Presentation Transcript

1. Health Care Legislation and Insurance Law

   Class 4 – September 16th, 2009 Health and Medical Research for Lawyers: 524.01 Molly Brownfield brownfield@law.duke.edu
2. Today’s Agenda Quick background of U.S. health care system Clip from Sicko Research Resources Getting started - Health Sites v. Health Law Sites Health Statistics Federal Health Care Laws – pending, current, and past State Health Care Laws Health Law Practice-Oriented Resources Guest Lecture by Mirya Holman, Associate in Research In-class Exercise
3. Quick Background of U.S. Health Care System Traditionally, focus of health care policy was advancing medical science Shift in the 1980s: Cost of medical treatment Access to medical treatment Today, you often hear the term “health care” used synonymously with “health insurance” Legal doctrine now must take into account current public policy to limit or allocate governmental and private health care spending
4. Getting Started - Health Sites v. Health Law Sites
5. Health Sites – typically provide useful information for both consumers and healthcare professionals U.S. Dept. of Health & Human Services HIPAA site: http://www.hhs.gov/ocr/privacy/ National Health Information Center: http://www.health.gov/nhic/ Health & Human Services Centers for Medicare & Medicaid Services: http://www.cms.hhs.gov/ HealthReform.Gov: http://www.healthreform.gov/ Academy Health: http://www.academyhealth.org/ Management Resources for Healthcare & Medical Professionals: http://www.pohly.com/admin.html American Medical Association’s Doctor Finder: http://webapps.ama-assn.org/doctorfinder/home.jsp American Association of Family Practitioners: http://www.aafp.org/online/en/home/aboutus.html Federation of State Medical Boards DocInfo: https://s1.fsmb.org/Docinfo/Default.aspx
6. U.S. Dept. of Health & Human Services HIPAA site: http://www.hhs.gov/ocr/privacy/
7. National Health Information Center: http://www.health.gov/nhic/
8. Health & Human Services Centers for Medicare & Medicaid Services: http://www.cms.hhs.gov/
9. http://www.cms.hhs.gov/home/regsguidance.asp
10. http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage
11. http://www.cms.hhs.gov/NationalHealthExpendData/05a_NationalHealthAccountsStateHealthAccountsProvider.asp#TopOfPage http://www.cms.hhs.gov/NationalHealthExpendData/05a_NationalHealthAccountsStateHealthAccountsProvider.asp#TopOfPage
12. This is a government site, so we need to keep in mind that there is an agenda behind it. Scroll down the page… http://www.healthreform.gov/
13. Click on NC to see what we can find out about how the proposed health care legislation might affect our state.
14. Can use the footnotes to confirm the information provided, and to get to other, perhaps more objective, resources
15. Academy Health: http://www.academyhealth.org/
16. Management Resources for Healthcare & Medical Professionals: http://www.pohly.com/admin.html
17. AMA’s DoctorFinder: http://webapps.ama-assn.org/doctorfinder/home.jsp
18. American Association of Family Practitioners: http://www.aafp.org/online/en/home/aboutus.html
19. Federation of State Medical Boards DocInfo: https://s1.fsmb.org/Docinfo/Default.aspx Provides public access to disciplinary records. Maintained by the Federation of State Medical Boards.
20. Health Law Sites - Typically provide information for legal professionals employed in the area of health law Georgetown University Law Library Research Guide - Health Law http://www.ll.georgetown.edu/guides/health.cfm University of Houston Health Law & Policy Institute - Health Pathfinder http://www.law.uh.edu/healthlaw/pathfinder/HealthLaw.html SMU Professor Tom Mayo’s Health Law & Medicine Law Page http://faculty.smu.edu/tmayo/twmlinkshealthmedicine.htm ABA Health Law Sectionhttp://www.abanet.org/health/ American Health Lawyers Association (AHLA) http://www.healthlawyers.org/Pages/Default.aspx Guide to Health Law, HierosGamos http://www.hg.org/health.html Cornell Legal Information Institute – Health Law http://topics.law.cornell.edu/wex/health
21. http://www.ll.georgetown.edu/guides/health.cfm
22. University of Houston Health Law & Policy Institute- Health Pathfinder: http://www.law.uh.edu/healthlaw/pathfinder/HealthLaw.html Provides hundreds of annotated links from the UHLC Health Law and Policy Institute’s web page. Covers health law, health policy, and general health.
23. SMU Professor Tom Mayo’s Health Law & Medicine Law Page: http://faculty.smu.edu/tmayo/twmlinkshealthmedicine.htm
24. ABA Health Law Section: http://www.abanet.org/health/
25. http://www.hg.org/health-law.html Annotated list of health-related resources including foreign and international health law sources
26. http://www.healthlawyers.org/Pages/Default.aspx
27. Cornell LII page on Health Law: http://topics.law.cornell.edu/wex/health
28. Health Statistics
29. Medical Statistics Goodson Law Library Empirical Research Data Sources > Health: http://www.law.duke.edu/lib/facultyservices/empirical/links/miscellaneous CDC’s National Center for Health Statistics http://www.cdc.gov/nchs/default.htm Centers for Medicare & Medicaid Services’ Research, Statistics, Data & Systems http://www.cms.hhs.gov/home/rsds.asp
30. http://www.law.duke.edu/lib/facultyservices/empirical/links/miscellaneous http://www.law.duke.edu/lib/facultyservices/empirical/links/miscellaneous Annotated list of health-related resources
31. http://www.cdc.gov/nchs/default.htm
32. http://www.cms.hhs.gov/home/rsds.asp
33. Federal Health Care Laws – pending, current, and past
34. NYT Prescriptions Blog: http://prescriptions.blogs.nytimes.com/faq-health-care/ Where you might to go get a sense of health care legislation on the horizon, and the relevant conversations/debates
35. PolitiFact.com: http://www.politifact.com/truth-o-meter/ A site like this could offer tools to evaluate rumors over pending legislation, and to get started sorting out truth from fiction…though it is NOT something to cite to/rely wholly upon.
36. LOC’s Thomas site for Legislative Research: http://thomas.loc.gov/ Ultimately you need to read the legislation itself, which you can do for free on LOC’s Thomas website Can search or browse Congressional Bills and Public Laws Here, we get a shortcut as this is a hot topic!
37. Clicking on H.R. 3200 (the Congressional Bill number of this piece of this act) brings us to this page, where we can link to all kinds of information about this bill
38. The Subjects page provides a list of CRS (Congressional Research Service) Index Terms
39. The Summary provides a nice overview of the bill
40. Congressional Actions lets us see what has happened with this bill since it was introduced
41. The text of the bill in html (can also link to PDF, which routes you to GPO Access site)
42. Current Federal Health Care Law
43. Much quicker, however, to go with Topical Practice Area tool, or with Lexis’s Area of Law-By Topic

44. Past Federal Health Care Bills

45. GPO Access: http://www.gpoaccess.gov/index.html
46. Soon to be Fdsys: http://www.gpo.gov/fdsys/search/home.action
47. Freely available, but only goes back about 15 years for Public Laws and Congressional bills Also, not the most search-friendly resource
48. What if we wanted to look at the Health Care Reform legislation under Clinton? Might start with Google or Wikipedia to get a year/title/etc.
49. Scroll down to scout for references to primary sources Bingo! Footnote 16 leads us to the Congressional Bill
50. Links us into the bill in Thomas, which we know is a legitimate and reliable site Click on “Bill Summary & Status”
51. Now we can read the text of the proposed legislation, see all Congressional actions on the bill, see related bills, etc. – all for FREE!
52. Why wouldn’t we be able to get it on Westlaw using a tool like the Popular Name Table???
53. So we know it never became a Public Law, which means the Popular Names Table won’t work… What about in the Congressional Bills database? Nope – only goes back to 1994
54. We could also search the Federal Bill Tracking Archives (US-BILLTRK-OLD) Searching this is awkward and display is not nearly as user-friendly as on Thomas Reminds us that Lexis and Westlaw aren't’ always the resource of choice

55. State Health Care Laws

56. http://topics.law.cornell.edu/wex/table_health

57. Health Law Practice-Oriented Resources

    BNA’s Health Law Reporter Health Law Looseleaf Services Lexis & Westlaw Topical Resources
58. http://www.law.duke.edu/lib/lresources
59. Lexis - Area of Law by Topic guide to healthcare legal forms
60. Westlaw – Topical Practice Areas guide to healthcare legal forms
61. Guest Lecture by Mirya Holman http://www.thefacultylounge.org/2009/08/death-taxes-and-medical-bills-.html
62. http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1425814

63. Managing Medical Debt on the Brink of Bankruptcy

    Melissa Jacoby and Mirya Holman
64. The Problem: Scholars, politicians, and pundits have been fighting over the relationship between medical bills and bankruptcy Warren’s 2005 and 2009 studies found that medical bills contribute to a substantial number of bankruptcies Department of Justice study that found that bankruptcy filers had limited medical debt
65. The Politics: In 2005, Senators Grassley and Sessions used the DOJ analysis to disparage the Warren study as “myth,” “misrepresentation,” and “fiction.”   Recently, Rep. Conyers cited the Warren studies But a witness at the hearing from the American Enterprise Institute cited the DOJ analysis, which was referred to as the “closest comparable study,” to cast doubt on the Warren studies’ findings
66. Who is right? Is anyone right? Our paper is the first to use both methods survey question analysis like the Warren study court record analysis like the DOJ A single nationally representative dataset of bankruptcy filers. 
67. Dataset: 2007 Consumer Bankruptcy Project Random National Sample of Chapter 7 and 13 cases (n=2438) Written Questionnaires (50% response rate) Court records (Telephone Surveys) Funders: Robert Wood Johnson Foundation, FDIC, AARP (& universities)
68. Out-Of-Pocket Medical Expense from Questionnaire and Schedule F Medical Debt
69. Filer-by-Filer Comparison (by $$ Category) More than $10,000 in expense (and perhaps much more) and zero schedule F medical debt At least $5,000 more expense than schedule F medical debt At least $1,000 more expense than schedule F medical debt (20% of sample in prior 3 categories) 1 “category” more expense than schedule F medical debt Same category for both measures
70. Use of Cash, Credit Cards, and Home Equity Loans for Medical Bills
71. Average Schedule F Credit Card Debt
72. Medical-Related Reasons for Filing for Bankruptcy, by Discrepancy in Measures
73. Questions?
74. Setting up our In-Class Exercise: http://www.hulu.com/watch/2340/saturday-night-live-old-glory
75. In-Class Exercise Hypo A long-time client of ours, Mr. Stevens, has heard a number of rumors about the new healthcare legislation, and is very concerned for himself, his family, and his business. He has asked for our counsel as to whether the rumors are true or not.
76. In-Class Exercise Questions Specifically, he wants to know: Whether he might have to change doctors How it will affect his small business If his elderly parents will be forced into end-of-life decisions As you consider these questions, think about possible health sites and health law sites, as well as other informative current awareness sites that can get you started
77. Factcheck.org: http://www.factcheck.org/2009/08/twenty-six-lies-about-hr-3200/
78. http://www.politifact.com/truth-o-meter/statements/2009/sep/09/barack-obama/health-insurance-through-work-stays-place-under-re/ http://www.politifact.com/truth-o-meter/statements/2009/sep/09/barack-obama/health-insurance-through-work-stays-place-under-re/
79. http://thomas.loc.gov/
80. White House Reality Check: http://www.whitehouse.gov/realitycheck/faq