Health Insurance Reform
SLN #: 13144Course Prefix: LAW-791
Course Section: 018
Credit Hours: 2
Instructor(s): Michaels
Course Books: View List of Books
Course Description:
The course will focus on the law surrounding three key principles of health insurance reform: (1) providing expanded access to health care coverage through private insurance plans in both the commercial and government subsidized markets; (2) the need of health insurers to change provider payment systems that impact health care costs and quality outcomes; and (3) the challenges associated with greater consumer engagement in the health insurance marketplace through the design and pricing of health benefit plans, as well as increased consumer understanding of health care costs and quality outcomes. The objective of the course is to examine the legal interplay of the three principles referenced above in the health insurance market context. These components will need to be aligned if meaningful health insurance reform in the U.S. is to occur under the current health care financing system. The course captures the very dynamic changes occurring in this area of health law.
The course will analyze the commercial health insurance markets with a particular focus on the impact of the Affordable Care Act on the stability of these markets, as well as any changes that are made as a result of judicial determinations or Executive Branch policy following the recent national elections. As part of the examination of the health insurance markets, the health insurer response to the COVID-19 pandemic will be reviewed.
The use of private insurers to provide coverage to Medicare beneficiaries, including the Medicare Advantage Part C and Medicare Part D Programs will be analyzed. In addition, the course will assess managed care plans engaged by State Medicaid Programs. This will include Arizona’s longstanding managed Medicaid Program known as “AHCCCS.”
The impact of prescription drug prices on health insurance premiums will be addressed. This includes efforts by health insurers to manage these costs, as well as state and federal law initiatives that attempt to control prescription drug prices.
Evolving changes in provider payment systems utilized by health insurers will be identified along with the dramatic shift away from the traditional fee-for-service model to payment innovations focused on quality outcomes and cost efficiencies. How will these changes affect the legal environment which was initially based on a fee-for-service system?
Finally, the role of the insured as a consumer of health
care services will be explored. This will include the issue
of financial engagement and the challenge of underinsurance,
and the information consumers need to have about provider
networks, health care costs, and quality outcomes to ensure
the competitiveness of the health insurance marketplace.
Additional Information:
Credit Hours: 2
Grading Option: Letter Grade Only
Graduation Writing Requirement: No
Flexible/Upper-Level Writing Requirement: Yes
Skills Requirement: No
Simulation Course: No
Experiential Learning: No
Seminar: Yes
Prerequisite: It is recommended that students have taken a more general health law survey course or health law and policy course before enrolling in this course.
Special Withdrawal Course: No
Limited Enrollment Number: 15
Final Exam Given: No
Paper Or In-Class Presentation: Yes, Paper
Attendance Policy: Per Statement Of Student Policies
Teaching Method: Remotely
* The law school has a policy that is used to calculate credit hours. Please see the Statement of Student Policies.