Health matrix (Cleveland, Ohio : 1991)最新文献

Many genetic counselors recommend that individuals secure desired insurance policies, such as life insurance, prior to undergoing predictive genetic testing. It has been argued, however, that this practice is "tantamount to fraud" and that failure to disclose genetic test results, or conspiring to secure a policy before testing, opens an individual up to legal recourse. This debate traps affected individuals in a Catch-22. If they apply for life insurance and disclose a genetic test result, they may be denied. If they apply without disclosing the information, they may have committed fraud. The consequences of life insurance fraud are significant: If fraud is found on an application, a life insurer can rescind the policy, in some cases even after the individual has passed away. Such a rescission could leave family members or beneficiaries without the benefits of the life insurance policy payment after the individual's death and place them in in economic difficulty. Although it is clear that lying in response to a direct question about genetic testing would be tantamount to fraud, few, if any, life insurance applications currently include broad questions about genetic testing. This paper investigates whether non-disclosure of unasked for genetic information constitutes fraud and explores varying types of insurance questions that could conceivably be interpreted as seeking genetic information. Life insurance applicants generally have no duty to disclose unasked for information, including genetic information, on an application. However, given the complexities of genetic information, individuals may be exposed to fraud and rescission of their life insurance policy despite honest attempts to truthfully and completely answer all application questions.

Addressing health care disparities rarely focuses on how the "gold" (meaning the federal dollars flowing into the nation's health system) has, at different times, both widened and narrowed health care disparities. This paper describes (1) the early attempts to use the power of the federal purse to address disparities that led to the enactment of Title VI of the 1964 Civil Rights Act; (2) how Title VI, as applied in the implementation of Medicare, reduced disparities; and (3) the lessons that this story offers for similar opportunities in the implementation of the Affordable Care Act (ACA). Reducing disparities with the implementation of the ACA will require (1) rekindling the spirit of the grass roots movement that captured the Title VI enforcement process with the implementation of Medicare; (2) exposing adversaries through data disclosure and taking advantage of the "invisible army" that supports these goals; (3) using the power of both the economic and ethical versions of the Golden Rule; and (4) creating the political insulation and urgency necessary to reduce health care disparities.

Medicaid is failing to meet the health needs of qualified migrant farmworkers because of their migratory lifestyle. This populationmoves frequently, following various agricultural harvests, and the state residency requirements imposed by Medicaid create a significantaccess barrier that most migrant farmworkers cannot overcome. Migrant farmworkers are unable to overcome the state residencyrequirement for several reasons: language and cultural barriers, the difficulty in applying, and statutory impediments such as the five-yearban and the proof-of-citizenship requirement. Several states have attempted to integrate migrant farmworkers into both their state-runMedicaid and general public health systems with varying degrees of success. Both Texas and Wisconsin have implemented creativesolutions to this Medicaid coverage problem and these existing models will be examined for both strengths and weaknesses. Finally, afterassessing whether the Equal Protection Clause of the Fourteenth Amendment requires that a state provide U.S. citizen migrantfarmworkers with access to Medicaid despite their transient lifestyles, I will propose three possible solutions to the problem—the ACAMedicaid Expansion, a hybrid Wisconsin/Texas model, and individualized solutions tailored to each state.