Skip to main content
SpringerLink
Log in

Healthcare Reform

  • Chapter
  • First Online:
Laws of Medicine

  • 348 Accesses

Abstract

This chapter provides an overview of U.S. health reform and related legal concepts. It provides a brief history of health reform proposals in the United States and assesses the resulting legal frameworks, stakeholders, and structures of those efforts as the basis for recent and ongoing health reform initiatives. The chapter then provides an overview of the Affordable Care Act (ACA). This overview touches on the law’s major tenets, including the individual mandate, insurance exchanges, consumer protections and coverage requirements, and Medicaid expansion. The chapter also explores state health reforms, such as the 2006 Massachusetts health reform law, that laid the foundation for the ACA and subsequent state reforms that build on the law. The chapter further reviews major legal challenges to the ACA, including NFIB v. Sebelius, California v. Texas, King v. Burwell, and Burwell v. Hobby Lobby.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Notes

  1. 1.

    “Adverse selection” refers to the concept that if insurance guaranteed to be made available whenever needed, consumers will only purchase coverage when they have health needs or if they are consistently in need of health care. This structure disrupts the insurance market by allowing healthy entrants to opt in and out of coverage, reducing the number of overall enrollees over which health care costs are distributed.

References

  1. Centers for Medicare and Medicaid Services [Internet]. National Health Expenditure Data, NHE Fact Sheet. 2020. [cited 2021 Jul 24]. Available from: https://cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.

  2. Emanuel, E. Reinventing American Health Care. 1st ed. New York: Public Affairs; 2014. p. 18-33.

    Google Scholar 

  3. Guyton, G. A brief history of worker’s compensation [Internet]. Iowa Orthop. J. 1999; 19: 106-110. [cited 2022 Jun 4]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888620/.

  4. Kaiser Family Foundation [Internet]. Timeline: History of Health Reform in the U.S. 2011. [cited 2021 Jul 25]. Available from: https://www.kff.org/health-reform/timeline/history-of-health-reform-efforts-in-the-united-states/.

  5. Executive Order 9250. Providing for the Stabilizing of the National Economy. 7 FR 7871. 1942. Established pursuant to The Stabilization Act of 1942, 50a U.S.C. § 961. 1942.

    Google Scholar 

  6. National Bureau of Economic Research [Internet]. Employer-Sponsored Health Insurance and Health Reform. Bulletin on Aging and Health No. 2. 2009. [cited 2021 Jul 25]. Available from: https://www.nber.org/bah/2009no2/employer-sponsored-health-insurance-and-health-reform.

  7. Carroll A. The Real Reason the U.S. Has Employer-Sponsored Health Insurance [Internet]. New York Times. 5 Sept. 2017. [cited 2021 Jul 25]. Available from: https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-employer-sponsored-health-insurance.html.

  8. McCarran-Ferguson Act. 15 U.S.C. §§ 1011-1015 (1945).

    Google Scholar 

  9. U.S. v. South-Eastern Underwriters Ass’n. 322 U.S. 533 (1944).

    Google Scholar 

  10. Employee Retirement Income Security Act of 1974. 29 U.S.C. § 18 (1974). Establishing federal oversight of employee benefits, including ESI.

    Google Scholar 

  11. Health Maintenance Organization Act of 1973. 42 U.S.C. § 300e (1973). Establishing a federal trial program to support the development of HMOs.

    Google Scholar 

  12. Centers for Medicare and Medicaid Services [Internet]. Medicaid.gov. Program History. [cited 2021 Jul 25]. Available from: https://www.medicaid.gov/about-us/program-history/index.html.

  13. Medicare Modernization Act of 2003. 42 U.S.C. § 1395w, 101-154 (2021).

    Google Scholar 

  14. Health Insurance Portability and Accountability Act of 1996 (HIPAA). 110 Stat. 1936. Pub. L. 104-191 (1996).

    Google Scholar 

  15. For example, in the early 1990s, Minnesota established MinnesotaCare, a public program offering coverage to residents who were not eligible for Medicaid but did not have sufficient income to support private insurance coverage. Minn. Stat. Chap. 257L. (2021).

    Google Scholar 

  16. PBS. Frontline. Obama’s Deal (documentary). [cited 2021 Jul 25]. Available from: www.pbs.org/wgbh/frontline/film/obamasdeal/. Providing an overview of the legislative history of the ACA.

  17. Jacobson L. Obama says Heritage Foundation is source of health exchange idea [Internet]. Politifact. 1 April 2010. [cited 2021 Jul 25]. Available from: https://www.politifact.com/factchecks/2010/apr/01/barack-obama/obama-says-heritage-foundation-source-health-excha/.

  18. An Act Providing Access to Affordable, Quality, Accountable Health Care (Massachusetts Health Reform Act of 2006) [Internet]. Chapter 58 of the Acts of 2006, Massachusetts General Court. [cited 2021 Jul 25]. Available from: https://malegislature.gov/Laws/SessionLaws/Acts/2006/Chapter58.

  19. Long S, Skopec L, Shelto, A, Nordahl K, Kenney Walsh, K. Massachusetts Health Reform at Ten Years: Great Progress But Coverage Gaps Remain [Internet]. Health Affairs. 35:9. Sept. 2016. [cited 2021 Jul 25]. Available from: https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.0354.

  20. Affordable Care Act Glossary [Internet]. Healthcare.gov. [cited 2021 Jul 25]. Available from: www.healthcare.gov/glossary/affordable-care-act.

  21. Kaiser Family Foundation [Internet]. Summary of the Affordable Care Act. March 2017. This document is based on a more detailed summary of the law’s provisions, available at https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/, which was accessed 25 July 2021.

  22. Cox C, Semanskee A, Claxton G, Levitt L. Kaiser Family Foundation [Internet]. Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors. Aug. 2016. https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-risk-adjustment-reinsurance-and-risk-corridors/

  23. Claxton G, Rae M, Damico A, Young G, McDermott D, Whitmore H. Health Benefits in 2019: Premiums Inch Higher, Employers Respond to Federal Policy [Internet]. Health Affairs. 2019; 38:1. [cited 2022 Jun 4]. Available from: https://doi.org/10.1377/hlthaff.2019.01026

  24. In 2021, the American Rescue Plan Act of 2021, passed to address the COVID-19 pandemic, amended these provisions and lowered the definition of affordability to roughly 8.5% and temporarily expanded APTC subsidies to accommodate the new definition. McDermott D, Cox C, Amin K. Kaiser Family Foundation [Internet]. Impact of Key Provisions of the American Rescue Plan Act of 2021 COVID-19 Relief on Marketplace Premiums. 15 Mar. 2021. [cited 2021 Jul 5]. Available from: https://www.kff.org/health-reform/issue-brief/impact-of-key-provisions-of-the-american-rescue-plan-act-of-2021-covid-19-relief-on-marketplace-premiums/.

  25. Kaiser Family Foundation [Internet]. State Health insurance Marketplace Types, 2021. [cited 2021 Jul 25]. Available from: https://www.kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

  26. HHS.gov [Internet]. New HHS Data Show More Americans than Ever Have Health Coverage through the Affordable Care Act. 5 June 2021. [cited 2021 Jul 25]. Available from: https://www.hhs.gov/about/news/2021/06/05/new-hhs-data-show-more-americans-than-ever-have-health-coverage-through-affordable-care-act.html.

  27. Kaiser Family Foundation [Internet]. Status of State Medicaid Expansion Decisions: Interactive Map. 23 July 2021. [cited 2021 Jul 25]. Available from: https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/.

  28. IRS.gov. [Internet]. Affordable Care Act Tax Provisions. [cited 2021 Sept 17]. https://www.irs.gov/affordable-care-act/affordable-care-act-tax-provisions.

  29. Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal. Exec. Order 13765. 20 Jan. 2017.

    Google Scholar 

  30. Promoting Healthcare Choice and Competition Across the United States. Exec. Order 13813, 12 Oct. 2017.

    Google Scholar 

  31. Nat’l Fed. Ind. Bus. v. Sebelius. 567 U.S. 519 (2012).

    Google Scholar 

  32. California v. Texas. 593 U.S. __ (2021). WL 2459255.

    Google Scholar 

  33. King v. Burwell. 576 U.S. 473 (2015).

    Google Scholar 

  34. Burwell v. Hobby Lobby Stores, Inc. 573 U.S. 682 (2014). Stating that “protecting the free-exercise rights of corporations like Hobby Lobby…protects the religious liberty of the humans who own and control those companies.”

    Google Scholar 

  35. Burwell v. Hobby Lobby Stores, Inc. 573 U.S. 682 (2014). Dissent noting that “the determination that [federal religious freedom law] extends to for-profit corporations is bound to have untoward effects” and that “the Court’s expansive notion of corporate personhood” will contribute to future lawsuits seeking religious exemptions for other regulations.

    Google Scholar 

Download references

Acknowledgments

None

Author information

Authors and Affiliations

  1. Department of Public Affairs, Mayo Clinic, Rochester, MN, USA

    Kate Johansen

Authors
  1. Kate Johansen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kate Johansen .

Editor information

Editors and Affiliations

  1. Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Amirala S. Pasha

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Johansen, K. (2022). Healthcare Reform. In: Pasha, A.S. (eds) Laws of Medicine . Springer, Cham. https://doi.org/10.1007/978-3-031-08162-0_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-08162-0_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-08161-3

  • Online ISBN: 978-3-031-08162-0

  • eBook Packages: Law and CriminologyLaw and Criminology (R0)

Publish with us

Policies and ethics

Search

Navigation