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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.

Introduction, Alexander Williams

Saint Louis University Journal of Health Law & Policy

No abstract provided.

Racism, Health Equity, And Crisis Standards Of Care In The Covid-19 Pandemic, Charlene Galarneau, Ruqaiijah Yearby

Saint Louis University Journal of Health Law & Policy

Long-standing and deeply embedded institutional racism, notably anti-Black racism in U.S. health care, has provided a solid footing for the health inequities by race evident in the COVID-19 pandemic. Inequities in susceptibility, exposure, infection, hospitalization, and treatment reflect and reinforce this racism and cause incalculable and preventable suffering in and loss of Black lives. This Article identifies multiple expressions of racism evident in the crisis standards of care (CSC) created by states and health care institutions to guide the ethical allocation of scarce critical care resources including ventilators. Contextualized within the broad landscape of health inequities pre-COVID-19 as well as …

Centering Racial Equity: Disparities Task Forces As A Strategy To Ensure An Equitable Pandemic Response, Dawn M. Hunter, Betsy Lawton

Saint Louis University Journal of Health Law & Policy

COVID-19 has had a stark and severe impact on health, economic stability, housing, and education in communities of color in the United States. As the pandemic has unfolded, the disproportionate number of cases, hospitalizations, and deaths due to COVID-19 among Black, Hispanic and Latinx, and Indigenous people has served as a stark reminder that the systems and structures that lead to these disparities need to be changed in order to achieve equitable outcomes.

This Article assesses efforts by cities, counties, states, and organizations to address the impact of COVID-19 on communities of color through formal task forces or working groups …

Seeking Safety While Giving Birth During The Pandemic, Elizabeth Kukura

Saint Louis University Journal of Health Law & Policy

As COVID-19 spread throughout the United States in early 2020, many pregnant people sought alternatives to delivering in a hospital. Midwifery practices offering services at home or in a freestanding birth center reported record numbers of inquiries, including from people looking to transfer care near the end of pregnancy. Whether due to fear of COVID-19 exposure in health care settings or out of a desire to avoid restrictive hospital policies regarding support people and newborn separation, people who had not previously considered home birth were newly drawn to midwifery care and others who had considered a midwife-attended birth redoubled their …

Policies Of Exclusion: The Impact Of Covid-19 On People With Disabilities, Amanda M. Caleb, Stacy Gallin

Saint Louis University Journal of Health Law & Policy

COVID-19 has had a significant impact on marginalized groups and has amplified the social and health inequalities in society, particularly for people with disabilities (PwDs), who are at higher risk of dying from the coronavirus. As such, it is vital that policies and practices include and protect PwDs, yet that is not the case across the United States. In this article, we examine policies related to COVID-19 that have further othered PwDs and that have created practical and theoretical inequity. In looking at public health strategies that are meant to protect the public, we argue that measures such as social …

Disability, Access, And Other Considerations: A Title Ii Framework For A Pandemic Crisis Response (Covid-19), George M. Powers, Lex Frieden, Vinh Nguyen

Saint Louis University Journal of Health Law & Policy

This Article examines how plans for emergency medical rationing during the COVID-19 pandemic may discriminate against those with disabilities. More specifically, this Article lays out the obligation of state and local governments under Title II of the ADA in creating and enforcing equitable and fair rationing plans during this COVID-19 crisis. For example, ventilator shortages are a common occurrence. The ADA, similar to other civil rights laws, operates so that a person with a disability is not denied a ventilator or other resources because of his/her disability. One reason that a person with a disability may be denied limited medical …

Should We Discriminate Among Discriminations?, Teneille R. Brown, Leslie Francis, James Tabery

Saint Louis University Journal of Health Law & Policy

The COVID-19 pandemic has demonstrated the complexities of rationing needed health care in a pandemic. It has also revealed deep, structural inequities in health care systems and societies, with certain disadvantaged groups experiencing alarmingly disproportionate rates of infection. A number of anti-discrimination statutes exist to ameliorate some of these historical inequities in the United States. Under federal law, health care facilities receiving federal funding may not discriminate on the basis of race, color, or national origin; disability; age; or sex. Three of these forms of discrimination were already prohibited by statutes that have been in effect for nearly fifty years: …

Retaining Medicaid Covid-19 Changes To Support Community Living, Elizabeth Edwards, David Machledt, Jennifer Lav

Saint Louis University Journal of Health Law & Policy

The impact of COVID-19 on people with disabilities in institutional settings, like nursing facilities, has garnered significant attention. But people receiving comparable services in the community have also been affected significantly. States used several emergency authorities in efforts to facilitate access to and stabilize these Medicaid home and community-based services (HCBS), including behavioral health services. Although states made different policy choices within those authorities, many states expanded the provider pool, increased HCBS provider rates, decreased onerous utilization controls and other barriers to care, expanded telehealth, and added new community-based services. These state policy responses have resulted in new services or …

Lessons Learned From Community-Driven Responsiveness During Covid-19, Amanda Harris, Brittini "Ree Belle" Gray, Ciearra Walker, Melinique Walls Castellanos

Saint Louis University Journal of Health Law & Policy

People of color are suffering and dying from COVID-19 at greater rates than the general population. Additionally, population-level health interventions can worsen health disparities by failing to reach already underserved populations. In response, PrepareSTL, a collaborative, community-led campaign, aims to reach communities of color in St. Louis with accessible information and resources to stop the spread of the coronavirus among the target audiences and help these communities survive the virus’s adverse social and economic impacts. This study (1) analyzes factors contributing to the success of PrepareSTL as a community-led and equity-centered response to COVID-19 and (2) identifies lessons from the …

Covid-19, Doctors, And The “Realities Of Prison Administration” Part I: The Realities Of A Subject Matter Expert, Fred Rottnek

Saint Louis University Journal of Health Law & Policy

COVID-19 is still novel. As scientists continue racing to characterize the virus and its mutations, promote behavioral change, and optimize treatment and vaccination strategies, public policy makers shift their attention from one high priority population to the next. These spotlights have converged on one truism of the pandemic: COVID-19 infection, and all its sequelae, have magnified long-established social and structural inequities in U.S. institutions—including practices in jails, prisons, and detention facilities. While these facilities were recognized as early incubators of the virus, the response of the facility administrators and local leaders were at best uneven and at worst nonexistent. When …

Covid-19, Courts, And The “Realities Of Prison Administration” Part Ii: The Realities Of Litigation, Chad Flanders

Saint Louis University Journal of Health Law & Policy

Lawsuits challenging prisons and jails for not doing enough to stop the spread of COVID-19 among inmates have faced mixed results in the courts: wins at the district court level are almost always followed by losses (in the form of stays of any orders to improve conditions) at the appeals court level or at the Supreme Court. This short Article tries to explain why this is happening and makes three comparisons between how district courts and appeals courts have analyzed these lawsuits. First, district courts and appeals courts tend to emphasize different facts in their decisions. District courts focus more …

The Urban Trauma Drama: The Intersecting Path Of Criminal Justice And Public Health Revealed During The Covid-19 Pandemic, José Felipé Anderson

Saint Louis University Journal of Health Law & Policy

Our society often operates under the delusion that more incarceration in urban areas will make us safer. Crowded cities and the problems for its inhabitants are not new. Those problems often fall more heavily on minority groups. Failed education, healthcare unavailability, and a lack of decent housing have made it difficult for cities to cope with addiction and crime. The COVID-19 pandemic has made the issues in the criminal system harder to ignore. Decline of major manufacturing jobs in cities like the steel and auto industries removed key opportunities for those seeking to overcome poverty and raise families. Debilitating riots …

Skirting The Law: Medicaid Block Grants And Per-Capita Caps In A Pandemic, Laura D. Hermer

Saint Louis University Journal of Health Law & Policy

To what extent can an administration abridge Medicaid’s entitlement status by administrative fiat? In the final year of the Trump administration, just before the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) sought to push the outer bounds of this question by announcing the Healthy Adult Opportunity (HAO) initiative. It invited states to submit § 1115 demonstration applications to cover individuals not eligible for Medicaid benefits under the state’s Medicaid plan—meaning, in many cases, the Affordable Care Act’s (ACA’s) Medicaid expansion population. Spending on those populations would be capped, not by purporting to waive federal law regarding matching …

Examining Sociodemographic Data Reporting Requirements In State Disease Surveillance Systems, Samantha Bent Weber, Amanda Moreland, Rachel Hulkower, Tara Ramanathan Holiday

Saint Louis University Journal of Health Law & Policy

Law plays an important role in the collection of data related to disease and injury in a population. A robust system of laws sets out requirements for the collection, analysis, and dissemination of disease reporting data from local, state, territorial, and federal public health institutions. Occurrence of disease, including outbreaks of novel infectious agents like coronaviruses, influenza viruses, and others that have arisen in recent years, often require epidemiologists and others to understand not only the etiology and specific context of diseases and conditions, but also the trajectory of their spread among and across communities. Capturing sociodemographic data is critical …

Rights Not Fundamental: Disability And The Right To Marry, Gabriella Garbero

Saint Louis University Journal of Health Law & Policy

Disabled people have long been systematically excluded from marriage, despite its personal, religious, cultural, and symbolic importance, and despite it being treated as a fundamental right in other contexts. This exclusion has been perpetuated by arcane laws that require Social Security and Medicaid beneficiaries to include their spouse’s income and assets in eligibility calculations. Since eligibility is contingent upon very little income and very few assets, couples who marry and intend to keep benefits are forced to live far below the poverty line in order to meet income and asset criteria, and many people are unable to make such a …

Enforcing The “Safe And Sanitary” Environment Standard Within U.S. Detention Facilities To Save Children’S Lives, Anam A. Khan

Saint Louis University Journal of Health Law & Policy

Overcrowding and unsanitary conditions within Customs and Border Protection (CBP) detention facilities are ideal for the transmission of infectious disease among CBP detainees. This is a dangerous problem. Between 2018 and 2019, at least six children died after acquiring infectious diseases while detained at CBP facilities. Migrant children are particularly vulnerable because their immune systems are not fully developed and due to the negative impact of trauma and stress have on their immune systems. Infectious disease promulgation within CBP facilities also puts the American public at risk because of the potential for transmission beyond CBP facilities. Employees who are regularly …

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.