Chapter 8.A.2: Private Health Insurance

To insert after Ch. 8.A.2 (p. 725):

For accounts of the law’s enactment and general descriptions of its contents, see Washington Post, Landmark: The Inside Story of America’s New Health Care Law (2010); Jonathan Gruber, Health Care Reform: What It Is, Why It’s Necessary, How It Works (2011); Paul Starr, Remedy and Reaction: The Peculiar American Struggle over Health Care Reform (2011); Stuart Altman, Power, Politics and Universal Health Care (2011); John McDonough, Inside National Health Reform (2011); Lawrence Jacobs & Theda Skocpol, Health Care Reform and American Politics (2010).

For an important book on the occasion of the ACA’s tenth anniversary from roughly 20 distinguished contributors, see The Trillion Dollar Revolution: How The Affordable Care Act Transformed Politics, Law, and Health Care In America (Ezekiel J. Emanuel and Abbe R. Gluck, eds. (2020)).

For more about the Massachusetts precursor to the ACA, see Edward Zelinsky, The New Massachusetts Health Law: Preemption and Experimentation, 49 Wm. & Mary L. Rev. 229 (2008); Michael Tanner, No Miracle in Massachusetts: Why Governor Romney’s Health Care Reform Won’t Work (Cato Institute, 2006); Symposium, 55 U. Kan. L. Rev. 1091 (2007); Symposium, 28(4) Health Aff. w578 (July–Aug. 2009); Symposium, 36(5) Hastings Center Rep. 14 (Oct. 2006); Symposium, 354 New Eng. J. Med. 2093 (2006). 

To insert after notes on NFIB v. Sebelius (p. 734):

For commentary on the Supreme Court’s decision, see The Health Care Case: The Supreme Court’s Decision and Its Implications (Nathaniel Persily et al. eds. 2013); David A. Hyman, Why Did Law Professors Misunderestimate the Lawsuits Against PPACA?, 2014 U. Ill. L. Rev. 805; Josh Blackman, Unprecedented: The Constitutional Challenge to Obamacare (2013); Symposium, Health Care and the Constitution: A Forum on the Supreme Court’s Affordable Care Act Decision, 81 Fordham L. Rev. 1697 (2013); Einer Elhauge, Obamacare on Trial (2012); Andrew Koppleman, The Tough Luck Constitution and the Fight over Health Care Reform (2013); Symposium, 38 J. Health Pol. Pol’y & L. 215 (2013); Martha Minow, Affordable Convergence: “Reasonable Interpretation” and the Affordable Care Act, 126 Harv. L. Rev. 117 (2012) (“Reading the two opinions . . . is a bit like traveling between two countries speaking different languages.”).

On the fairness of community rating (note 3), see Jessica L. Roberts, “Healthism”: A Critique of the Antidiscrimination Approach to Health Insurance and Health-Care Reform, 2012 U. Ill. L. Rev. 1159; Allison K. Hoffman, Three Models of Health Insurance: The Conceptual Pluralism of the Patient Protection and Affordable Care Act, 159 U. Pa. L. Rev. 1873 (2011); Deborah Stone, The Struggle for the Soul of Insurance, 18 J. Health Pol. Pol’y & L. 287 (1993); Lisa Klautzer et al., Can We Legally Pay People for Being Good?, 49 Inquiry 268 (2012).

On insurance markets and regulation under the ACA, see Tom Baker, Health Insurance, Risk, and Responsibility After the Patient Protection and Affordable Care Act, 159 U. Pa. L. Rev. 1577 (2011); Amy Monahan, On Subsidies and Mandates: A Regulatory Critique of the ACA, 36 J. Corp. L. 781 (2011); Allison K. Hoffman, Oil and Water: Mixing Individual Mandates, Fragmented Markets, and Health Reform, 36 Am. J. Law Med. & Ethics 7 (2010); Timothy Jost, Loopholes in the Affordable Care Act, 5 St. Louis U. J. Health L. & Pol’y 27 (2011).

On the merits of decoupling insurance from employment (note 4), see Edward A. Zelinsky, The Defined Contribution Paradigm, 114 Yale L. J. 451 (2004); Symposium, 38 Inquiry 175 (2001); Symposium, 25(6) Health Aff. 1474 (Dec. 2006). On the possible demerits, see David A. Hyman & Mark A. Hall, Two Cheers for Employment-Based Health Insurance, 2 Yale J. Health Pol’y L. & Ethics 23 (2002). See generally Mark V. Pauly, Health Benefits at Work (1998).

For discussions of wellness programs (note 5), see Symposium, 27 Health Matrix 1 (2017); Special Issue, 39 Journal of Health, Politics, Policy and Law 955 (2014); Jill R. Horwitz et al., Wellness Incentives in the Workplace: Cost Savings Through Cost Shifting to Unhealthy Workers, 32 Health Affairs 468 (2013).

An excellent textbook on health insurance economics and regulation generally is Michael A. Morrisey, Health Insurance (2013).

To insert after notes on King v. Burwell (p. 740):

For some of the voluminous commentary on King v. Burwell, see Josh Blackman, Unraveled: Obamacare, Religious Liberty, and Executive Power (2016); Abbe R. Gluck, Imperfect Statutes, Imperfect Courts: Understanding Congress’s Plan in an Era of Unorthodox Lawmaking, 129 Harv. L. Rev. 62 (2015); Nicholas Bagley, Three Words and the Future of the Affordable Care Act, 40 J. Health Pol. Pol’y & L. 589 (2015); Jonathan H. Adler & Michael F. Cannon,  Taxation Without Representation: The Illegal IRS Rule to Expand Tax Credits under the PPACA 23 Health Matrix 119 (2013).

For further discussion of the health-care exchanges, see Jeanne M. Lambrew, The Tortuous Journey of the Health Insurance Marketplace, 46 J. Law Med. & Ethics 862 (2018); Brendan S. Maher, Unlocking Exchanges, 24 Conn. Ins. L.J. 125 (2017).

For background on House v. Price (note 2), see Nicholas Bagley, Legal Limits and the Implementation of the Affordable Care Act, 164 Penn. L. Rev. 1715, 1729-1735 (2016).

For discussion of the medical loss ratio (note 4), see Michael McCue et al., Impact of Medical Loss Regulation on the Financial Performance of Health Insurers, 32 Health Affairs 1546 (2013); Michael McCue & Mark A. Hall, The Federal Medical Loss Ratio Rule: Implications for Consumers in Year 3 (2013); Benjamin Day et al., The Affordable Care Act and Medical Loss Ratios: No Impact in First Three Years, 45 Int’l J. Health Servs. 127 (2015).

To insert after notes on California v. Texas (p. 744):

For further discussion associated with the mandate’s repeal, see Wendy Netter Epstein, Private Law Alternatives to the Individual Mandate, 104 Minn. L. Rev. 1429 (2020); Matthew Fiedler, How Did the ACA’s Individual Mandate Affect Insurance Coverage? USC-Brookings Schaeffer Initiative for Health Policy (May 2018).