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Health care reform

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Articles 1 - 30 of 128

Full-Text Articles in Health Law and Policy

Unlocking Access To Health Care: A Federalist Approach To Reforming Occupational Licensing, Gabriel Scheffler Jan 2019

Unlocking Access To Health Care: A Federalist Approach To Reforming Occupational Licensing, Gabriel Scheffler

Health Matrix: The Journal of Law-Medicine

Several features of the existing occupational licensing system impede access to health care without providing appreciable protections for patients. Licensing restrictions prevent health care providers from offering services to the full extent of their competency, obstruct the adoption of telehealth, and deter foreign-trained providers from practicing in the United States. Scholars and policymakers have proposed a number of reforms to this system over the years, but these proposals have had a limited impact for political and institutional reasons.

Still, there are grounds for optimism. In recent years, the federal government has taken a range of initial steps to reform licensing ...


The Shadows Of Life: Medicaid's Failure Of Health Care's Moral Test, Barak D. Richman, Kushal T. Kadakia, Shivani A. Shah Jan 2019

The Shadows Of Life: Medicaid's Failure Of Health Care's Moral Test, Barak D. Richman, Kushal T. Kadakia, Shivani A. Shah

Faculty Scholarship

North Carolina Medicaid covers one-fifth of the state’s population and makes up approximately one-third of the budget. Yet the state has experienced increasing costs and worsening health outcomes over the past decade, while socioeconomic disparities persist among communities. In this article, the authors explore the factors that influence these trends and provide a series of policy lessons to inform the state’s current reform efforts following the recent approval of North Carolina’s Section 1115 waiver by the Centers for Medicare and Medicaid Services. The authors used health, social, and financial data from the state Department of Health and ...


Reform At Risk — Mandating Participation In Alternative Payment Plans, Scott Levy, Nicholas Bagley, Rahul Rajkumar May 2018

Reform At Risk — Mandating Participation In Alternative Payment Plans, Scott Levy, Nicholas Bagley, Rahul Rajkumar

Articles

In an ambitious effort to slow the growth of health care costs, the Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI) and armed it with broad authority to test new approaches to reimbursement for health care (payment models) and delivery-system reforms. CMMI was meant to be the government’s innovation laboratory for health care: an entity with the independence to break with past practices and the power to experiment with bold new approaches. Over the past year, however, the Department of Health and Human Services (HHS) has quietly hobbled CMMI, imperiling its ability to generate meaningful ...


Small Change, Big Consequences — Partial Medicaid Expansions Under The Aca, Adrianna Mcintyre, Allan M. Joseph, Nicholas Bagley Sep 2017

Small Change, Big Consequences — Partial Medicaid Expansions Under The Aca, Adrianna Mcintyre, Allan M. Joseph, Nicholas Bagley

Articles

Though congressional efforts to repeal and replace the Affordable Care Act (ACA) seem to have stalled, the Trump administration retains broad executive authority to reshape the health care landscape. Perhaps the most consequential choices that the administration will make pertain to Medicaid, which today covers more than 1 in 5 Americans. Much has been made of proposals to introduce work requirements or cost sharing to the program. But another decision of arguably greater long-term significance has been overlooked: whether to allow “partial expansions” pursuant to a state Medicaid waiver. Arkansas has already submitted a waiver request for a partial expansion ...


Federalism And The End Of Obamacare, Nicholas Bagley Apr 2017

Federalism And The End Of Obamacare, Nicholas Bagley

Articles

Federalism has become a watchword in the acrimonious debate over a possible replacement for the Affordable Care Act (ACA). Missing from that debate, however, is a theoretically grounded and empirically informed understanding of how best to allocate power between the federal government and the states. For health reform, the conventional arguments in favor of a national solution have little resonance: federal intervention will not avoid a race to the bottom, prevent externalities, or protect minority groups from state discrimination. Instead, federal action is necessary to overcome the states’ fiscal limitations: their inability to deficit-spend and the constraints that federal law ...


Macra And Stark: Strange Bedfellows At The Heart Of Health Care Reform, Rebecca Olavarria Jan 2017

Macra And Stark: Strange Bedfellows At The Heart Of Health Care Reform, Rebecca Olavarria

Journal Publications

The enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was well-received by all as it repealed Medicare’s Sustainable Growth Rate and, in its place, mandates the implementation of a new system for health care delivery and payment. Under MACRA, health care providers are expected to work together and coordinate their efforts with the goal of improving patient outcomes and controlling costs. For the first time ever, federal reimbursements will be tied to quality of care and improved cost efficiencies. However, as a new law, MACRA’s potential for success needs to be measured in terms ...


N.C. Medicaid Reform: A Bipartisan Path Forward, Barak D. Richman, Allison Rice Jan 2017

N.C. Medicaid Reform: A Bipartisan Path Forward, Barak D. Richman, Allison Rice

Faculty Scholarship

The North Carolina Medicaid program currently constitutes 32% of the state budget and provides insurance coverage to 18% of the state’s population. At the same time, 13% of North Carolinians remain uninsured, and even among the insured, significant health disparities persist across income, geography, education, and race.

The Duke University Bass Connections Medicaid Reform project gathered to consider how North Carolina could use its limited Medicaid dollars more effectively to reduce the incidence of poor health, improve access to healthcare, and reduce budgetary pressures on the state’s taxpayers.

This report is submitted to North Carolina’s policymakers and ...


The Affordable Care Act Is Not Tort Reform, Andrew F. Popper Nov 2016

The Affordable Care Act Is Not Tort Reform, Andrew F. Popper

Andrew Popper

On March 23, 2010, President Obama signed The Patient Protection and Affordable Care Act (PPACA). Prior to the enactment of the PPACA, Congress held several hearings focused on subrogation and relaxation of collateral source restrictions as well as caps on damages in an effort to promote tort reform. While the ACA included provisions on medical liability reform, the suggested tort reform was thwarted, and the ACA had no actual legal effect on limiting medical malpractice liability. This article argues that the reality is that the PPACA has done nothing to change the admissibility of collateral sources nor has it enhanced ...


Implementing Behavioral Health Integration In Primary Care, Joshua P. Twomey, Judith Steinberg, Joan D. Johnston, Amy Leary, Amy Norrman-Harmon, Jean Carlevale Jun 2016

Implementing Behavioral Health Integration In Primary Care, Joshua P. Twomey, Judith Steinberg, Joan D. Johnston, Amy Leary, Amy Norrman-Harmon, Jean Carlevale

Commonwealth Medicine Publications

A detailed review of the teaching assistance (TA) and shared learning (SL) in the area of behavioral health integration UMass Medical School provided to participants of the Primary Care Payment Reform program, an alternative payment pilot developed by the Massachusetts Medicaid program, MassHealth. PCPR was designed to improve access, patient experience, quality and efficiency. As a result of TA and SL, practices reported higher rates on behavioral health quality measures and milestones.


Policy Opportunities For Promoting Employment For People With Psychiatric Disabilities, Alexis D. Henry, Jennie Fishman, Alison Barkoff, Jennifer Mathis, Bethany J. Lilly May 2016

Policy Opportunities For Promoting Employment For People With Psychiatric Disabilities, Alexis D. Henry, Jennie Fishman, Alison Barkoff, Jennifer Mathis, Bethany J. Lilly

Commonwealth Medicine Publications

Outlines policy opportunities that can be leveraged to expand opportunities for people with psychiatric disabilities to successfully obtain and maintain employment, including increased access to career development, supported employment, and critical health services.

The authors’ recommendations include:

  • Develop guidance and incentives for Medicaid coverage of supported employment.
  • Maximize opportunities for access to healthcare made possible by the Affordable Care Act.
  • Continue service innovations focused on educational and career development.
  • Include people with psychiatric disabilities in federal and state employment initiatives.

The authors say there is compelling evidence that people with psychiatric disabilities want to work, but statistics show their employment ...


Whole-Person Care: Implementing Behavioral Health Integration In The Patient-Centered Medical Home, Joshua P. Twomey, Joan Johnston, Judith L. Steinberg, Anita Morris Mar 2016

Whole-Person Care: Implementing Behavioral Health Integration In The Patient-Centered Medical Home, Joshua P. Twomey, Joan Johnston, Judith L. Steinberg, Anita Morris

Commonwealth Medicine Publications

Primary Care Payment Reform (PCPR) is an alternative payment pilot program of MassHealth, with learning collaborative support from UMass Medical School, that introduces the principles of accountable care, behavioral health integration and patient-centered medical homes in primary care practices. The pilot demonstrated that behavioral health integration is a necessary component of whole-person care and a complex, but highly accomplishable task; numerous transformation strategies can support the clinical, financial and cultural challenges to integration; and alternative payment models are essential to support sustainable, expandable and successful behavioral health services in primary care.


The Affordable Care Act Is Not Tort Reform, Andrew F. Popper Feb 2016

The Affordable Care Act Is Not Tort Reform, Andrew F. Popper

Catholic University Law Review

On March 23, 2010, President Obama signed The Patient Protection and Affordable Care Act (PPACA). Prior to the enactment of the PPACA, Congress held several hearings focused on subrogation and relaxation of collateral source restrictions as well as caps on damages in an effort to promote tort reform. While the ACA included provisions on medical liability reform, the suggested tort reform was thwarted, and the ACA had no actual legal effect on limiting medical malpractice liability. This article argues that the reality is that the PPACA has done nothing to change the admissibility of collateral sources nor has it enhanced ...


Spending Medicare’S Dollars Wisely: Taking Aim At Hospitals’ Cultures Of Overtreatment, Jessica Mantel Dec 2015

Spending Medicare’S Dollars Wisely: Taking Aim At Hospitals’ Cultures Of Overtreatment, Jessica Mantel

University of Michigan Journal of Law Reform

With Medicare’s rising costs threatening the country’s fiscal health, policymakers have focused their attention on a primary cause of Medicare’s high price tag—the overtreatment of patients. Guided by professional norms that demand they do “everything possible” for their patients, physicians frequently order additional diagnostic tests, perform more procedures, utilize costly technologies, and provide more inpatient care. Much of this care, however, does not improve Medicare patients’ health, but only increases Medicare spending. Reducing the overtreatment of patients requires aligning physicians’ interests with the government’s goal of spending Medicare’s dollars wisely. Toward that end, recent ...


Three Words And The Future Of The Affordable Care Act, Nicholas Bagley Oct 2015

Three Words And The Future Of The Affordable Care Act, Nicholas Bagley

Articles

As an essential part of its effort to achieve near universal coverage, the Affordable Care Act (ACA) extends sizable tax credits to most people who buy insurance on the newly established health care exchanges. Yet several lawsuits have been filed challenging the availability of those tax credits in the thirty-four states that refused to set up their own exchanges. The lawsuits are premised on a strained interpretation of the ACA that, if accepted, would make a hash of other provisions of the statute and undermine its effort to extend coverage to the uninsured. The courts should reject this latest effort ...


Medicine As A Public Calling, Nicholas Bagley Oct 2015

Medicine As A Public Calling, Nicholas Bagley

Michigan Law Review

The debate over how to tame private medical spending tends to pit advocates of government-provided insurance—a single-payer scheme—against those who would prefer to harness market forces to hold down costs. When it is mentioned at all, the possibility of regulating the medical industry as a public utility is brusquely dismissed as anathema to the American regulatory tradition. This dismissiveness, however, rests on a failure to appreciate just how deeply the public utility model shaped health law in the twentieth century— and how it continues to shape health law today. Closer economic regulation of the medical industry may or ...


Beyond Repeal--A Republican Proposal For Healthcare Reform, Timothy Stoltzfus Jost Sep 2015

Beyond Repeal--A Republican Proposal For Healthcare Reform, Timothy Stoltzfus Jost

Timothy S. Jost

Not available.


Belgian Health Care: A System Worth Studying, Douglas John Maragas Jul 2015

Belgian Health Care: A System Worth Studying, Douglas John Maragas

Akron Law Review

This article will focus on basic information pertinent to the Belgian system. A more extensive explanation of the Belgian system, and a proposed American health care plan adapted from the Belgian system, can be found in my report: "A Comprehensive Health Care System Incorporating Public and Private Enterprise: With the Belgian system as a Base, America can Develop a Cost Efficient Comprehensive Health Care System."


Healthcare Reform Symposium September 18, 1992 Jul 2015

Healthcare Reform Symposium September 18, 1992

Akron Law Review

I would like to talk a little bit about what the right questions are when we go about looking at the reform of health care.

Should everyone be guaranteed a health care plan? If you're going to have a universal health care plan, how do you provide universal coverage, how will you expand coverage? How can we pay for it? Who do you think should administer the health care program?


Staffing National Health Care Reform: A Role For Advanced Practice Nurses, Linda H. Aiken, William M. Sage Jul 2015

Staffing National Health Care Reform: A Role For Advanced Practice Nurses, Linda H. Aiken, William M. Sage

Akron Law Review

Expanding access and coverage while containing costs can only be accomplished by getting more health care value for our money. Two facts about our current system make this seem possible. First, the currently uninsured are not costless. Providing stop-gap health care to those who lack health insurance is extremely expensive -- people without formal coverage cannot afford preventive services, delay treatment of illness and face substantial barriers to reaching appropriate providers. When they receive care, it is often degrading, usually complicated and costly, and more than occasionally too late. The cost of this "uncompensated" care is borne by all of us ...


Managed Competition Theory As A Basis For Health Care Reform, Catherine T. Dunlay, Peter A. Pavarini Jul 2015

Managed Competition Theory As A Basis For Health Care Reform, Catherine T. Dunlay, Peter A. Pavarini

Akron Law Review

[T]his article will seek to explain the fundamental principles of managed competition and the basic features of reform based on managed competition. It will also examine some of the criticisms of managed competition and the practical and legal impediments that will be faced in seeking to reform the health care industry based upon managed competition theory.


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 ...


Health Care Payment Reform: Options And Recommendations, James P. Highland, Julia Feldman, Katharine London, Carol Gyurina, Rachel Gershon Apr 2015

Health Care Payment Reform: Options And Recommendations, James P. Highland, Julia Feldman, Katharine London, Carol Gyurina, Rachel Gershon

Commonwealth Medicine Publications

This report evaluates a variety of strategies, from short-term actions to comprehensive reforms, and issues recommendations New Hampshire can choose from to contain health care costs while maintaining access and quality.

View a video of the report being presented at a public forum hosted by the New Hampshire Insurance Department.


Will Americans Embrace Single-Payer Health Insurance: The Intractable Barriers Of Inertia, Free Market And Culture, Susan A. Channick Feb 2015

Will Americans Embrace Single-Payer Health Insurance: The Intractable Barriers Of Inertia, Free Market And Culture, Susan A. Channick

Susan A. Channick

In a country that prides itself on equality of opportunity, why is there so little equality when it comes to healthcare? Why does the value of equality of opportunity not translate into social solidarity? This Article seeks answers to these questions. Risking the label of socialist, I posit that the most cost-effective, efficacious, and efficient solution to the health care mess that the United States is in is universal single-payer reform with the federal government as that payer. Part I examines the United States' current climate as it affects health care reform. In Part II, this Article scrutinizes recent state ...


Can State Health Reform Initiatives Achieve Universal Coverage: Lessons From California’S Recent Failed Experiment, Susan A. Channick Feb 2015

Can State Health Reform Initiatives Achieve Universal Coverage: Lessons From California’S Recent Failed Experiment, Susan A. Channick

Susan A. Channick

This article is about the struggle toward health care reform. It looks at the mandated health care insurance model as well as the experiences of Massachusetts and California.


Making Sense Of The Health Care Reform Debate, Robert Hockett Dec 2014

Making Sense Of The Health Care Reform Debate, Robert Hockett

Robert C. Hockett

It has been bemusing to behold how ill-informed, mis-informed, and even dis-informed much of the current debate over health care reform has been these past several months. Some of the trouble surely has stemmed from bad faith on the part of some protagonists. Another part of the trouble has stemmed from ineffective communication on the part of other protagonists. Much of our trouble, however, might stem from less than full clarity on all of our parts about two facts. The first is that in talking about “health care reform” as a public policy issue, we are actually talking about social ...


Vermont Price Variation Analysis, Katharine London, Michael G. Grenier, Carol Gyurina Gyurina, Rebecca Kushner, Tami Ohler Oct 2014

Vermont Price Variation Analysis, Katharine London, Michael G. Grenier, Carol Gyurina Gyurina, Rebecca Kushner, Tami Ohler

Commonwealth Medicine Publications

Presentation to Vermont's Green Mountain Care Board about a Price Variation Analysis undertaken in partnership with the University of Vermont College of Medicine and Wakely Consulting Group. The presentation outlined price variations across the state and suggested a process and methodology that the Board could use to set standard rates.


Vermont Price Variation Analysis, Katharine London, Michael G. Grenier Aug 2014

Vermont Price Variation Analysis, Katharine London, Michael G. Grenier

Commonwealth Medicine Publications

This analysis documents price variations across the state and suggests a process and methodology that the Vermont Green Mountain Care Board could use to set standard rates. The report determined that inpatient prices among Vermont's 14 hospitals and Dartmouth-Hitchcock Medical Center in New Hampshire vary from 71 to 130 percent of the state average. The analysis identified a number of factors that explain some variation in professional prices among providers and also showed there is no consistency in the share of variation explained by each factor across health services.


The Unintended Federalism Consequences Of The Affordable Care Act’S Insurance Market Reforms, Joshua Phares Ackerman Jul 2014

The Unintended Federalism Consequences Of The Affordable Care Act’S Insurance Market Reforms, Joshua Phares Ackerman

Pace Law Review

This Article, which is the first to examine the relationship between the ACA’s insurance market reforms and state regulation of insurance, argues that states’ decisions to forego creating their own exchanges may mark the beginning of an important shift of regulatory authority from the states to the federal government. It begins by sketching the historical antecedents of the current allocation of state and federal authority over insurance regulation. The aim of this discussion is to highlight the unique role states play in the regulation of insurance as opposed to other financial products. Part III explains the pre-ACA structure of ...


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.


Building A Better Laboratory: The Federal Role In Promoting Health System Experimentation, Kristin Madison May 2014

Building A Better Laboratory: The Federal Role In Promoting Health System Experimentation, Kristin Madison

Pepperdine Law Review

While expanding federal involvement in the health care system, the Patient Protection and Affordable Care Act (ACA) preserves states' roles as policy laboratories and private providers' roles as health care delivery laboratories. State-based and provider-based laboratories suffer from many shortcomings, however, as mechanisms to develop, evaluate, and facilitate diffusion of reforms within the health system. This Article argues that the federal government can take steps to address these shortcomings. It first briefly reviews ACA provisions that promote policy and delivery experimentation. It then suggests that by tying funding to policy outcomes, making use of regulatory variation and regulatory menus, and ...