Updates on coverage and spending statistics can be found on the web pages of CMS and the Census Bureau.
This page has resources and notes on the following topics:
Web Resources and Notes on Private Insurance, Long-term Care, Uncompensated Care, and Health Care Fraud
The Georgetown Institute for Health Care Research and Policy has
produced
a very useful set of consumer guides that describe in each state all of
the various state and federal provisions that affect the availability,
pricing, and coverage of private health insurance. These guides can be
found at:
http://www.healthinsuranceinfo.net/.
Although they are very user friendly and clearly written, the dominant
impression one takes away from reading them is how incredibly complex
the
fragmented health insurance system is in the U.S. See also University
of Houston Health Law and Policy Institute, Choosing a Health Care
Plan..
A good place to explore what type of information is available in
choosing
among health plans, and how a managed competition system might work, is
the web site for
federal
employees. To get a sense of what health insuarnce costs at
different benefit levels, go to EHealthInsurance.Com.
Here is a link to various federal statutes discussed in this section, such as the Health Insurance Portability and Accountability Act and COBRA.
The results of an in-depth study of various components of health insurance market reforms such as open enrollment and community rating can be found at: Wake Forest University Health Insurance Market Reform Study.
For discussion of various, more incremental or private-sector based reform proposals that are receiving current attention, see update for section F.1 of this chapter.
Analysis of bankruptcy filings reveals that
medical problems are a leading cause of personal bankruptcy.
David
U. Himmelstein, Elizabeth Warren, et al., Illness
and Injury as Contributors to Bankruptcy, W5 Health Aff. 63 (2005)
; M.B. Jacoby, T.A. Sullivan, and
For overviews and discussions of recent developments in private health insurance generally, see Symposium, The Future of Insurance, 23(6) Health Affairs (Dec. 2004); Symposium, 32(3) J. L. Med. & Ethics 386 (Fall 2004); John K. Iglehart, Changing Health Insurance Trends, 347 New Eng. J. Med. 956 (2002); Peter Budetti, 10 Years Beyond the Health Security Act Failure, 292 JAMA 2000 (2004).
Discussing the logic and fairness of insurance risk classification,
see Mary Crossley, Discrimination against the unhealthy in health
insurance. 54 U. Kan. L. Rev. 73-153 (2005): Katherine Swartz,
Reinsuring Health: Why More Middle-Class People are Uninsured and What
Government Can Do (2006). Swartz's book also discusses a new
approach to making insurance more afforable, known as reinsurance, in
which the government reimburses private health insurers for subscribers
who have very high claims costs. See also John V. Jacobi,
Government reinsurance programs and consumer-driven care, 53 Buff. L.
Rev. 537-576 (2005).
On health care fraud, see Keith D. Barber, David B. Honig and Neal A. Cooper, Prolific plaintiffs or rabid relators? Recent developments in False Claims Act litigation, 1 Ind. Health L. Rev. 131-173 (2004).
For additional discussion of federalism themes, see
Symposium,
Federalism In Health Care, 3 Hous. J. Health L. & Pol'y 151-340
(2003);
Wendy Netter Epstein Bottoms up: a toast to the success of health care
collaboratives ... what can we learn? 56 Admin. L. Rev. 739-798 (2004);
Lars Noah, Ambivalent Commitments to Federalism in Controlling the
Practice
of Medicine, 53 U. Kan. L. Rev. 149 (2004); Linda Fentiman, Internet
Pharmacies
and the Need for a New Federalism: Protecting Consumers While
Increasing
Access to Prescription Drugs, 56 Rutgers Law Review 119 (2003).
For a thorough analysis of the problem of adverse selection
generally
in insurance law and public policy, see Peter Siegleman, Adverse
Selection in Insurance Markets: An Exaggerated Threat, 113 Yale L. J.
1223 (2004).
For additional discussion of consumer-directed
health plans and
increased
patient cost-sharing, see updates to Chapter 1.C.3; Beth Fuchs &
Julia A. James, Health Savings
Accounts: The Fundamentals (National Health Policy Forum, April 2005);
Edward A. Zelinsky, The Defined Contribution Paradigm, 114 Yale L. J.
451 (2004); John V. Jacobi, Consumer-Driven Health Care and the
Chronically Ill, 38 U. Michigan J. Law Reform 531 (2005); J.M.
Razor, Health savings accounts: increasing health care access in
America? 17 Loy. Consumer L. Rev. 419-449 (2005); Richard L. Kaplan,
Who's afraid of personal responsibility? Health savings accounts and
the future of American health care. 36 McGeorge L. Rev. 535-568 (2005);
Timothy Stoltzfus Jost, Consumer-driven health care in South Africa:
lessons from comparative health policy studies. 1 J. Health &
Biomed. L. 83-109 (2005); Edward J. Larson & Marc Dettmann, The
Impact of HSAs on Health Care Reform: Preliminary Results after One
Year, 40 Wake Forest L. Rev. 1087 (2005); Timothy S. Jost and Mark A.
Hall, The role of state regulation in consumer driven health care, 31
Am. J.L. & Med. 395-418 (2005); Amy B. Monahan, The promise and
peril of ownership society health care policy, 80 Tul. L. Rev. 777-848
(2006); Mark A. Hall and Clark C. Havighurst, Reviving
Managed Care with Health Savings
Accounts, 24(6) Health Affairs 1490-1500
(Nov/Dec 2005); Douglass Farnsworth, Moral Hazard in Health Insurance:
Are Consumer-Directed Plans the Answer?, 15 Ann. Health L. 251 (2006).
Consumer-driven
ideas being applied even
to Medicaid. Jeb Bush, Market
principles: the right prescription for Medicaid, 17 Stan. L. &
Pol'y Rev. 33-55 (2006).
Questioning the premise that moral hazard is a problem under health
insurance, see Malcom Gladwell, The Moral-Hazard Myth, The New Yorker,
Sept. 8, 2005.
The Treasury Department has a useful website on
Health Savings
Accounts, at http://www.treas.gov/offices/public-affairs/hsa/.
See also John
C. Goodman and
Web Resources and Notes on Medicare and Medicaid
A good source for Medicare/Medicaid statutes and regulations is: http://hippo.findlaw.com/hippomed.html
Information about the current status of Medicare and Medicaid can be found on these two government web sites, www.cms.hhs.gov and www.Medicare.gov. See also Kaiser Family Foundation, Medicare at a Glance (June 2001); Eleanor Kinney, ed., Guide to Medicare Coverage Decision-Making and Appeals (2002); Terry Coleman, Medicare Law (AHLA, 2nd ed. 2006).
From Tom Mayo on the Health Law Professors blog: “Kaiser Family Foundation has a slick website to commemorate the 40th anniversary of the passage of Titles XVIII and XIX of the Social Security Act - the Medicare and Medicaid laws. What caught my eye were video documentaries on the political history of the two programs, from the 1930s to the mid-1960s. The documentaries (one on Medicare, one on Medicaid, one on both) are quite well done, partly because of some compelling excerpts of interviews with some of the principal players in 1965. Of course, Wilbur Mills and LBJ are long gone, but there are still some terrific interviews with the president of the AMA at that time, Edward Annis; Joe Califano, a White House staffer at the time; LBJ's chief of staff, Jim Jones, and others. Best of all, longer (7- to 9-minute) interviews with each of these fellows are available on the same page. I like the way these videos really make the federal health care programs come alive.”Additional discussion of issues relating to the history and future
of
Medicare generally can be found at: Symposium: The Future of
Medicare,
Post Great Society and Post Plus-Choice: Legal and Policy Issues,
60 Wash. & Lee L. Rev. 1087-1512 (2003); Jonathan Oberlander, The
Political
Life of Medicare (Univ. Chicago Press, 2003); David A. Hyman, Medicare
Meets Mephistopheles, 60 Wash. & Lee L. Rev. 1165 (2003); Dean M.
Harris,
Beyond Beneficiaries: Using the Medicare Program to Accomplish Broader
Public Goals, 60 Wash. & Lee L. Rev. 1251 (2003).
More detailed information on managed care under Medicare (known
variously
as "Medicare Advantage" or "Medicare+Choice" or Medicare Part C) can be
found at: www.cms.hhs.gov/medicarereform.
See also Brian Biles, et al., Medicare Advantage: Deja vu All Over
Again?,
W4
Health Affairs 586 (Dec. 15, 2004). Questioning the wisdom and
practicality of using consumer choice principles to reform Medicare,
see Yaniv Hanoch & Thomas Rice, Can Limiting Choice Increase Social
Welfare? The Elderly and Health Insurance, 84 Milbank Q. 37 (2006).
Excellent information about Medicaid, including a primer, program
overview,
and detailed fact sheets, can be found on the web site for the Kaiser
Family
Foundation, at these three links: primer
program
overview fact
sheet
See
also Murphy's
Unofficial
Medicaid Page
and the AHLA's question and answer Guide
to Medicaid Basics (or here).
John K. Iglehart, The Dilemma of Medicaid, 348 New Eng. J. Med. 2140
(2003); Jeanne M. Lambrew, Making Medicaid a Block Grant Program: An
Analysis of the Implications of Past Proposals, 83 Milbank Q. 41
(2005); John V. Jacobi, Dangerious Times for Medicaid, __ J. L. Med.
& Ethics 834 (2005); Richard P. Nathan, Federalism and Health
Policy, 24(6) Health Aff. 1458 (2005).
For detailed explanation of Medicaid eligibility for nursing home benefits, see www.ces.ncsu.edu/depts/fcs/frm/docs/fcs420.html
The Supreme Court upheld Maine’s requirement that pharmaceutical
companies
doing business with its state Medicaid program must give equivalent
discounts
to uninsured residents of the state. Pharmaceutical Research and
Manufactuers of America v. Walsh, 538 U.S. 644 (2003). For
extensive analysis of pharmaceutical pricing and importation issues,
see Kevin Outterson, Pharmaceutical Arbitrarge: Balancing Access and
Innovation in International Prescription Drug Markets, 5 Yale J. Health
Policy L. & Ethics 193 (2005).
In an intriguing article, Barak Richman argues that expanding access
to Medicaid may not achieve its goals since many people who are
eligible
for public coverage do not see the need to apply for it, and health
insurance
does not improve health status as much as other social and economic
interventions
such as education. Behavioral Economics and Health
Policy:
Understanding Medicaid's Failure, 90 Cornell L. Rev. Law Rev. 705
(2005).
The government maintains a webpage for the Medicare
Moderization Act. For opposing viewpoints, see the
materials compiled by Community
Catalyst. For additional discussion, see the detailed summary
by McDermott Will & Emery, the shorter summaries by the Kaiser
Family Foundation here
and here,
and the extensive Congressional
Committee report and diagram.
See also John
Rother,
Advocating for a Medicare prescription drug benefit, 3 Yale J. Health
Pol'y
L. & Ethics 279-290 (2003); John K. Iglehart, The New Medicare
Prescription-Drug
Benefit: A Pure Power Play, 350 New Eng. J. Med. 826 (2004); Thomas R.
Oliver, et al., A Political History of Medicare and Presription Drug
Coverage,
82 Milbank Q. 283 (2004); Timothy S. Jost, The Most Important Health
Care Legistiona of the Millennium (So Far): The Medicare Modernization
Act, 5 Yale J. Health Policy & Ethics 437 (2005).
Capturing the maddening complexity of all of the Medicare
prescription drug benefit is the following
diagram, prepared by Yaniv Hanoch & Thomas Rice, Can Limiting
Choice Increase Social
Welfare? The Elderly and Health Insurance, 84 Milbank Q. 37 (2006).
The following is an example of how Medicaid estate planning can be used to pay for long term care for the middle class elderly. It was prepared by Wake Forest University law student Daren McDonough (class of 1999). Do you think this use of Medicaid funds is proper, or does this constitute abuse?
Example: Medicaid Estate Planning
Widow is a 70 year old woman who has recently been diagnosed with Alzheimer's disease. She owns a lovely home in suburban Charlotte, North Carolina. The home is completely paid off with a fair market value of $250,000. This does not include the value of the half acre garden which is adjacent to the property and which is used to produce vegetables which Widow consumes herself. She has one car, a 1991 Cadillac El Dorado. Widow has never worked, she was supported by her husband, Dirk, who was a pilot for U.S. Air. Dirk owned a restaurant as a tenant in common with two other individuals, and upon his death he transferred his interest in the business to Widow, along with $500,000 in the form of proceeds from a life insurance policy and other cash savings.
Widow has recently used her money to buy a new 1997 Lexus (after trading in her El Dorado), titled in only her name, a new bedroom setting, a new kitchen lay out, as well as three new pieces of jewelry. Upon learning that she has Alzheimer's, Widow contacted a local attorney, Will Mack, who advised Widow she had a number of options concerning her estate. At the time of her meeting with Mr. Mack, Widow received $800/month in social security and $300/month from Dirk's pension fund. Widow has four children, all over 22, one child has severe mental retardation and currently lives in an assisted living home. (This is paid for by a trust set up by Dirk, which has Mercantile Bank as the trustee, and upon the child's death the remainder is to be given to a stated charity.)
Widow is worried about losing her home. She currently has the home willed to one of her children. Widow has over $100,000 dollars invested in stocks and bonds and plans on giving these assets along with proceeds from her full life insurance policy to her three able bodied children at her death.
Mr. Mack informs Widow that there is a way she can keep her home, give away her other assets as she sees fit, and let Medicaid pay for her upcoming nursing home care. Mr. Mack informs Widow that in order to qualify for Medicaid assistance some assets may need to be transferred and some assets may need to change form or be liquidated and invested into other areas. Mr. Mack's proposal sets out:
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