Category Archives: Legal Issues

12.04.09

Remedies Against Health Plans Under the Senate Bill

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Section 2719 of the Senate Patient Protection and Affordable Care Act, HR 3590, provides for appeals of coverage determinations and claims. This section explicitly applies to group health plans and health insurance issuers offering group or individual insurance coverage. Section 1551(a) of the bill incorporates the definitions found in 42 U.S.C. § 300gg-91, which defines […]

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11.27.09

Hit the Delete Key on “Bending the Cost Curve”

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Is anyone else as sick as I am of hearing the wonky phrase ”bending the cost curve” as a proxy for why we need to enact health reform legislation? I’m all for including cost controls in whatever legislation emerges from Congress. But the primary policy goal for me remains the moral imperative of covering those […]

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11.27.09

Federalism and Health Reform

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For academics, federalism (the enduring tension between the states and the federal government for primary in formulating and implementing policy) is an endlessly fascinating source of debate and the focal point for constitutional analysis. But federalism is far more than an academic or intellectual exercise. Which level of government takes responsibility for a given issue […]

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11.25.09

More on the Constitutionality of the Individual Mandate

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See Ruth Marcus’ op ed this morning (November 25) in the Washington Post quoting Walter Dellinger, Laurence Tribe, and Jack Balkin supporting the constitutionality of the mandate.

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11.24.09

Senate Bill’s Interstate Commerce Findings

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Here is a link to the Senate’s health care bill.  Perusing some of its 2000 pages, I came across the following, SEC. 1501 (p. 320), which should put to rest any argument that an individual mandate exceeds Congress’ powers under the Commerce Clause: Congress makes the following findings: In GENERAL.—The individual responsibility requirement provided for in […]

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11.23.09

The Confusing Insurance Categories in the Senate Bill

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Another feature of the Senate bill that compares unfavorably with the House bill is its confusing definitions of insurance coverage. The House bill recognizes one category of private insurance, a “qualified health benefits plan,” which employers are obligated to provide and individuals to buy. This term is used throughout the bill. Only grandfathered plans are […]

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11.23.09

The Senate Bill and the States

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In my post of November 16, Returning to the Articles of Confederation, I compared the position that I expected the Senate bill to take on the role of the states in implementing health reform unfavorably to the approach taken by the House bill. The language of the Senate bill is now available, and, unfortunately, it […]

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11.19.09

Federalism and Health Insurance Regulation

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Responding to Tim’s excellent post on the states’ role in implementing health insurance reform, here are my thoughts about lessons to draw from the experience with HIPAA’s insurance regulation provisions.

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11.18.09

Does HR 3962 Make Being Uninsured a Crime?

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According to the Wall Street Journal of November 18, the latest front of the health care debate is a charge that people who refuse to buy health insurance could, under the House bill, spend five years in prison. The article quotes Rep. Peter Roskam (R. Ill.) as stating “if you don’t comply with the individual […]

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11.17.09

ERISA Tort Preemption and HR 3962, Take Four

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In recent days, Mark Hall, Richard Johnson, and Peter Jacobson have all offered opinions as to how HR 3962, if enacted, would affect ERISA preemption of state tort claims against insurers. Let me offer a fourth opinion. First, remember that ERISA tort liability preemption is based primarily on section 502 of ERISA (29 USC 1132). […]

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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