Federalism and Managed Care: Introductory Comments to the American Association of Law Schools\u27 Section on Law, Medicine and Health Care on the Role of the States in Managed Care Regulation

This section of the Annals of Health Law represents a compilation of materials concerning the state regulation of managed care. The following materials were first presented at the annual meeting of the American Association of Law Schools ( AALS ), Section on Law, Medicine and Health Care in January 1999. Chairman John Blum introduces the subject and questions the dual role assumed by state and federal authorities in regulating managed care

Restoring the Parameters of Public Health in a Time of Hobby Lobby and Ebola: The Case for a Wellness Account

The genesis of this piece lies in two seemingly unrelated events in law and public health, the governmental response to the Ebola crisis, and the U.S. Supreme Court ruling in Burwell v. Hobby Lobby, sparked by religious objections to certain employer mandates under the Affordable Care Act. While this essay focuses on the Burwell v. Hobby Lobby case and not Ebola, its core premise is that health policy is best served when government authorities focus strategies and responses within the parameters of individual and population concern. This piece will propose an alternative approach to women’s health promotion, a wellness account, which carves out employers from coverage decisions in the prevention area. Not only will the wellness account circumvent corporate paternalism in health, it will strengthen the promotion and prevention goals of the Affordable Care Act (“ACA”) by more effectively engaging individuals and clinicians in their own health decisions, as well as provide coverage options that include a broader array of health services not routinely available under the law. The essay will be divided into four sections. Section 1 will review the U. S. Supreme Court decision in Burwell v. Hobby Lobby, highlighting the core findings of the majority, as well as key points made by the minority. Section 2 will present some general reflections on the Hobby Lobby case, focusing on the free exercise of religion issue under RFRA, as well as an exploration of the compelling interest standard as it relates to women’s health. Section 3 of the article will explore possible avenues around the legal barriers of Hobby Lobby through legislative and judicial fixes, as well as alternative approach to the employer mandate. In Section 4 a proposal will be posited to amend the ACA to create a lockbox for prevention and wellness services that will provide a new home for women’s health services including the four contraceptives that sparked the Hobby Lobby litigation. It will be argued that removal of the coverage mandate from employer discretion is a way to restore the parameters of public health to matters of science, public need and individual patient right

A Revisionist Model of Hospital Licensure.

This article explores the use of a new governance approach in the context of American acute care hospital regulation, specifically focusing on the core regulatory process of licensure. This article calls for the alteration of current command and control regulations through the adoption of a four-part revisionist licensing model. The model seeks to reinvigorate the licensing process by making it not only more relevant to efficient operations, but also adaptable to current industry challenges. Based generally on alternative regulatory models such as responsive regulation, meta-regulation, and management-based regulation, the revisionist licensing proposal is driven by the broad goals of bureaucratic reduction, participatory regulation, and more focused obligations. Elements of the model include refocusing on baseline requirements, problem identification and correction, negotiated obligations, and alteration of the structure of oversight. Specific application examples are provided in the areas of charity care and health planning