Monday, February 24, 2014
I am spending a sabbatical semester as a scholar in residence at the Centers for Disease Control and Prevention (CDC). Several CDC employees have told me that they worry that the public outcry against the National Security Agency’s (NSA) surveillance practices will transform into public opposition to the government’s efforts to use medical records for research and public health purposes. Indeed, long before revelations about NSA surveillance, privacy advocates expressed grave concerns about the privacy implications of health information technology. What I want to emphasize in this posting is that while informational privacy must be safeguarded in every possible way, we ought not prioritize it to such an extent that it prevents us from enjoying the considerable benefits of data analysis. Rather, we should promote both privacy protection and data use simultaneously.
Friday, February 21, 2014
In a concise opinion, Judge Spencer of the Eastern District of Virginia upheld the IRS regulations facilitating tax credits for insurance purchased through federally-run health insurance exchanges. The decision in King v Sebelius cited frequently to Halbig v. Sebelius (which I wrote about briefly here) and proceded much as that decision did. The plaintiffs were individuals who would have been exempt from purchasing health insurance on the Exchanges but for the tax credit offered by the federal government for purchasing health insurance. Their argument was that the ACA only permits tax credits for insurance purchased on state-based exchanges, not federally-run exchanges. Judge Spencer, like Judge Friedman, analyzed the IRS regulations under Chevron's first prong and found that the statute was clear in its intent to create premium tax credits for all Americans purchasing health insurance, regardless of the purveyor of the exchange. Although the court found the statute to be unambiguous, it analyzed the second Chevron prong and found that deference would be appropriate if it were at issue. The court noted that the plaintiffs' claims rendered many absurdities in the ACA that were too tenuous to bear serious consideration, and it granted the United States' request for summary judgment.
The Halbig and King decisions are on solid legal footing, and they have both noted the absurdity of the statutory interpretation being driven by Adler and Cannon. Once again, the real question is what will happen next. Briefs were already submitted in the Halbig appeal. An appeal in King would not be surprising. And, the decision in NFIB v. Sebelius revealed that the Supreme Court is not above absurd statutory interpretation. (Refresher: the Medicaid expansion was not "Medicaid enough" to pass the Court's new coercion doctrine, but it was "Medicaid enough" for the remedy of severing the Secretary's power to enforce the Medicaid expansion against the states, which was found in the original Medicaid Act. See my co-authored work with Weeks Leonard and Outterson, here.)
Thursday, February 20, 2014
The Hall Center for Law and Health at Indiana University McKinney School of Law is proud to welcome Professor Maxwell Mehlman to receive the McDonald Merrill Ketcham Award for Excellence in Law & Medicine for 2014. For more details please see here.
Professor Mehlman serves as Distinguished University Professor, Petersilge Prof. of Law and Director of the Law-Medicine Center, Case Western Reserve School of Law, and Professor of Biomedical Ethics, Case Western Reserve School of Medicine. His lecture is entitled "Are Physicians Fiduciaries for Their Patients?" Professor Mehlman will then join a panel discussion on the topic. The panelists are Mary Ott, M.D., M.A., AssociateProfessor of Pediatrics, Indiana University School of Medicine, Joshua Perry, J.D., M.T.S., Assistant Professor of Business Law and Ethics and a Life Sciences Research Fellow, Indiana University Kelley School of Business (Bloomington) and Mark Rothstein, J.D., Herbert F. Boehl Chair of Law and Medicine, University of Louisville Louis D. Brandeis School of Law, and Director of the Institute for Bioethics, Health Policy, and Law, University of Louisville School of Medicine.
Wednesday, February 19, 2014
Life insurance provides important financial support for surviving family members when income-providers die. Although the surviving spouse is entitled to a Social Security widow(er)’s benefit—the Social Security benefit amount of the deceased spouse, if greater than the benefit amount of the surviving spouse—death may bring a significant drop in Social Security income. If couples were each receiving equal Social Security benefits, for example, the survivor will receive only half of what they were receiving as a couple—but it is unrealistic to expect that expenses will be cut in half by the death of one spouse. Yet life insurance receives far less statutory protection than health insurance; for example, the Genetic Information Non-Discrimination Act does not apply to either life or disability insurance. A recent 6th Circuit decision concluded that ERISA did not protect retirees against cutbacks in life insurance when employer promises were ambiguous. Haviland v. Metropolitan Life Ins. Co., 730 F.3d 563 (6th Cir. 2013).
The plaintiffs in Haviland were General Motors retirees who had been salaried employees. GM reduced their life insurance benefits to a maximum of $10,000. Some 42,000 of these retirees, those retiring between October 1, 1997, and December 1, 2011, have also faced pension plan changes; on June 1, 2012, these retirees were offered the choice of taking a lump sum benefit (supposedly calculated to be the actuarial equivalent of their prior defined benefit plan) or an annuity purchased by GM from Prudential. These retirees and their surviving spouses also lost GM health care benefits and Medicare part B payments at the age of 65, although with an offset of $300/month presumably to cover increased health care costs. So it is understandable that they were concerned about the additional cutback in the financial buffer provided by life insurance in case of death.
GM’s promises to retirees sent conflicting messages. On the one hand, GM reserved the right to make changes in the plan. On the other hand, the letter from Metropolitan Life, the issuer of the life insurance policy, stated that the plan “will remain in effect for the rest of your life,” without any further payment. The plaintiffs contended that MetLife had violated its obligations under ERISA when the plan changed. As important background, ERISA preempts state law claims, so plaintiffs’ state law claims such as breach of contract were dismissed; and ERISA does not provide vesting standards for life insurance, health insurance, or other benefits coming under the “welfare” plans provisions of the statute rather than the pension provisions. The 6th Circuit rejected all of the plaintiffs’ claims. For example, although recognizing that promissory estoppel claims can be brought against ERISA plan fiduciaries, the court limited this possibility to cases in which the plan documents did not unambiguously reserve the right to alter plan benefits. The court also concluded that GM had not violated ERISA fiduciary duties in what plaintiffs had been told; at the time the letters were sent, they correctly represented the plan in place at the time, even though the plan was subject to later change.
Retiree benefits impose costs that in many cases are considered to be unsustainable. However, individuals cannot undo retirement; once retired, they and their spouses are stuck with the circumstances of their retirement. Employers, by contrast, are not stuck, at least with welfare plans when they have reserved rights to change or discontinue. This asymmetry with respect to retiree welfare plans will only continue to exacerbate the impoverished economic circumstances of many retirees.
Monday, February 17, 2014
Evanson Chege Kamau, Gerd Winter, An Introduction to the International ABS Regime and a Comment on Its Transposition by the EU, 9 Law, Env't & Dev. J. 108 (2013) .
Robert B. Leflar, Discerning Why Patients Die: Legal and Political Controversies in Japan, the United States, and Taiwan, 22 Mich. St. Int'l L. Rev. (Forthcoming 2014) .
Penney J. Lewis, Isra Black, Reporting and Scrutiny of Reported Cases in Four Jurisdictions Where Assisted Dying Is Lawful: A Review of the Evidence in the Netherlands, Belgium, Oregon and Switzerland, Med. L. Int'l (2013).
“Assessment Across the Curriculum” is a one-day conference for new and experienced law teachers who are interested in designing and implementing effective techniques for assessing student learning. The conference will take place on Saturday, April 5, 2014, at the University of Arkansas at Little Rock William H. Bowen School of Law in Little Rock, Arkansas.
Conference Content: Sessions will address topics such as
· Formative Assessment in Large Classes
· Classroom Assessment Techniques
· Using Rubrics for Formative and Summative Assessment
· Assessing the Ineffable: Professionalism, Judgment, and Teamwork
· Assessment Techniques for Statutory or Transactional Courses
By the end of the conference, participants will have concrete ideas and assessment practices to take back to their students, colleagues, and institutions.
Who Should Attend: This conference is for all law faculty (full-time and adjunct) who want to learn about best practices for course-level assessment of student learning.
Bill Sage and David Hyman offer an interesting proposal in “Let’s Make a Deal: Trading Malpractice Reform for Health Reform,” in last month’s issue of Health Affairs. Traditional tort reform is a perennial issue that will surely arise again during the next medical liability insurance crisis. Rather than wait for that crisis, why not use traditional tort reform now, when we have the luxury to think about it, and use it as a bargaining chip with which to attain other, arguably far more important, systemic concessions from American physicians? We could, they argue, institute traditional liability reforms (hewing, e.g., to California’s MICRA) in exchange for substantial payment and/or delivery reform, such as replacing fee-for-service with bundled, episodic payments and mandating participation in accountable care organizations or other coordinated care delivery models, requiring greater public transparency concerning medical errors, or setting aside opposition to provision of primary care services by non-physician providers. Improvements to payment and delivery systems are not inevitable, and so offering liability reforms would help sweeten the deal.
I wonder, though, if such concessions would be productive. They may indeed yield the results Sage and Hyman hypothesize. Many physicians view MICRA-style reforms as the “gold standard,” and would like to see them instituted nationwide. Such measures have been found by a number of researchers to reduce liability insurance premiums. However, physicians in states that have instituted them or measures like them report that they still worry about lawsuits, even if perhaps less so than physicians in other states. They still practice defensive medicine. And health care costs remain as high as ever.
MICRA-style reforms, in other words, may sound good to physicians but ultimately offer far less than they promise. The reforms suggested by Sage and Hyman, on the other hand, have real potential to improve health care quality and costs, yet at the same time will also likely produce substantial changes in how physicians practice and are compensated – changes that many physicians will likely experience as negative. It is true that major physician organizations have been quite supportive of changes proposed to the SGR and have expressed support for certain ACA demonstration projects. Yet individual physicians appear more skeptical. According to a 2010 Physicians Foundation survey, for example, a substantial majority of individual physicians expressed negative views about the impact they expected the ACA to have on their workload and earnings, and about specific ACA demonstration projects such as bundled payments. These fears might not be misplaced, as it is quite possible that some of these reforms may result in not only changes in physician revenue and incentives, whether positive or negative, but also, in the worst case, a burdensome bureaucratization of clinical practice and strictures on innovation.
Giving physicians what they want – traditional liability reform – in exchange for payment, delivery, and other reforms won’t likely make them happy, at least not in the long run. Would a genuine possibility for greater autonomy and substantially decreased administrative burdens offer a better route to success? Will we have to wait for a generational change among practicing physicians before we see a more general acceptance, let alone embrace, of reform?
Guest Blogger Associate Professor Laura Hermer
At the age of 93, my mother-in-law, who lives alone, fell and broke her ankle in three places. We knew that after her hospitalization, she would need to be in a rehabilitation facility until, hopefully, she regained mobility.
But on her first full day in the hospital we received terrible news: my mother-in-law was under observation rather than admitted, and thus was considered to be an outpatient. What this meant, was that she would incur co-payments for doctors’ fees and hospital services and would have to pay for the many drugs she ordinarily takes at home that were now being provided by the hospital. Worst of all, my mother-in-law would not be eligible for Medicare coverage for her follow-up rehab care in a nursing home because Medicare patients must spend three consecutive days as admitted patients in a hospital to be eligible for such coverage. In some sense, we were lucky to find out that she was only under observation, because hospitals are under no obligation to inform patients of this consequential fact. After much begging and pleading, the hospital admitted her, much to our relief.
Recently, the Centers for Medicare and Medicaid Services issued its “two midnight rule,” which will be enforced starting in October of 2014. The rule establishes that doctors should admit patients if they expect their stays to last through two midnights, but to list those expected to stay for less time as being under observation. Many have criticized this rule as arbitrary because it will advantage individuals who arrive shortly before midnight (they are more likely to stay a second midnight) and disadvantage those who arrive shortly after midnight, but the rule, at least, provides some clarity.
Were my mother-in-law’s financial concerns over once she was admitted? Far from it. Patients who meet Medicare requirements can receive 20 days of free nursing home care per benefit period and then pay a daily co-pay for days 21-100 (up to $152 per day in 2014), after which no Medicare funds are available until the next benefit period. Those who “spend down” their assets may meet Medicaid eligibility for full nursing home benefits. But “spending down” is a fairly literal term and requires one to drain most assets other than one’s home, personal effects, and vehicle. Detailed guidelines determine Medicaid eligibility, but typically, single people must have no more than $2,000 in “countable resources” (cash, financial accounts, stocks, bonds, available assets in trust).
I recently posted a new piece that uses technology as a lens for examining some of the fragmentation and coodination problems exhibited by the healthcare system. Here's the abstract.
Fragmentation and lack of coordination remain as some of the most intractable problems facing health care. Attention has often alighted on the promise of Health care Information Technology not least because IT has had such positive impact on many other personal, professional and industrial domains. For at least two decades the HIT-panacea narrative has been persistent even though the context has shifted. At various times we have been promised that patient safety technologies would solve our medical error problems, electronic transactions would simplify healthcare administration and insurance and clinical data would become interoperable courtesy of electronic medical records. Today the IoM is positioning HIT at the center of its new “continuously learning” health care model that is in large part aimed at solving our fragmentation and lack of coordination problems. While the consensus judgment that HIT can reduce fragmentation and increase coordination has intuitive force the specifics are more complicated. First, the relationship between health care and IT has been both culturally and financially complex. Second, HIT has been overhyped as a solution for all of health care’s woes; it has its own problems. Third, the HIT-fragmentation solution presents a chicken-and-egg problem — can HIT solve health care fragmentation and lack of coordination problems or must health care problems such as episodic care be solved prior to successful deployment of HIT? The article takes a critical look at both health care and HIT with those questions in mind before concluding with some admittedly difficult recommendations designed to break the chicken-and-egg deadlock.
Tuesday, February 11, 2014
Stanley A. Terman, It Isn’t Easy Being Pink: Potential Problems with POLST Paradigm Forms, 36 Hamline L. Rev. 177 (2013).
Laura D. Hermer, Merle Lenihan, The Future of Medicaid Supplemental Payments: Can They Promote Patient-Centered Care?, 102 Ky. L. J. (Forthcoming 2014).
Jonathan J. Darrow, Pharmaceutical Efficacy: The Illusory Legal Standard, 70 Wash. & Lee L. Rev. 2073 (2013).
The American Society for Bioethics & Humanities's call for proposals is now live.
Program Theme: Inclusive & Interprofessional: Bioethics & Humanities?
Bioethics and the health humanities purport to offer guidance on how to act ethically in collaboration with patients, their families and support circles, and within the health care system. As fields of study and practice, they call attention to power and disparities, from the classroom to the clinic. They expose injustice and act to right wrongs. But how well do bioethics and the health humanities truly recognize power and privilege? They are inclusive, but how well do they represent differences in identity, such as race and ethnicity, disability, sexuality, gender, and socio-economic status? They are multi-disciplinary, but are they interprofessional? This annual meeting is dedicated to three questions: 1. How inclusive and interprofessional are bioethics and the health humanities? 2. How inclusive and interprofessional can we become? 3. How can we improve practice, education, and health for all, through attention to inclusion and interprofessionalism?
The call for proposals will close at 11:59 pm Central Time, Thursday, March 6, 2014. No proposals or changes will be accepted after that time. The ASBH office closes at 5 pm CT and no live assistance will be available after that time.
Questions? Call 847-375-4745 or email email@example.com.
On October 15, 2013 my husband, at the age of 55, learned that he has Parkinson’s Disease. He had had a tremor for many months, and when it grew more persistent and became accompanied by stiffness and other discomfort, Andy decided it was time to see a neurologist. We had been anxious for days before the appointment. Hours of Internet searches encouraged us to cling to the hope that the tremor was benign, as many are. But we also knew that we could get life-changing news from the doctor.
The neurologist did a very thorough examination. Then, without indicating that he was ready to deliver his decree, he blurted out, “Well, this is clearly Parkinson’s Disease.” He explained that it was a degenerative, neurological disease caused by loss of dopamine cells in the brain and that it usually progresses over decades. The doctor discussed a variety of drugs and recommended one for Andy to try first, assuring us that “most patients tolerate this one well.” He instructed us to make another appointment in three months and left the exam room to see his next patient.
What followed were some of the most difficult days of our marriage. Life had changed in an instant. We were consumed by fear that our future was bleak and uncertain, that our place in the world had permanently shifted, that our sense of ourselves would never be the same. And our next medical appointment was not for three months.
Guest Blogger Associate Dean Elizabeth Pendo: New Study: Quantifying Lack of Access for People with Disabilities
Many thanks to Katharine and the other editors for inviting me to share my thoughts this month. One of my areas of interest is the impact of inaccessible medical and diagnostic equipment on access to basic health care for people with mobility disabilities. In the course of my research, I see many stories such as this one:
It took a while . . . but I gradually realized that I wasn’t getting the same level of care I had received when I could walk, and get on the scale, and climb up on the examination table. Doctors were prescribing dosages based on what they guessed I weighed, so I began thinking maybe I should be weighed. And doctors stopped routinely examining the back of my body, because it's so difficult to get clothes on and off when you can't stand up that they took the easy way out.
This was from a quote from John Lonberg, a plaintiff in the first class-action challenging inaccessible medical equipment, Metzler v. Kaiser Foundation Health Plan. He eventually developed a pressure sore, which required surgery by the time it was detected. How many other men and women across the country share his experience? The Annals of Internal Medicine recently published a study focused on that question, one of the first to quantify the lack of access to subspecialists for people with mobility impairments.
The surveyors used a “secret shopper” method, reminiscent of the investigatory testing model used to document discrimination in housing, lending, employment and public accommodations. Posing as fictitious patients, they attempted to make appointments with a variety of subspecialists in four large cities. In each case, the surveyor explained to the scheduler the chief symptoms relevant to the practice and medical history, which included obesity, a condition requiring the use of a wheelchair, and the inability to self-transfer during the appointment.
Monday, February 10, 2014
Where does one start with AOL CEO Armstrong's ridiculous and unfeeling justifications for changes in his company’s 401(k) plan. Cable TV and Twitter came out of the blocks fast with the obvious critiques. And the outrage only increased after novelist Deanna Fei took to Slate to identify her daughter as one of the subjects of Armstrong’s implied criticism. Armstrong has now apologized and reversed his earlier decision.
As the corporate spin doctors contain the damage, Armstrong’s statements likely will recede from memory, although I am still hoping The Onion will memorialize Armstrong’s entry into the healthcare debate (suggested headline, "CEO Discovers Nation's Healthcare Crisis Caused by 25 Ounce Baby”). But supposing (just supposing) your health law students ask about the story in class this week. What sort of journey can you take them on?
February 10, 2014 in Affordable Care Act, Cost, Coverage, Employer-Sponsored Insurance, Health Care, Health Care Costs, Health Care Reform, Health Economics, Health Law, HIPAA, privacy | Permalink | Comments (0) | TrackBack (0)
Friday, February 7, 2014
Opponents of the Affordable Care Act (ACA) have claimed for years that it will “kill jobs.” Because of ostensibly onerous and expensive mandates, higher taxes, and increased regulations, the ACA will cause employers to shed jobs, refrain from hiring additional workers, and reduce the hours present employees work.
Indeed, now it appears even the Congressional Budget Office, the nonpartisan source of information on all things financial for Congress, agrees. On Feb. 4, CBO released its projection that 2.5 million fewer Americans will be employed by the end of the next ten years as a result of the ACA.
Will this occur because CBO projects that employers will decide to cut jobs or hours in an effort to avoid the ACA’s “play or pay” provision, or because increased benefit costs under the ACA will make it untenable for employers to open new positions? Not particularly (although it does project a possible very small and speculative effect as a result of the employer mandate). Rather, “[t]he estimated reduction stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in businesses’ demand for labor, so it will appear almost entirely as a reduction in labor force participation and in hours worked relative to what would have occurred otherwise rather than as an increase in unemployment … or underemployment…” (CBO, pp 117-18).
Thursday, February 6, 2014
Medicaid cutbacks and prescription footwear: Plaintiffs prevail against New York’s cost cutting measures
Pressures to cut back Medicaid benefits continue to be impressive. In a noteworthy decision, New York’s effort to limit funding for prescription footwear was recently rebuffed by a New York federal district court.
In the class action suit, New York Medicaid patients challenged the state’s decision to limit coverage of medically necessary prescription footwear and compression stockings to selected conditions, Davis v. Shah, 2013 WL 6451176 (W.D.N.Y. 2013). Footwear coverage was limited to use as an integral part of a lower limb orthotic appliance, as part of a diabetic treatment plan, or to address growth or development issues in children. Compression stockings were limited to patients during pregnancy or for treatment of venous stasis ulcers. New York contended that the limits were a reasonable legislative compromise necessitated by funding constraints. It argued that the limits prioritized the most common serious conditions, eliminated coverage for needs that could be met with ordinary footwear (such as bunions or hammer toes), and saved the state over $14 million that could be used on other Medicaid expenditures. New York admitted, however, that the plaintiffs’ conditions were serious even though not on the list: for example, multiple sclerosis, paraplegia, and cellulitis. The plaintiffs argued that the limits violated the Medicaid Act, the Rehabilitation Act and Title II of the Americans with Disabilities Act, and the U.S. Constitution.
With respect to the Medicaid statute, New York provides nursing home services for the categorically needy and the medically needy and must therefore provide home health benefits for these groups who are appropriate for the services. New York argued that prescription footwear was not a “home health benefit” because it was not “medical supplies, equipment, and appliances suitable for use in the home” and instead was a prosthetic, an optional benefit. The court applied both deferential review (appropriate when the US Department of Health and Human Services has approved the state plan, as here) and de novo review to find that the state’s understanding of the home health benefit provision was reasonable. A problem for the plaintiffs' argument is that they included at least one amputee whose footwear was arguably prosthetic, thus blurring the line. On this point, the court granted summary judgment for the state.
As an alternative, the plaintiffs argued that the footwear limits violated the Medicaid Act’s “reasonable standards” provision, 42 U.S.C. § 1396a(a)(17)(2013) since they did not allow for individualized determinations of medical necessity. Indeed, a diabetic with peripheral neuropathy would be covered but a patient with multiple sclerosis-caused peripheral neuropathy would not be covered. Regulations under the statute prohibit arbitrary denial of a benefit to an otherwise eligible beneficiary solely because of diagnosis, 42 C.F.R. § 440.230(c) (2013). New York contended that because prosthetics are an optional benefit, it had greater flexibility to make determinations based on diagnosis and could impose cost-control limits on patients with less serious diagnoses. The court rejected this argument, reasoning that a classification based on diagnosis for utilization control reasons that failed to serve people in similar medical need was not valid, and granted summary judgment to the plaintiffs on this claim. For similar reasons, the court granted the plaintiff’s claim that the limitations violated the Medicaid Act’s comparability provision, 42 U.S.C. § 1396a(a)(10)(B) (2013). A final argument under the Medicaid Act under which the plaintiffs were granted summary judgment was that the state could not discontinue Medicaid coverage for a service without giving them any notice at all.
With respect to disability discrimination, the plaintiffs contended that the limitations violated the integration mandate of the ADA, that services be delivered in the most integrated setting appropriate to the person’s needs. The plaintiffs argued that without prescription footwear, they were at significant risk of worsening of their conditions and the resulting need for institutionalization. The state contended in response that decisions about allocating scarce funds in the face of competing demands cannot be discrimination as long as rationally related to a legitimate state purpose. The court agreed with the plaintiffs, reasoning that unjustified isolation might result from the limitations imposed by the state’s decisions. When state policies lead to such discrimination, the court stated, the public entity must make reasonable modifications unless such modifications would fundamentally alter the service being provided. Carefully pointing out that the plaintiffs were not seeking a service that New York did not provide to anyone, the court concluded that the limitations were discriminatory under the ADA.
This is not the only recent case in which plaintiffs have prevailed against arbitrary limitations on Medicaid benefits. In Conley v. Dept. of Health, 287 P.3d 452, 465–468 (Utah Ct.App.2012), the court held that Utah's decision to cover assistive speech devices for children and pregnant women but not for adults under the home health benefit violated the Medicaid Act. These cases illustrate the importance for states seeking Medicaid cost-savings to look to such matters as treatment efficacy or determinations about individual patients' needs, rather than drawing arbitrary lines.
Tuesday, February 4, 2014
It seems that everyone is talking about “big data.” The New York Times deemed this the “Age of Big Data” in a 2012 article and a Google search for the term yields over 14 million hits. I am spending a sabbatical semester at the Centers for Disease Control and Prevention, and here too there is much enthusiastic discussion of big data. Large databases containing electronic health records (EHR) and genomic data from millions of patients have the potential to facilitate medical discoveries, improve health care outcomes, and promote public health. Big data resources are being established by government agencies such as the Centers for Medicare and Medicaid Services, the Food and Drug Administration, and the Department of Veterans Affairs. They are also being launched by private entities such as Geisinger Health Systems, Explorys, the Electronic Medical Records and Genomics Network (eMERGE), and many others.
While the promise of big data is considerable, so are the challenges it poses. First, big data collections may be populated by data that is of poor quality, incomplete, or even deliberately distorted. Second, very careful attention must be paid to study design in order to avoid biases and other flaws.
HealthLawProf Blog extends a warm welcome to our third, and final, guest blogger for the month of February, Professor Sharona Hoffman. Here is her short bio:
Sharona Hoffman, J.D., LL.M., is the Edgar A. Hahn Professor of Law and a Professor of Bioethics at Case Western Reserve University. She is also the Co-Director of the Law School’s Law-Medicine Center and has been a member of the faculty since 1999. Professor Hoffman served as Associate Dean for Academic Affairs from 2006 until 2009.
Prior to becoming an academic, Ms. Hoffman was a Senior Trial Attorney at the Equal Employment Opportunity Commission in Houston; an associate at O'Melveny & Myers in Los Angeles, where she spent much of her time working on the Exxon Valdez oil spill case; and a judicial clerk for Judge Douglas W. Hillman of the U.S. District Court of the Western District of Michigan. Spring 2007, Professor Hoffman was a Guest Researcher at The Centers for Disease Control and Prevention (CDC) Public Health Law Program. From 2008-12, she served on the Board of Scientific Counselors for the CDC’s Office of Public Health Preparedness and Response. In 2013, Professor Hoffman was selected by the Robert Wood Johnson Foundation as one of six inaugural scholars-in-residence in public health law. In this capacity, she worked with the Oregon Health Authority on the challenges of regulating in-home care agencies.
Professor Hoffman received her B.A. magna cum laude from Wellesley College, her J.D. cum laude from Harvard Law School, and an LL.M. in health law from the University of Houston.
She teaches Health Law and related courses, Employment Discrimination, and Civil Procedure. She was voted First Year Teacher of the Year in 2011 and 2012.
Professor Hoffman has published over fifty articles and book chapters on employment discrimination, health insurance, disability law, biomedical research, the concept of race and its use in law and medicine, emergency preparedness, and health information technology. Her work has appeared in the Georgetown Law Journal, William & Mary Law Review, Boston College Law Review , and many other publications. She twice received Case Western Reserve University’s Mather Spotlight Series Prize for Women’s Scholarship (2005 & 2013). She has lectured throughout the United States and internationally and has been quoted widely in the press, including in USA Today, BusinessWeek, The Los Angeles Times, and The New York Times.
Professor Hoffman is currently on sabbatical, spending the semester in Atlanta, Georgia. She is serving as a visiting scholar at both Emory University School of Law and the Centers for Disease Control and Prevention.
Sunday, February 2, 2014
HealthLawProf Blog extends a big welcome to our second guest blogger for the month of February, Associate Dean Elizabeth Pendo:
Elizabeth Pendo is the Associate Dean for Academic Affairs and a Professor of Law at the Saint Louis University School of Law. She is also Professor of Health Management and Policy at the Saint Louis University School of Public Health (secondary appointment). Elizabeth teaches and writes in disability law, bioethics, and health law. Her scholarship focuses on the difference disability makes in settings such as the health care system and the workplace. She recently published articles exposing inaccessible medical equipment as a barrier to care for people with mobility disabilities, and comparing civil rights and health care reform responses. Other areas on inquiry include sociological models of disability and their impact on care, accessible public rights-of-way, and the use of genetic information in the workplace. Elizabeth has published with a number of law journals and peer-reviewed journals, and frequently submits testimony and comment to agencies and legislatures. She is an elected member of the American Law Institute, and a recent recipient of the YWCA Leadership Award, the Women’s Justice Legal Scholar Award, and the first SLU Faculty Excellence Award for Excellence in Diversity & Social Justice.
How flexible will CMS be in granting waivers to expand Medicaid coverage under the Affordable Care Act (ACA) in states still holding out? Should states be permitted to insert provisions ostensibly intended to promote “personal responsibility” in such waivers? Given CMS’s approval of Michigan’s “Healthy Michigan” plan at the end of 2013, and given that other states, such as Indiana and Pennsylvania, seek to go even farther in their waiver proposals, we may not yet have seen the limits of CMS’s flexibility in permitting state holdouts to join the ACA expansion fold.
Healthy Michigan is perhaps the most modest of several state proposals based loosely on the Healthy Indiana Plan, a waiver program that has been in effect since 2008. Healthy Michigan expands Medicaid to all childless adults in the state from age 19 through 64 earning up to 133% of the federal poverty level (FPL). Enrollees will be responsible for nominal cost-sharing and, for those earning between 100% and 133% FPL, premium amounts up to 2% of their income.