Up close shot of an orange prison jumpsuit

Prison Health Care is Broken Under the Medicaid Inmate Exclusion Policy

By Sarah Wang

Incarcerated individuals need health care, but punitive policies make securing access to care particularly difficult among this population, which numbers about 2.1 million as of 2021.

As a first step to protecting incarcerated individuals’ right to health, Congress should repeal the Medicaid Inmate Exclusion Policy (MIEP).

The MIEP, established in 1965, prohibits Medicaid from covering incarcerated individuals, despite any prior eligibility. Through the MIEP, two populations are affected: first, jail inmates, defined as those convicted or accused of a crime, and second, prison inmates, defined as those convicted or awaiting trial. In other words, both convicted individuals and those still presumed innocent are stripped of their access to the federal health insurance program for low-income individuals.

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Field hospital in NY during COVID-19 pandemic.

Systemic Failures Need Systemic Solutions: COVID-19 and Macromedical Regulation

By Barak D. Richman and Steven L. Schwarcz

Among the many failures to mitigate the harm from COVID-19 in the U.S. has been the failure to meet surging demand for inpatient care. Hospital bed shortages, overwhelmed intensive care nurses, and scarcities of needed medical equipment have been embarrassing but constant features of the American health care landscape. A nation that spends nearly one out of every six dollars on health care should get much, much more for its money.

Though there is much blame to go around — and many insightful commentators have already allocated culpability — we observe that a significant regulatory deficiency has contributed to the nation’s failure to meet population health needs. This is the failure to regulate our hospitals holistically, as part of a comprehensive health care system.

Existing health care regulation focuses almost exclusively on regulating individual components of the health care industry. This existing regulation lacks the capacity to address how those components work together as a system — a system in which deficiencies in one component adversely impact the performance of the other components. We should not view hospitals as individual providers that treat individual patients. Instead, they are part of a larger safety net that needs to expand capacity when emergencies arise. Today’s pandemic destabilized hospital care because hospitals were neither coordinated nor managed systemically in order to meet population demands.

In Macromedical Regulation, 82 Ohio State Law Journal 727 (2021), we address the nation’s systemic failure to contain an infectious contagion, and we offer solutions by deriving lessons from the 2008 financial contagion. We contend that health care regulation must also include what we call “macromedical” regulation: regulation that focuses on protecting the stability of the health care sector as a system of interconnected parts.

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A male pharmacist is examining a drug from a pharmacy inventory.

HHS’ New Prescription Drug and Health Care Spending Rule

By Cathy Zhang

Today, the Department of Health and Human Services — alongside the Department of Labor, the Department of the Treasury, and the Office of Personnel Management — published an interim final rule requiring health insurance plans and issuers on the marketplace to report data on prescription drug and health care spending to the three Departments.

This rule is part of a series of rules issued by the Biden Administration to implement Title I (No Surprises Act) and Title II (Transparency) of the Consolidated Appropriations Act, 2021.

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Busy Nurse's Station In Modern Hospital

Call Your Senator and Help Give Doctors a Break

By Jacob Madden

Want to help make a big change for our nation’s overworked doctors? Call your senator and tell them to hire more.

In March of this year, Senators Robert Menendez (D-N.J.), John Boozman (R-Ark.), and Chuck Schumer (D-N.Y.) introduced S.834, the Resident Physician Shortage Reduction Act to confront the country’s growing shortage of doctors.

The proposed legislation will increase the number of resident physician positions supported by Medicare by 2,000 each year from 2023 to 2029, for a total of 14,000 newly supported positions.

This legislation could make a small but significant dent in the nation’s physician shortage. By 2034, the Association of American Medical Colleges expects a shortage ranging from 17,800 to 48,000 primary care physicians, and 21,000 to 77,100 non-primary care physicians. Take both worst-case scenarios, and we are short 125,100 doctors.

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Blister pack of pills, but instead of bills dollar bills are rolled up in the packaging

What Democrats’ Drug Pricing Plan Means for Consumers

By Cathy Zhang

At the start of the month, Democrats announced a new drug pricing plan, detailed in the House’s Build Back Better Act (H.R. 5376). In the immediate short term, the drug pricing plan has enabled the $1.75 trillion bill to go forward through the House. If ultimately enacted, it will generate savings for consumers, some more directly than others, and at a more modest pace and magnitude than many had hoped.

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Senior citizen woman in wheelchair in a nursing home.

The Barriers to Aging in Place

By Renu Thomas and John Roth

The COVID-19 pandemic has highlighted the risks associated with institutionalized care for the elderly, and has further shifted sentiments toward a preference for aging in place. But most seniors and their loved ones don’t realize the barriers that make aging in place a difficult proposition until a crisis occurs and they’re faced with finding services.

Take our family, for example. My father was diagnosed with Parkinson’s disease and it was after his first fall and discharge from the hospital that our family realized my parents’ independence was severely limited. We knew their house was not wheelchair or walker accessible, but we also needed to address other issues as well; neither of them could drive anymore, so how would we get them to appointments, how would their prescriptions and groceries get picked up, and how could we prevent them from being socially isolated? Like many families, we do not live nearby, let alone in the same state, which made coordinating these services even more challenging.

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Healthcare concept of professional psychologist doctor consult in psychotherapy session or counsel diagnosis health.

Beyond Parity in Mental Health Coverage

By Kaitlynn Milvert

Mental health “parity” laws require insurers to provide the same level of mental health benefits as they do medical or surgical benefits.

These laws have made important strides toward reducing restrictions in an area of historically limited and inconsistent coverage. But this comparative approach also creates complexities and gaps, which reveal the need to move beyond “parity” in addressing mental health coverage restrictions.

Recent state legislative developments show a way forward. These developments build on parity laws to codify baseline requirements for coverage of “medically necessary” treatment, designed to ensure that necessary coverage is not improperly denied under overly restrictive standards for evaluating mental health care claims. Read More

Glasses, case for contact lenses and eye test chart on mint background, top view

Medicare Poised to Expand Vision, Hearing, and Dental Benefits

By Bailey Kennedy

Though Pres. Biden’s expansive infrastructure and social spending bills remain mired in Congress, it still seems likely that his administration will preside over one of the most dramatic revisions in America’s public safety net since the Great Society.

One of the most discussed provisions in the omnibus bill would expand Medicare benefits to include hearing, vision, and dental care. Currently, millions of Americans are forced to go without the types of care that the proposed Medicare expansion would address. And seniors, in particular, are likely to deal with vision and hearing-related health care issues, which pose a high financial burden.

While the proposed expansion has met pushback, including these aspects of health care in standard insurance plans is significantly overdue.

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rear view of a dump truck loaded on the road laden with scrap metal

It’s Time for Biden to Scrap Trump-era Junk Plans

By Cathy Zhang

Open enrollment for the health insurance marketplace begins on November 1.

Among the options available to consumers will be short-term, limited-duration insurance (STLDI), also known as junk insurance plans. The Trump administration facilitated the proliferation of these cheap, underprotective plans in an attempt to undermine the marketplace, and the Biden administration has yet to reverse that policy.

As part of the Biden administration’s public effort “to restore and strengthen Americans’ access to quality, affordable health care,” the administration needs to take executive action to protect consumers and eliminate junk plans.

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Gavel and stethoscope.

Symposium Conclusion: Health Justice: Engaging Critical Perspectives in Health Law & Policy

By Lindsay F. Wiley and Ruqaiijah Yearby

As our digital symposium on health justice comes to a close, we have much to be thankful for and inspired by. We are honored to provide a platform for contributions from scholars spanning multiple disciplines, perspectives, and aspects of health law and policy. Collectively with these contributors, we aim to define the contours of the health justice movement and debates within it, and to explore how scholars, activists, communities, and public health officials can work together to engage critical perspectives in health law and policy.

As we described in our symposium introduction, the questions we posed to contributors focused their work on four main themes: (1) subordination (including discrimination and poverty) is the root cause of health injustice, (2) subordination shapes health through multiple pathways, (3) health justice engages multiple kinds of experiences and expertise, and (4) health justice requires empowering communities, redressing harm, and reconstructing systems. Most of the contributions to this symposium cut across more than one of these themes, but we present them here in four broad categories.

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