Health Equity, Healthy People 2020, and Coercive Legal Mechanisms as Necessary for the Achievement of Both

Principles of health equity require that all people have equal opportunity to develop and maintain their health, yet in the face of widespread and presumptively inequitable health disparities, the law has done little. This paper argues that health equity demands the use of coercive legal mechanisms in certain circumstances given the existence of current disparities and the evidence of effectiveness of direct regulation as compared to its alternatives. Moreover, the paper argues that Healthy People 2020, which is the nation\u27s “master blueprint for health” and explicitly seeks to achieve health equity, has not fully incorporated the principles of health equity in the formulation of its objectives and indicators because it fails to recognize the varying distributive effects of policies that could achieve population health targets. To truly incorporate the principles of health equity, Healthy People 2020 should advocate for those demonstrably effective coercive legal mechanisms that would both achieve its population health objectives and reduce health disparities

Certificate of Need in the Post-Affordable Care Act Era

Certifcate of need ( CON ) programs were conceived approximately fifty years ago as supply constraint mechanisms for healthcare services, in an environment that is essentially unrecognizable today. Every aspect of the healthcare landscape has changed dramatically, particularly in the years since the enactment of the Affordable Care Act. The historical rationales in support of CON programs have been vigorously questioned by scholars across disciplines, roundly criticized by the federal government, and largely disproven by research. Yet the status quo persists with thirty-five states retaining CON laws, due in large part to a combination of entrenched interests and polrical inertia that prevents either repeal or significant modification. Stil, proponents of a more efficient healthcare model need not lose hope. Kentucky was widely recognized as among the most successful states in its implementation of the Affordable Care Act. As part of its implementation efforts, the Commonwealth reformed its CON program to reward healthcare providers who embrace rather than resist the changes occasioned by healthcare reform. While the eventual impact of Kentucky\u27s CON modernization cannot yet be known, these reforms may offer insights for additional states as they consider whether and how to reform their own CON programs. Indeed, rather than being a historic relic that must be tolerated in the absence of political will for change, it may be possible for a modernized CON program to serve as an additional regulatory tool for states seeking to nudge their healthcare providers into fuller engagement in the post-Affordable Care Act healthcare landscape

Certificate of Need in the Post-Affordable Care Act Era

Certificate of need (“CON”) programs were conceived approximately fifty years ago as supply constraint mechanisms for healthcare services, in an environment that is essentially unrecognizable today. Every aspect of the healthcare landscape has changed dramatically, particularly in the years since the enactment of the Affordable Care Act. The historical rationales in support of CON programs have been vigorously questioned by scholars across disciplines, roundly criticized by the federal government, and largely disproven by research. Yet the status quo persists with thirty-five states retaining CON laws, due in large part to a combination of entrenched interests and political inertia that prevents either repeal or significant modification. Still, proponents of a more efficient healthcare model need not lose hope. Kentucky was widely recognized as among the most successful states in its implementation of the Affordable Care Act. As part of its implementation efforts, the Commonwealth reformed its CON program to reward healthcare providers who embrace rather than resist the changes occasioned by healthcare reform. While the eventual impact of Kentucky’s CON modernization cannot yet be known, these reforms may offer insights for additional states as they consider whether and how to reform their own CON programs. Indeed, rather than being a historic relic that must be tolerated in the absence of political will for change, it may be possible for a modernized CON program to serve as an additional regulatory tool for states seeking to nudge their healthcare providers into fuller engagement in the post- Affordable Care Act healthcare landscap

Emerging Consensus for Legal Action on Pharmaceutical Pricing?

The United States is an outlier compared to other high-income countries in its relative lack of government oversight and regulation of pharmaceutical pricing. However, the political consensus may be shifting in favor of some degree of price regulation. Across political parties, federal and state elected officials and candidates for office are increasingly likely to accept as true that U.S. pharmaceutical prices are excessively high. While proposals vary, certain key themes are emerging: the need for more transparency in pricing, particularly in regard to the relationships between pharmacy benefit managers and state Medicaid programs; recognition that the existing patent system is being misused; the need to protect and incentivize generic production; and recognition of the arbitrariness of certain pricing structures. The presentation will highlight these key themes, with reference to legal strategies proposed and under consideration in different jurisdictions

Emerging Consensus for Legal Action on Pharmaceutical Pricing?

The United States is an outlier compared to other high-income countries in its relative lack of government oversight and regulation of pharmaceutical pricing. However, the political consensus may be shifting in favor of some degree of price regulation. Across political parties, federal and state elected officials and candidates for office are increasingly likely to accept as true that U.S. pharmaceutical prices are excessively high. While proposals vary, certain key themes are emerging: the need for more transparency in pricing, particularly in regard to the relationships between pharmacy benefit managers and state Medicaid programs; recognition that the existing patent system is being misused; the need to protect and incentivize generic production; and recognition of the arbitrariness of certain pricing structures. The presentation will highlight these key themes, with reference to legal strategies proposed and under consideration in different jurisdictions

Health Equity, Healthy People 2020, and Coercive Legal Mechanisms as Necessary for the Achievement of Both

Principles of health equity require that all people have equal opportunity to develop and maintain their health, yet in the face of widespread and presumptively inequitable health disparities, the law has done little. This paper argues that health equity demands the use of coercive legal mechanisms in certain circumstances given the existence of current disparities and the evidence of effectiveness of direct regulation as compared to its alternatives. Moreover, the paper argues that Healthy People 2020, which is the nation\u27s “master blueprint for health” and explicitly seeks to achieve health equity, has not fully incorporated the principles of health equity in the formulation of its objectives and indicators because it fails to recognize the varying distributive effects of policies that could achieve population health targets. To truly incorporate the principles of health equity, Healthy People 2020 should advocate for those demonstrably effective coercive legal mechanisms that would both achieve its population health objectives and reduce health disparities