The article discusses contemporary legal practice and how new understandings of how the law can emerge from empirical information about current approaches to legal issues. It presents the argument that a new public interest law is emerging to deal with current legal problems in a contemporary context. The new public interest law requires a rethinking of the relationship between public interest goals and mainstream practice. Legal education is an integral part of constructing legal practices, and is now confronted with the challenge of changing is pedagogy to reflect the new practice of law. The article describes how a new framework is emerging, and how some law schools are beginning to revise their curriculum to reflect this new framework. It closes with a discussion of the barriers to embed these innovative projects more generally in law schools.
{"title":"Crossing Boundaries: Legal Education and the Challenge of the New Public Interest Law","authors":"L. Trubek","doi":"10.2139/SSRN.896761","DOIUrl":"https://doi.org/10.2139/SSRN.896761","url":null,"abstract":"The article discusses contemporary legal practice and how new understandings of how the law can emerge from empirical information about current approaches to legal issues. It presents the argument that a new public interest law is emerging to deal with current legal problems in a contemporary context. The new public interest law requires a rethinking of the relationship between public interest goals and mainstream practice. Legal education is an integral part of constructing legal practices, and is now confronted with the challenge of changing is pedagogy to reflect the new practice of law. The article describes how a new framework is emerging, and how some law schools are beginning to revise their curriculum to reflect this new framework. It closes with a discussion of the barriers to embed these innovative projects more generally in law schools.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115526162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When the tax-financed share of an industry’s revenue approaches 50%, a company will often find that its financial statements are held to a higher standard. That higher standard is often labeled “transparency”. With the recent extension of Medicare to cover outpatient prescriptions of the elderly, it is expected that the tax-financed portion of expenditures on outpatient drug prescriptions will approach 50%.The purpose of this paper is to raise the transparency issue with regard to a major institution in the pharmaceutical supply chain – Walgreens – the dominant retail chain drugstore in the country. The key result is that in 2003, there was considerable disparity between the net profitability of Walgreens front store operations – 1.4 % -- and the net profitability of its pharmacy operations – 8.3%. The front store drives a disproportionate share of Walgreens labor and occupancy operating expenses – 61.5% -- versus 38.5% for the pharmacy operation.Even though the front store enjoys a higher gross profit margin than the pharmacy – 36.1% versus 21.6% -- it incurs an even greater operating expense margin – 34.6% versus 13.3%. This disparity may be interpreted as a cross-subsidy and that this may become an issue as Medicare is extended to cover outpatient prescriptions of the elderly.
{"title":"Walgreens' Transparency Issue","authors":"L. Abrams","doi":"10.2139/ssrn.2849542","DOIUrl":"https://doi.org/10.2139/ssrn.2849542","url":null,"abstract":"When the tax-financed share of an industry’s revenue approaches 50%, a company will often find that its financial statements are held to a higher standard. That higher standard is often labeled “transparency”. With the recent extension of Medicare to cover outpatient prescriptions of the elderly, it is expected that the tax-financed portion of expenditures on outpatient drug prescriptions will approach 50%.The purpose of this paper is to raise the transparency issue with regard to a major institution in the pharmaceutical supply chain – Walgreens – the dominant retail chain drugstore in the country. The key result is that in 2003, there was considerable disparity between the net profitability of Walgreens front store operations – 1.4 % -- and the net profitability of its pharmacy operations – 8.3%. The front store drives a disproportionate share of Walgreens labor and occupancy operating expenses – 61.5% -- versus 38.5% for the pharmacy operation.Even though the front store enjoys a higher gross profit margin than the pharmacy – 36.1% versus 21.6% -- it incurs an even greater operating expense margin – 34.6% versus 13.3%. This disparity may be interpreted as a cross-subsidy and that this may become an issue as Medicare is extended to cover outpatient prescriptions of the elderly.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131142619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James W. Hughes, Michael J. Moore, Edward A. Snyder
We analyze the effects on consumers of an extreme policy experiment -- Napsterizing' pharmaceuticals -- whereby all patent rights on branded prescription drugs are eliminated for both existing and future prescription drugs without compensation to the patent holders. The question of whether this policy maximizes consumer welfare cannot be resolved on an a priori basis due to an obvious tradeoff: While accelerating generic entry will yield substantial gains in consumer surplus associated with greater access to the current stock of pharmaceuticals, future consumers will be harmed by reducing the flow of new pharmaceuticals to the market. Our estimates of the consumer surpluses at stake are based on the stylized facts concerning how generic entry has affected prices, outputs, and market shares. We find that providing greater access to the current stock of prescription drugs yields large benefits to existing consumers. However, realizing those benefits has a substantially greater cost in terms of lost consumer benefits from reductions in the flow of new drugs. Specifically, the model yields the result that for every dollar in consumer benefit realized from providing greater access to the current stock, future consumers would be harmed at a rate of three dollars in present value terms from reduced future innovation. We obtain this result even accounting for the stylized fact that after generic entry branded drugs continue to earn significant price premia over generic products and hence recognizing that Napsterizing does not completely eliminate the incentives to innovate.
{"title":"\"Napsterizing\" Pharmaceuticals: Access, Innovation, and Consumer Welfare","authors":"James W. Hughes, Michael J. Moore, Edward A. Snyder","doi":"10.3386/W9229","DOIUrl":"https://doi.org/10.3386/W9229","url":null,"abstract":"We analyze the effects on consumers of an extreme policy experiment -- Napsterizing' pharmaceuticals -- whereby all patent rights on branded prescription drugs are eliminated for both existing and future prescription drugs without compensation to the patent holders. The question of whether this policy maximizes consumer welfare cannot be resolved on an a priori basis due to an obvious tradeoff: While accelerating generic entry will yield substantial gains in consumer surplus associated with greater access to the current stock of pharmaceuticals, future consumers will be harmed by reducing the flow of new pharmaceuticals to the market. Our estimates of the consumer surpluses at stake are based on the stylized facts concerning how generic entry has affected prices, outputs, and market shares. We find that providing greater access to the current stock of prescription drugs yields large benefits to existing consumers. However, realizing those benefits has a substantially greater cost in terms of lost consumer benefits from reductions in the flow of new drugs. Specifically, the model yields the result that for every dollar in consumer benefit realized from providing greater access to the current stock, future consumers would be harmed at a rate of three dollars in present value terms from reduced future innovation. We obtain this result even accounting for the stylized fact that after generic entry branded drugs continue to earn significant price premia over generic products and hence recognizing that Napsterizing does not completely eliminate the incentives to innovate.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123899763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The conventional wisdom is that because at any time the aged cost more than the young, there is a positive relationship between aging and health care spending. It is hard, however, to find evidence that aging correlates positively with such spending. Intrigued by the puzzle, we account for the factors that contribute to changes of the age distribution of medical costs and their potential effect on aggregate cost. As changes in costs are not age neutral, the health system needs to facilitate a dynamic shift of resources from those whose relative cost rise less -- the young -- to those whose relative costs rise more -- the old. As there is an apparent market failure associated with uncertainty about growth in longevity (no market for 'death insurance'), the private market does not seem to effectively facilitate this shift. Aging, and its known correlates and antecedents produce a complex picture about the potential effect of aging on total cost of medical care in Israel. Shifting morbidity and mortality to older age can lower cost of care, all other things equal. Growth in incomes and insurance coverage are likely to increase use of care particularly amongst the old. Rising levels of education would have the opposite effect, but among the relatively young. The effect of a key element, technology, remains unknown. The Israeli experience also points to the advantages of a unified publicly financed health system with a timely allocation mechanism.
{"title":"Toward a Framework for Improving Health Care Financing for an Aging Population: The Case of Israel","authors":"D. Chernichovsky, S. Markowitz","doi":"10.3386/W8415","DOIUrl":"https://doi.org/10.3386/W8415","url":null,"abstract":"The conventional wisdom is that because at any time the aged cost more than the young, there is a positive relationship between aging and health care spending. It is hard, however, to find evidence that aging correlates positively with such spending. Intrigued by the puzzle, we account for the factors that contribute to changes of the age distribution of medical costs and their potential effect on aggregate cost. As changes in costs are not age neutral, the health system needs to facilitate a dynamic shift of resources from those whose relative cost rise less -- the young -- to those whose relative costs rise more -- the old. As there is an apparent market failure associated with uncertainty about growth in longevity (no market for 'death insurance'), the private market does not seem to effectively facilitate this shift. Aging, and its known correlates and antecedents produce a complex picture about the potential effect of aging on total cost of medical care in Israel. Shifting morbidity and mortality to older age can lower cost of care, all other things equal. Growth in incomes and insurance coverage are likely to increase use of care particularly amongst the old. Rising levels of education would have the opposite effect, but among the relatively young. The effect of a key element, technology, remains unknown. The Israeli experience also points to the advantages of a unified publicly financed health system with a timely allocation mechanism.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124061264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
One of the benefits commonly claimed for expanded public health insurance is improved efficiency of medical care delivery, but this claim has little rigorous empirical support. We provide such support by assessing the impact of the Medicaid expansions over the 1983-1996 period on the incidence of avoidable hospitalizations. We find that expanded public insurance eligibility leads to a significant decline in avoidable hospitalization: over this period Medicaid eligibility expansions were associated with a 22% decline in avoidable hospitalization. But we also find that there is a countervailing and larger impact in terms of increased access to hospital care for newly eligible children, so that there is an overall 10% rise in child hospitalizations due to the expansions. The expansions have mixed implications for treatment intensity, but appear to be associated with a significant shift in the types of hospitals at which children are treated, with fewer children treated in public hospitals and more in for-profit facilities.
{"title":"Does Public Insurance Improve the Efficiency of Medical Care? Medicaid Expansions and Child Hospitalizations","authors":"Leemore S. Dafny, J. Gruber","doi":"10.3386/W7555","DOIUrl":"https://doi.org/10.3386/W7555","url":null,"abstract":"One of the benefits commonly claimed for expanded public health insurance is improved efficiency of medical care delivery, but this claim has little rigorous empirical support. We provide such support by assessing the impact of the Medicaid expansions over the 1983-1996 period on the incidence of avoidable hospitalizations. We find that expanded public insurance eligibility leads to a significant decline in avoidable hospitalization: over this period Medicaid eligibility expansions were associated with a 22% decline in avoidable hospitalization. But we also find that there is a countervailing and larger impact in terms of increased access to hospital care for newly eligible children, so that there is an overall 10% rise in child hospitalizations due to the expansions. The expansions have mixed implications for treatment intensity, but appear to be associated with a significant shift in the types of hospitals at which children are treated, with fewer children treated in public hospitals and more in for-profit facilities.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2000-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129040968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tobacco advertising is a public health issue if these activities increase smoking. Although public health advocates assert that tobacco advertising does increase smoking, there is significant empirical literature that finds little or no effect of tobacco advertising on smoking. In this paper, these prior studies are examined more closely with several important insights emerging from this analysis. This paper also provides new empirical evidence on the effect of tobacco advertising. The primary conclusion of this research is that a comprehensive set of tobacco advertising bans can reduce tobacco consumption and that a limited set of tobacco advertising bans will have little of no effect. The regression results indicate that a comprehensive set of tobacco advertising bans can reduce consumption by 6.3 percent. The regression results also indicate that the new European Commission directive tobacco advertising in the EC countries, will reduce tobacco consumption by about 6.9 percent on average in the EC. The regression results also indicate that the ban on outdoor advertising included in the US tobacco industry state level settlement will probably not result in much change in advertising expenditures nor in tobacco use. Under the settlement industry would also contribute $1.5 billion over five years for public education on tobacco use. This counteradvertising could reduce tobacco use by about two percent.
{"title":"Tobacco Advertising: Economic Theory and International Evidence","authors":"H. Saffer, F. Chaloupka","doi":"10.3386/W6958","DOIUrl":"https://doi.org/10.3386/W6958","url":null,"abstract":"Tobacco advertising is a public health issue if these activities increase smoking. Although public health advocates assert that tobacco advertising does increase smoking, there is significant empirical literature that finds little or no effect of tobacco advertising on smoking. In this paper, these prior studies are examined more closely with several important insights emerging from this analysis. This paper also provides new empirical evidence on the effect of tobacco advertising. The primary conclusion of this research is that a comprehensive set of tobacco advertising bans can reduce tobacco consumption and that a limited set of tobacco advertising bans will have little of no effect. The regression results indicate that a comprehensive set of tobacco advertising bans can reduce consumption by 6.3 percent. The regression results also indicate that the new European Commission directive tobacco advertising in the EC countries, will reduce tobacco consumption by about 6.9 percent on average in the EC. The regression results also indicate that the ban on outdoor advertising included in the US tobacco industry state level settlement will probably not result in much change in advertising expenditures nor in tobacco use. Under the settlement industry would also contribute $1.5 billion over five years for public education on tobacco use. This counteradvertising could reduce tobacco use by about two percent.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"141 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124492781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chinese health care policy has undergone numerous reforms in recent years that have often led to new challenges, inciting the need for further reform. The most recent reforms attempt to find a middle path between public health care provision and commercial private insurance. In this way, China is following in the footsteps of countries that initially increased the role of privatization in the 1990s and at the beginning of the 21st century, but are now gearing towards public health care. However, this process of constant reform has led to a lack of transparency in the functioning of the health care system, provoking a loss in public trust. There remains an important degree of uncertainty about the future direction of developments in China. Nonetheless, a dual financing approach to health care using tax finance and social insurance might yet crystallize, offering a potential model to inform developments in other countries.
{"title":"The Health Care System of the People's Republic of China: Between Privatization and Public Health Care","authors":"Dong-mei Liu, B. Darimont","doi":"10.1111/issr.12004","DOIUrl":"https://doi.org/10.1111/issr.12004","url":null,"abstract":"Chinese health care policy has undergone numerous reforms in recent years that have often led to new challenges, inciting the need for further reform. The most recent reforms attempt to find a middle path between public health care provision and commercial private insurance. In this way, China is following in the footsteps of countries that initially increased the role of privatization in the 1990s and at the beginning of the 21st century, but are now gearing towards public health care. However, this process of constant reform has led to a lack of transparency in the functioning of the health care system, provoking a loss in public trust. There remains an important degree of uncertainty about the future direction of developments in China. Nonetheless, a dual financing approach to health care using tax finance and social insurance might yet crystallize, offering a potential model to inform developments in other countries.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120514971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medically, three distinct terms viz. abortion, miscarriage and premature labour, are used to denote the expulsion of a foetus at different stages of gestation. Thus a term, abortion, is used only when an ovum is expelled within the first three months of pregnancy, before the placenta is formed. Miscarriage is used when a foetus is expelled from the fourth to the seventh month of gestation, before it is viable, while premature labour is the delivery of a viable child possibly capable of being reared, before it has become fully mature. Section 312 IPC made causing miscarriage an offence except in good faith for the purpose of saving the life of the woman without laying down the manner in which pregnancy could be medically terminated. Section 3 of the Medical Termination of Pregnancy Act, 1971 provides the guidelines or limitation within which the pregnancy could be terminated. A compromise which guarantees both protection of foetus as well as the freedom of abortion of a pregnant woman is impossible because termination of pregnancy always means “destruction of unborn life”. The legal order cannot, therefore, make a woman's self-determination, the principle of its regulations. On the other hand, protection of foetus must be given priority to the woman's right of self-determination.
{"title":"Moral Force in the Rule of Law: Morality behind Abortion Laws and Right to Life of Foetus – in Context of Savita’s Case","authors":"Dr. Om Prakash Gautam","doi":"10.2139/ssrn.3661489","DOIUrl":"https://doi.org/10.2139/ssrn.3661489","url":null,"abstract":"Medically, three distinct terms viz. abortion, miscarriage and premature labour, are used to denote the expulsion of a foetus at different stages of gestation. Thus a term, abortion, is used only when an ovum is expelled within the first three months of pregnancy, before the placenta is formed. Miscarriage is used when a foetus is expelled from the fourth to the seventh month of gestation, before it is viable, while premature labour is the delivery of a viable child possibly capable of being reared, before it has become fully mature. Section 312 IPC made causing miscarriage an offence except in good faith for the purpose of saving the life of the woman without laying down the manner in which pregnancy could be medically terminated. Section 3 of the Medical Termination of Pregnancy Act, 1971 provides the guidelines or limitation within which the pregnancy could be terminated. A compromise which guarantees both protection of foetus as well as the freedom of abortion of a pregnant woman is impossible because termination of pregnancy always means “destruction of unborn life”. The legal order cannot, therefore, make a woman's self-determination, the principle of its regulations. On the other hand, protection of foetus must be given priority to the woman's right of self-determination.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130153698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medicaid plays key roles in supporting our nation’s health. Under the Affordable Care Act, Medicaid took an even more central position in public health endeavors by extending coverage in all interested states to millions of adults who typically fell through the health care cracks. Nevertheless, the Trump administration is now undoing these gains by actively encouraging states to curtail access to Medicaid in key respects while using the rhetoric of health. This article examines Trump administration efforts in two contexts: (1) state § 1115 waiver applications seeking to better align their Medicaid programs with cash welfare and food stamp programs, and (2) changes to Medicaid funding for contraceptive and other reproductive health services. It concludes that, to better protect Medicaid and strengthen public support for it, it may make more sense to focus not on granular medical outcomes when evaluating Medicaid’s success, but rather on the larger role it plays in supporting beneficiaries’ lives. The Trump administration is right that independence is healthy. However, it is difficult to be independent if one lacks health, or faces financial ruin if one needs healthcare, or has unreasonable or nonexistent family planning and reproductive health choices. Evidence suggests that stable, secure access to coverage via Medicaid, as one piece of our safety net, makes beneficiaries feel more emotionally and financially secure and provides them improved access to needed services. As such, if Medicaid were allowed to remain both expansive and stable, we may reasonably expect gradually to see more stability in communities supported by Medicaid and other social supports, and more freedom of opportunity for beneficiaries and their families. Such a strategy would call the Trump administration on its own rhetoric while providing working-class Trump supporters, among many others, with means to help attain their desired ends.
医疗补助在支持我们国家的健康方面发挥着关键作用。根据《平价医疗法案》(Affordable Care Act)，医疗补助计划(Medicaid)在公共卫生事业中占据了更加核心的地位，它将所有感兴趣的州的医疗保险范围扩大到数百万通常没有享受到医疗保险的成年人。然而，特朗普政府现在正以健康为由，积极鼓励各州在关键方面削减医疗补助计划的覆盖面，从而抵消这些成果。本文研究了特朗普政府在两个方面的努力:(1)寻求更好地将其医疗补助计划与现金福利和食品券计划结合起来的州§1115豁免申请，以及(2)改变医疗补助计划对避孕和其他生殖健康服务的资助。它的结论是，为了更好地保护医疗补助计划并加强公众对它的支持，在评估医疗补助计划的成功时，更有意义的可能不是关注具体的医疗结果，而是关注它在支持受益者生活方面发挥的更大作用。特朗普政府认为独立是健康的，这是正确的。然而，如果一个人缺乏健康，或在需要医疗保健时面临经济崩溃，或有不合理或不存在的计划生育和生殖健康选择，则很难独立。有证据表明，作为我们安全网的一部分，通过医疗补助获得稳定、安全的覆盖，使受益人在情感上和经济上更有安全感，并为他们提供更多获得所需服务的机会。因此，如果允许医疗补助计划保持扩张和稳定，我们可以合理地期望在医疗补助计划和其他社会支持支持的社区中逐渐看到更多的稳定，并为受益人及其家庭提供更多的自由机会。这样的策略会让特朗普政府屈服于自己的言论，同时为特朗普的工薪阶层支持者以及其他许多人提供帮助实现其预期目标的手段。
{"title":"Independence Is the New Health","authors":"Laura D. Hermer","doi":"10.2139/ssrn.3401253","DOIUrl":"https://doi.org/10.2139/ssrn.3401253","url":null,"abstract":"Medicaid plays key roles in supporting our nation’s health. Under the Affordable Care Act, Medicaid took an even more central position in public health endeavors by extending coverage in all interested states to millions of adults who typically fell through the health care cracks. Nevertheless, the Trump administration is now undoing these gains by actively encouraging states to curtail access to Medicaid in key respects while using the rhetoric of health. This article examines Trump administration efforts in two contexts: (1) state § 1115 waiver applications seeking to better align their Medicaid programs with cash welfare and food stamp programs, and (2) changes to Medicaid funding for contraceptive and other reproductive health services. It concludes that, to better protect Medicaid and strengthen public support for it, it may make more sense to focus not on granular medical outcomes when evaluating Medicaid’s success, but rather on the larger role it plays in supporting beneficiaries’ lives. The Trump administration is right that independence is healthy. However, it is difficult to be independent if one lacks health, or faces financial ruin if one needs healthcare, or has unreasonable or nonexistent family planning and reproductive health choices. Evidence suggests that stable, secure access to coverage via Medicaid, as one piece of our safety net, makes beneficiaries feel more emotionally and financially secure and provides them improved access to needed services. As such, if Medicaid were allowed to remain both expansive and stable, we may reasonably expect gradually to see more stability in communities supported by Medicaid and other social supports, and more freedom of opportunity for beneficiaries and their families. Such a strategy would call the Trump administration on its own rhetoric while providing working-class Trump supporters, among many others, with means to help attain their desired ends.","PeriodicalId":230649,"journal":{"name":"Health Care Law & Policy eJournal","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134173440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：