Health Insurance Reform

SLN #: 11573
Course Prefix: LAW-791
Course Section: 017
Credit Hours: 2
Instructor(s): Michaels

Course Description:
The course will focus on the law surrounding three key principles of health insurance reform: (1) providing access to health care coverage through private insurance plans; (2) the changing provider payment systems utilized by health insurers that impact health care costs and quality outcomes; and (3) the need for greater consumer engagement in the health insurance marketplace through the design and pricing of health benefit plans. The objective is to examine the legal interplay of the three principles referenced above in the health insurance market context. Each of these components will need to be aligned if meaningful health insurance reform is to occur in the United States.

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 to the legislation in its design or implementation, or as a result of judicial determinations. The use of private insurers to provide coverage to Medicare beneficiaries, including the Medicare Advantage Part C and Medicare Part D Programs, will also be reviewed and analyzed, along with managed care plans engaged by State Medicaid Programs (with a focus on Arizona’s Medicaid Program) to provide coverage to lower income populations. In addition, the impact of prescription drug prices on health insurance premiums will also be addressed.

Evolving changes in provider payment systems utilized by health insurers will be assessed to identify the dramatic shift away from the traditional fee for service model to payment innovations focused on quality outcomes and cost efficiencies. How will these new 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 issues of financial engagement and wellness, and what consumers need to know 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 Writing Requirement: Yes
Skills Requirement: No
Experiential Learning: No
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

* The law school has a policy that Is used To calculate credit hours. Please see the Statement of Student Policies.