A dose of reality: Assessing the Federal Trade Commission/Department of Justice report in an uninsured, underserved, and vulnerable population context

Despite the size of their report, the Federal Trade Commission and Department of Justice pay virtually no attention to tens of millions of uninsured and underinsured persons. By focusing on an increasingly rarified group of health care customers—healthy, affluent, and highly insured—the report takes on an untethered quality, with only the slightest tip of the hat to its own limitations. Furthermore, the report overstates the extent of legal constraints on the market, in particular, the degree to which the market is free to select its customers and tailor its goods and services to the best risks. By miscasting the legal context of the American health care system, the report ultimately undermines much of its potential value

Clash of the Titans: Medicaid Meets Private Health Insurance

Throughout its first forty-eight years of life, the federal Medicaid statute lacked a viable insurance pathway for most low-income adults\u27 ineligible for employer-sponsored coverage. In what is arguably the most important public health achievement since the enactment of Medicare and Medicaid fifty years ago, the Patient Protection and Affordable Care Act (ACA) fundamentally alters this picture. Building on earlier breakthroughs for children, the ACA restructures Medicaid to cover poor adults and juxtaposes its new architecture against an affordable and accessible private insurance market for people ineligible for employer-sponsored or government insurance

A broader regulatory scheme -- The constitutionality of health care reform

The fundamental goal of the ACA is no less than the preservation of the U.S. health care system. In a country that depends on health insurance to finance care, preservation cannot happen without a comprehensive regulatory scheme that reaches from coast to coast and sets the minimum rules of market entry and operation for health insurers. The glide path to this new system is long and complex, but the law\u27s end point is clear and visionary, and its constitutionality--at least in this first round--is incontrovertible

Managed Care Corporate Failures: An Overview of Bankruptcy and Insurance Insolvency Procedures

This Issue Brief examines managed care corporate failures and the legal process. Managed care organizations are corporate hybrids that possess the features of both insurance and health care. As a result, the question of whether the proper legal forum for addressing a failure is the federal bankruptcy process or state insurance insolvency procedures is a complex one. The answer to this question is more than academic: legal protections for purchasers, members, and health care providers differ significantly depending on which legal system is used

Clash of the Titans: Medicaid Meets Private Health Insurance

Throughout its first forty-eight years of life, the federal Medicaid statute lacked a viable insurance pathway for most low-income adults\u27 ineligible for employer-sponsored coverage. In what is arguably the most important public health achievement since the enactment of Medicare and Medicaid fifty years ago, the Patient Protection and Affordable Care Act (ACA) fundamentally alters this picture. Building on earlier breakthroughs for children, the ACA restructures Medicaid to cover poor adults and juxtaposes its new architecture against an affordable and accessible private insurance market for people ineligible for employer-sponsored or government insurance

Medicaid and access to the courts

The Medicaid program is grounded in a statute that is one of the most complex of all federal laws. An insurer of more than 60 million people — and poised to begin serving 16 million more by 2019 — Medicaid will be reexamined this year, in all its legal complexities, by the U.S. Supreme Court, which has agreed to hear California\u27s appeal in the case Maxwell-Jolly v. Independent Living Center of Southern California. The Court\u27s ruling could fundamentally alter states\u27 accountability to beneficiaries and providers when their official conduct allegedly violates Medicaid\u27s essential federal requirements

Olmstead v L.C.: Federal Implementation Guidelines, and Analysis of Recent Cases Regarding Medicaid Coverage of Long Term Care Services for Persons with Disabilities

This analysis reviews the key elements of the United States Supreme Court\u27s 1999 decision in Olmstead v L.C. as well as Federal implementation guidelines issued by the United States Department and Human Services. The Olmstead decision interprets the Americans with Disabilities Act ( ADA, PL 101-336), whose requirements apply to the use of all public funds. However, Medicaid represents the single largest source of public funding for both institutional and non-institutional services for persons with disabilities. As a result, when states expend Medicaid funds on care for persons with disabilities, two independent sets of legal requirements are triggered: those contained in the ADA, and those included in Federal Medicaid law. Therefore, this analysis also reviews recent judicial decisions concerning Medicaid coverage requirements in the case of institutional and noninstitutional for beneficiaries with disabilities