Mind the Gap: Basic Health Along the ACA’s Coverage Continuum

As ACA implementation proceeds, expansion states should mind the gap — the gap between Medicaid and Marketplace. In this transition between insurance platforms, people can stumble. As a bridge between expanded Medicaid and the insurance Marketplaces, the ACA allows states to enact a Basic Health Program (BHP) supported by federal funds. The BHP option, which has been delayed until 2015, aims to reduce insurance costs and increase care continuity for low-income individuals and families. Interested states face a complicated calculus, one with significant unknowns and moving parts. In this article, I first place this new insurance affordability program in the context of comprehensive health reform efforts. I then explain key issues in a state’s BHP decision-making, and go on to consider related, evolving coverage options. Ultimately, whether a state adopts the BHP or not, it ought to mind the gap between Medicaid and Marketplace. In this transition between insurance platforms, central ACA goals of affordability and continuity will be tested

Nobody Knew How Complicated: Constraining the President\u27s Power to Re(Shape) Health Reform

Beginning on inauguration day, President Trump has attempted an executive repeal of the Affordable Care Act. In doing so, he has tested the limits of presidential power. He has challenged the force of institutional and non-institutional constraints. And, ironically, he has helped boost public support for the ACA’s central features. The first two sections of this article respectively consider the use of the President’s tools to advance and to subvert health reform. The final two sections consider the forces constraining the administration’s attempted executive repeal. I argue that the most important institutional constraint, thus far, is found in multifaceted actions by states – and not only blue states. I also highlight the force of public voices. Personal stories, public opinion, and 2018 election results – bolstered by presidential messaging – reflect growing support for government-grounded options and statutory coverage protections. Indeed, in a polarized time, “refine and revise” seems poised to supplant “repeal and replace” as the conservative focus countering liberal pressure for a common option grounded in Medicare

Designing Model Homes for the Changing Medical Neighborhood: A Multi-Payer Pilot Offers Lessons for ACO and PCMH Construction

This Article first describes the ingrained construction incentives in our current health care system and the challenges they present. The Article then turns to key innovations to address these challenges, with a particular focus on accountable care and medical homes. Next, the Article considers the early spec houses that provide the model for the PCMHs under development throughout the country. Then, the Article focuses on the design and finance features of Washington\u27s ongoing pilot. Finally, the Article concludes with thoughts on a series of questions raised by this pilot and others like it. Ultimately, what medical home designs are best suited for our rezoned medical neighborhoods

What Scribner Wrought: How the Invention of Modern Dialysis Shaped Health Law and Policy

In March 1960, Clyde Shields, a machinist dying from incurable kidney disease, was connected to an artificial kidney by means of a Ushaped Teflon tube that came to be known as the Scribner shunt. By facilitating long-term dialysis, Dr. Belding Scriber\u27s invention changed chronic kidney failure from a fatal illness to a treatable condition. A half-century after this milestone, there are now more than 1.6 million people throughout the world on maintenance dialysis. This medical advancement has, in turn, had a profound impact on key areas of health law and policy. This paper focuses on the historical roots and current context of three interrelated areas: ethical allocation of scarce medical resources; public financing of expensive health care; and decisions to stop treatment for non-medically indicated reasons

Health Reform and Higher Ed: Campuses as Harbingers of Medicaid Universality and Medicare Commonality

Between 2010 and 2016, the percentage of uninsured higher education students dropped by more than half. All the Affordable Care Act’s key access provisions contributed, but the most important factor appears to be the Medicaid expansion. This article is the first to highlight this phenomenon and ground it in data. It explores the reasons for this dramatic expansion of coverage, links it to theoretical frameworks, and considers its implications for the future of health reform. Drawing on Medicaid universality scholarship, I discuss potential consequences of including the educationally privileged in this historically stigmatized program. Extending this scholarship, I argue that the student experience and its reverberating effects portend support for emerging proposals to make Medicare a more common option. Woven into both analyses is the role of the Trump-era retrenchment, notably the administration’s promotion of Medicaid “work or community engagement” requirements and of cheap, skimpy plans. Higher education students were an afterthought in the ACA’s debates, and yet the law has profoundly impacted their coverage options. Students are now much more likely to have health insurance, and for it to be comprehensive. Looking to the next decade, the student experience harbingers support for both Medicaid universality and Medicare commonality

What Scribner Wrought: How the Invention of Modern Dialysis Shaped Health Law and Policy

In March 1960, Clyde Shields, a machinist dying from incurable kidney disease, was connected to an artificial kidney by means of a Ushaped Teflon tube that came to be known as the Scribner shunt. By facilitating long-term dialysis, Dr. Belding Scriber\u27s invention changed chronic kidney failure from a fatal illness to a treatable condition. A half-century after this milestone, there are now more than 1.6 million people throughout the world on maintenance dialysis. This medical advancement has, in turn, had a profound impact on key areas of health law and policy. This paper focuses on the historical roots and current context of three interrelated areas: ethical allocation of scarce medical resources; public financing of expensive health care; and decisions to stop treatment for non-medically indicated reasons