the weather as a topic of everyday conversation at dinner tables and water coolers across the country. In the popular press, reports concerning managed care, usually derogatory, are …
Rights And Efficiency In American Health Law, Maxwell Gregg Bloche
Rights And Efficiency In American Health Law, Maxwell Gregg Bloche
Georgetown Law Faculty Publications and Other Works
During the 1960s and 1970s, the individual rights revolution that swept through American society remade much of the nation's health law in its image. Sick people acquired the right to be told of the risks and benefits of proposed treatments and then to give thumbs-up or thumbs-down to their doctors' decisions. Successful suits for medical negligence went from rare to commonplace. Elderly and poor Americans achieved statutory rights of access to publicly funded healthcare, and courts burnished these rights with myriad procedural protections. The critically ill and their families won the right to refuse aggressive, life-sustaining treatments. Psychiatric patients acquired …
Contemporary Social Policy Analysis And Employee Benefit Programs: Boomers, Benefits, And Bargains, Dana M. Muir
Contemporary Social Policy Analysis And Employee Benefit Programs: Boomers, Benefits, And Bargains, Dana M. Muir
Washington and Lee Law Review
No abstract provided.
Some Preliminary Thoughts On The Deregulation Of Insurance To Advantage The Working Poor, Maria O'Brien
Some Preliminary Thoughts On The Deregulation Of Insurance To Advantage The Working Poor, Maria O'Brien
Faculty Scholarship
The regulatory framework in which employee benefits products are marketed and consumed by individuals and groups seeking to reduce exposure to covered events creates a set of background rules. These rules influence the way in which insurance products are developed and impact the number of people who will enjoy the protection these insurance products afford. This means that every proposal to regulate an employment related insurance product likely will affect both the quality and quantity of insurance available to consumers. For example, over the past decade, as the public and professionally-interested parties have grappled with the insurance implications of the …
Democratizing Hmo Regulation To Enforce The "Rule Of Rescue", Kent G. Rutter
Democratizing Hmo Regulation To Enforce The "Rule Of Rescue", Kent G. Rutter
University of Michigan Journal of Law Reform
Despite heightened public concern about HMOs, misguided regulatory measures have not guaranteed HMO patients access to the treatment options many consider vital. This Note recommends four changes to the current regulatory system that would preserve HMOs' ability to control health care costs while allowing patients and doctors, rather than lawmakers or HMO administrators, to set health care priorities.
Drive-Through Deliveries: In Support Of Federal Legislation To Mandate Insurer Coverage Of Medically Sound Minimum Lengths Of Postpanum Stays For Mothers And Newborns, Freeman L. Farrow
Drive-Through Deliveries: In Support Of Federal Legislation To Mandate Insurer Coverage Of Medically Sound Minimum Lengths Of Postpanum Stays For Mothers And Newborns, Freeman L. Farrow
University of Michigan Journal of Law Reform
President Clinton signed the Newborns' and Mothers' Health Protection Act of 1996 into law on September 26, 1996. The Act requires insurers that provide maternity benefits to cover medically sound minimum lengths of inpatient, postpartum stays according to the joint guidelines of the American Academy of Pediatrics and the American College of Obstetrics and Gynecology. This Note discusses the historical context in which the necessity for passage of protective legislation arose, the interplay between state and federal statutes that created the need for federal legislation to provide desired protections for postpartum patients and examines the provisions of the Act. This …
Health Insurance Coverage For High-Cost Health Care: Reflections On The Rainmaker, Robert H. Jerry Ii
Health Insurance Coverage For High-Cost Health Care: Reflections On The Rainmaker, Robert H. Jerry Ii
Faculty Publications
This article reflects upon the film "The Rainmaker" and analyzes how the health insurance coverage problems that it addresses take us to the vortex of some of the most difficult issues facing our nation's health care system.
On Our Own: Strategies For Securing Health And Retirement Benefits In Contingent Employment, Gwen Thayer Handelman
On Our Own: Strategies For Securing Health And Retirement Benefits In Contingent Employment, Gwen Thayer Handelman
Washington and Lee Law Review
No abstract provided.
The Health Security Act: Coercion And Distrust For The Market, H. Richard Beresford
The Health Security Act: Coercion And Distrust For The Market, H. Richard Beresford
Cornell Law Faculty Publications
No abstract provided.
Book Review, Mitchell M. Simon
Book Review, Mitchell M. Simon
RISK: Health, Safety & Environment (1990-2002)
Review of: MARC A. RODWIN, MEDICINE, MONEY & MORALS: PHYSICIANS' CONFLICTS OF INTEREST. (Oxford University Press 1993). [430 pp.] Acknowledgements, acronyms, appendices, foreword, index, notes. LC: 92-49488; ISBN: 0-19-508096-3. [Cloth $25.00. 200 Madison Avenue, New York NY 10016.]