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Full-Text Articles in Health Law and Policy

New Aca Waiver Directives Signal Changes For State Health Insurance Marketplaces, Rachel Gershon, Catherine Torri Dec 2018

New Aca Waiver Directives Signal Changes For State Health Insurance Marketplaces, Rachel Gershon, Catherine Torri

Commonwealth Medicine Publications

New Trump Administrations Section 1332 waiver guidance increases state ACA flexibility. Rachel Gershon & Catie Torri discuss what this could mean for health care policy.


A Medicaid Compromise Expanded Coverage For Hoosiers, But Important Questions Linger, Robert W. Seifert Feb 2018

A Medicaid Compromise Expanded Coverage For Hoosiers, But Important Questions Linger, Robert W. Seifert

Commonwealth Medicine Publications

In today’s polarized political environment, it is easy to forget that most policy decisions are not black or white, but rather some indeterminate shade of gray. A case in point is Indiana’s Medicaid waiver, which the federal government just approved for a three-year extension.


Health Policy And The Tax Cuts And Jobs Act, Rachel Gershon Dec 2017

Health Policy And The Tax Cuts And Jobs Act, Rachel Gershon

Commonwealth Medicine Publications

Congress passed the Tax Cuts and Jobs Act. What does the Act mean for health policy?


Public Company Health Insurers And Medical Loss Ratios: An Event Study Of Dates Associated With The Affordable Care Act, Rachelle Quinn Mar 2017

Public Company Health Insurers And Medical Loss Ratios: An Event Study Of Dates Associated With The Affordable Care Act, Rachelle Quinn

Doctor of Business Administration (DBA)

The Affordable Care Act (ACA) has proved to be a contentious regulatory and political topic. Although key features were established within the law the complexity of the new provisions and political opposition resulted in a series of federal and state governmental process changes, rule clarifications, and legal challenges. One component of the ACA is the introduction of a federal Medical Loss Ratio (MLR), which requires insurers to spend specified percentages of their premium revenue dollars on medical services and quality improvement actions. If thresholds are not met, insurers must refund premiums to their members, potentially removing millions of dollars from ...


Waiver World: A Guided Tour Of 1115 And 1332 Waivers, Jean C. Sullivan, Marybeth Mccaffrey, Rachel Gershon, Josh Krintzman Nov 2016

Waiver World: A Guided Tour Of 1115 And 1332 Waivers, Jean C. Sullivan, Marybeth Mccaffrey, Rachel Gershon, Josh Krintzman

Commonwealth Medicine Publications

An overview of waivers made possible by Section 1115 of the Social Security Act and Section 1332 of the Affordable Care Act. This presentation explains spending and waiver authority and the legal considerations that may arise, the ways that states have used waiver authority, and reviews the limitations and new responsibilities that come with waivers.

Under Section 1115 of the Social Security Act, states can pursue waivers to implement pilot or demonstration projects affecting many programs, including Medicaid. Under the Affordable Care Act, Section 1332 allows states to pursue federal waivers for innovation strategies that will expand access to high-quality ...


Community Health Centers And Medicaid Payment Reform: Emerging Lessons From Medicaid Expansion States, Peter Shin, Jessica Sharac, Zoe Barber, Sara J. Rosenbaum Oct 2016

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 ...


The Double-Edged Sword Of Health Care Integration: Consolidation And Cost Control, Erin C. Fuse Brown, Jaime S. King Jan 2016

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 ...


Puerto Rico’S Community Health Centers In A Time Of Crisis, Peter Shin, Jessica Sharac, Marie Nina Luis, Sara J. Rosenbaum Dec 2015

Puerto Rico’S Community Health Centers In A Time Of Crisis, Peter Shin, Jessica Sharac, Marie Nina Luis, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2014, Puerto Rico’s twenty federally funded community health centers, operating in 71 sites located throughout the Commonwealth, served 330,736 patients, approximately one in ten Commonwealth residents. Compared to other Puerto Rico residents, health center patients are less likely to be insured. Despite considerable growth in Medicaid as a result of the supplemental funding provided under the Affordable Care Act, in 2014, 12.2% of health center patients remained uninsured.

Compared to health centers outside Puerto Rico, Puerto Rico’s health centers show a greater proportion of Medicaid patients served (69% compared to 46% outside Puerto Rico), a ...


How Has The Affordable Care Act Benefitted Medically Underserved Communities? : National Findings From The 2014 Community Health Centers Uniform Data System, Jessica Sharac, Peter Shin, Sara J. Rosenbaum Aug 2015

How Has The Affordable Care Act Benefitted Medically Underserved Communities? : National Findings From The 2014 Community Health Centers Uniform Data System, Jessica Sharac, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers represent the single largest comprehensive primary health care system serving medically underserved communities, operating in more than 9,000 urban and rural locations. Newly-released data for 2014 from the Uniform Data System (UDS; the federal health center reporting system) shed important light on the impact of the Affordable Care Act in its first full year of implementation in medically underserved urban and rural communities across the U.S. These communities experience elevated poverty, heightened health risks, lack of access to primary health care, and a significantly greater likelihood that residents will be uninsured.

The UDS data show ...


Medicare At Fifty Needs To Grow, William H. Lane Jul 2015

Medicare At Fifty Needs To Grow, William H. Lane

English Faculty Publications

In America everybody has a healthcare story. A bill impossible to read, an inscrutable "additional" charge, trouble getting insurance, trouble keeping it, a friend or family member who's fallen between the coverage "cracks." [excerpt]


State Differences In The Application Of Medical Frailty Under The Affordable Care Act, Peter Mosbach, Sherry Campanelli, A. E. Adams Jun 2015

State Differences In The Application Of Medical Frailty Under The Affordable Care Act, Peter Mosbach, Sherry Campanelli, A. E. Adams

Commonwealth Medicine Publications

This poster explains a study that examines how states undergoing Medicaid expansion differ in their treatment of the “medically frail” population. The medically frail are individuals who may need the extra benefits offered by traditional Medicaid.

The results provide needed information to policymakers that are interested in improving access among vulnerable populations in the 23 states that have not yet implemented Medicaid expansion, but may do so in the future. While regulations provide categories that qualify for medical frailty, each state is free to use their own method of determining who meets the definition. There is a need for ongoing ...


Understanding And Analyzing The New Federal Reporting Requirements: Performance Indicators Of State Medicaid & Chip Programs, Michael Chin May 2014

Understanding And Analyzing The New Federal Reporting Requirements: Performance Indicators Of State Medicaid & Chip Programs, Michael Chin

Commonwealth Medicine Publications

This presentation describes Medicaid and CHIP requirements to report performance indicators, describes the marketplace federal reporting requirements, describes and analyzes initial results from the reporting requirements, and reviews the future of federal reporting for Medicaid and CHIP.


Expanding Women’S Healthcare Access In The United States: The Patchwork “Universalism” Of The Affordable Care Act, Randy Albelda, Diana Salas Coronado Feb 2014

Expanding Women’S Healthcare Access In The United States: The Patchwork “Universalism” Of The Affordable Care Act, Randy Albelda, Diana Salas Coronado

Center for Social Policy Publications

This paper explores the promise of the Patient Protection and Affordable Care Act, commonly called “Obamacare” (referred to here as the ACA), with attention to the ways gender matter by tracing the development and implementation of key US social protection systems, an examination of the current health system with particular attention to women’s coverage, and the potential impacts of the ACA, including how it conforms to international human rights norms for health care. The ACA promises to vastly improve the key dimensions of health coverage in the US, but it conforms with other US social policy by relying on ...


Can Consumers Make Affordable Care Affordable? The Value Of Choice Architecture, Eric J. Johnson, Ran Hassin, Tom Baker, Allison T. Bajger, Galen Treuer Jul 2013

Can Consumers Make Affordable Care Affordable? The Value Of Choice Architecture, Eric J. Johnson, Ran Hassin, Tom Baker, Allison T. Bajger, Galen Treuer

Faculty Scholarship at Penn Law

Starting this October, tens of millions will be choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do ...


Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Designing And Implementing State Health Reform, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor Feb 2013

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Designing And Implementing State Health Reform, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

Provisions in the Medicaid statute permit states to apply for waivers from traditional program requirements. On January 16, 2009, the federal government approved Rhode Island's Global Consumer Choice Compact Waiver. In exchange for a cap on combined federal and state spending of $12.075 billion through 2013, Rhode Island received greater flexibility to adopt certain Medicaid program changes. This study analyzes the design and implementation of the Global Waiver to draw general lessons for health reform at the state-level, a key concern given ongoing state discretion to improve their health care systems under the Patient Protection and Affordable Care ...


Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Block Granting Medicaid And Other Retrenchment, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor Feb 2013

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Block Granting Medicaid And Other Retrenchment, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

On January 16, 2009, the Federal government approved Rhode Island’s application for a Global Consumer Choice Compact Medicaid Waiver whereby the state became the first granted permission to operate its entire Medicaid program under the state plan and a single 1115 “research and demonstration” waiver. The Global Waiver has been implemented in the context of Republican proposals to turn Medicaid into a block grant which would give states substantially more flexibility administering the program in exchange for receiving an upfront allotment from the Federal government. Proponents have held up the Global Waiver as a successful example of what might ...


Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Rebalancing Long-Term Care Under The Affordable Care Act, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor Feb 2013

Implications Of Rhode Island’S Global Consumer Choice Compact Medicaid Waiver For Rebalancing Long-Term Care Under The Affordable Care Act, Edward Alan Miller, Divya Samuel, Susan Allen, Amal Trivedi, Vincent Mor

Gerontology Institute Publications

Federal approval of Rhode Island’s Global Consumer Choice Compact Global Waiver in 2009 provided Rhode Island with greater flexibility to modify its Medicaid program. Because 96% of long-term care expenditures in Rhode Island were directed toward institutional settings, a primary goal was to facilitate the state’s efforts to shift the locus of long-term care to non-institutional settings. This study draws lessons from Rhode Island’s experience with the Global Waiver for the long-term care rebalancing provisions of the Patient Protection and Affordable Care Act of 2010. Data derive from 325 archival sources and 26 semi-structured interviews. Results suggest ...


Better Health, But Less Justice: Widening Health Disparities After National Federation Of Independent Business V. Sebelius, Emily W. Parento, Lawrence O. Gostin Jan 2013

Better Health, But Less Justice: Widening Health Disparities After National Federation Of Independent Business V. Sebelius, Emily W. Parento, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

At the time it was enacted in 2010, the Patient Protection and Affordable Care Act (ACA) was widely applauded by health activists, as it meant that the United States would at last join the overwhelming majority of industrialized countries in providing its population with guaranteed access to affordable health care. Roughly half of the increase in access to health insurance was to come from the expansion of Medicaid eligibility to all U.S. citizens and legal residents with income below 138% of the Federal Poverty Level. However, the Supreme Court’s 2012 ruling in National Federation of Independent Business v ...


Funding Health-Related Vr Services: The Potential Impact Of The Affordable Care Act On The Use Of Private Health Insurance And Medicaid To Pay For Health-Related Vr Services, Robert Silverstein Dec 2012

Funding Health-Related Vr Services: The Potential Impact Of The Affordable Care Act On The Use Of Private Health Insurance And Medicaid To Pay For Health-Related Vr Services, Robert Silverstein

All Institute for Community Inclusion Publications

One of the myriad of issues affecting the administration of the vocational rehabilitation (VR) program by State VR agencies under Title I of the Rehabilitation Act is how to maximize access to and use of all available funding sources to pay for VR services and supports for VR applicants and clients. In March 2010, Congress passed and the President signed into law the "Affordable Care Act" (ACA). 1 On June 28, 2012, the United States Supreme Court upheld all of the provisions of the ACA, with the exception of provisions mandating Medicaid expansion. The Supreme Court held that if a ...


The Power To Block The Affordable Care Act: What Are The Limits?, John D. Kraemer, Lawrence O. Gostin Nov 2012

The Power To Block The Affordable Care Act: What Are The Limits?, John D. Kraemer, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Though Supreme Court upheld most parts of the Affordable Care Act (ACA), Congress’ goals in enacting it could still be frustrated by non-implementation. During his campaign for president, Governor Romney promised “to issue Obamacare waivers to all fifty states.” While such blanket waivers would likely violate the Constitution’s Take Care Clause, the ACA does permit other waivers. To be lawful, however, they must meet certain requirements designed to enhance access and lower cost. A president who opposes the ACA might be able to limit its implementation by refusing to issue premium subsidies in federally operated insurance exchanges, and this ...


The Patient Protection And Affordable Care Act: Why It Is Important For Women’S Health, Mary Fanning Oct 2012

The Patient Protection And Affordable Care Act: Why It Is Important For Women’S Health, Mary Fanning

Journal of Interdisciplinary Feminist Thought

President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA) on March 23, 2010 ending the long history of disparity in access to health care services between insured and uninsured persons. Disparity between women and men in obtaining health insurance coverage is also corrected in the act. Women’s organizations that have focused attention on women’s distinctive health needs over the past century and a half laid the foundation for provisions in the legislation that address women’s health. This article addresses health insurance coverage, its impact on health, the particular challenges women have confronted ...


Justice Roberts’ America, Robin West Jul 2012

Justice Roberts’ America, Robin West

Georgetown Law Faculty Publications and Other Works

Less than a week after the Roberts Court issued its decision in National Federation of Independent Business v Sebelius, Jeffrey Toobin, writing in The New Yorker, compared the first part of Chief Justice John Roberts's opinion, in which he found that the Commerce Clause did not authorize Congress to enact the "individual mandate" section of the Affordable Care Act (ACA) that requires all individuals to buy health insurance, with an Ayn Rand screed, noting that the pivotal sections of the argument were long on libertarian rhetoric but short on citations of authority. Roberts held (although "held" might be stating ...


An O’Neill Institute Briefing Paper: The Supreme Court’S Landmark Decision On The Affordable Care Act: Healthcare Reform’S Ultimate Fate Remains Uncertain, Emily W. Parento, Lawrence O. Gostin Jul 2012

An O’Neill Institute Briefing Paper: The Supreme Court’S Landmark Decision On The Affordable Care Act: Healthcare Reform’S Ultimate Fate Remains Uncertain, Emily W. Parento, Lawrence O. Gostin

O'Neill Institute Papers

The Supreme Court’s decision on the constitutionality of the Patient Protection and Affordable Care Act (ACA) is a landmark on the path toward ensuring universal access to health care in the United States. In a 5-4 decision written by Chief Justice Roberts, the Court upheld the law in its entirety with the sole exception that Congress may not revoke existing state Medicaid funding to penalize states that decline to participate in the Medicaid expansion under the ACA. In this O’Neill Institute Briefing, we explain and analyze the Court’s decision, focusing on the individual purchase mandate and the ...


Healthcare Reform Hangs In The Balance, Lawrence O. Gostin Mar 2012

Healthcare Reform Hangs In The Balance, Lawrence O. Gostin

O'Neill Institute Papers

In this timely new briefing, Professor Lawrence O. Gostin, University Professor and Faculty Director, O’Neill Institute for National and Global Health Law, Georgetown University writes:

Prior to Tuesday’s arguments, I believed that the Supreme Court would uphold the health insurance purchase mandate by a comfortable margin. But now I believe that health care reform hangs in the balance. Here are the key arguments on which the future of President Obama’s health care reform depends: a greater freedom, cost-shifting, the health care market, acts versus omissions, limiting principles, the population-base approach, and what is necessary and proper. If ...


Why The Affordable Care Act's Individual Purchase Mandate Is Both Constitutional And Indispensable To The Public Welfare, Lawrence O. Gostin Mar 2012

Why The Affordable Care Act's Individual Purchase Mandate Is Both Constitutional And Indispensable To The Public Welfare, Lawrence O. Gostin

O'Neill Institute Papers

Integral to the Affordable Care Act's (ACA’s) conceptual design is the individual purchase mandate, which requires most individuals to pay an annual tax penalty if they do not have health insurance by 2014. Despite the vociferous opposition, the mandate is the most “market-friendly” financing device because it relies on the private sector. Ironically, less market-oriented reforms such as a single-payer system clearly would have been constitutional.

It is common sense for everyone to purchase health insurance and thus gain security against the potentially catastrophic costs of treating a serious illness or injury. However, Congress’ method of ensuring that ...


The Basic Health Program: What Would It Mean For Connecticut?, Katharine London, Robert W. Seifert Jan 2012

The Basic Health Program: What Would It Mean For Connecticut?, Katharine London, Robert W. Seifert

Commonwealth Medicine Publications

This presentation provides highlights of a research brief released by the Legal Assistance Resource Center of Connecticut. The research brief includes more detail about the State Basic Health Program (SBHP), the analysis, and citations to data sources.

Client/Partner: Legal Assistance Resource Center of Connecticut


Evaluating The State Basic Health Program In Connecticut, Katharine London, Robert W. Seifert Jan 2012

Evaluating The State Basic Health Program In Connecticut, Katharine London, Robert W. Seifert

Commonwealth Medicine Publications

The federal Patient Protection and Affordable Care Act (ACA) offers states many options and alternatives for tailoring national health reform to best meet their specific needs. The ACA’s State Basic Health Program (SBHP) option affords states an opportunity to design a program for low-income individuals that offers better continuity of care at a lower cost, while providing a financial benefit to the state. This issue brief examines the factors that Connecticut should take into account in assessing the potential benefits of a SBHP. This analysis relies on the parameters of a SBHP as described in the ACA. The federal ...