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A Not So Quiet Revolution: The Role of the Courts in Health System Change David Hyman

A Not So Quiet Revolution: The Role of the Courts in Health System Change David Hyman University of Maryland/Illinois Schools of Law Federal Trade Commission. What Bodies of Law are we talking about?. Insurance Law (McCarran-Ferguson Act/ERISA) Pilot Life v. Dedeaux (1987)

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A Not So Quiet Revolution: The Role of the Courts in Health System Change David Hyman

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  1. A Not So Quiet Revolution: The Role of the Courts in Health System Change David Hyman University of Maryland/Illinois Schools of Law Federal Trade Commission

  2. What Bodies of Law are we talking about? • Insurance Law (McCarran-Ferguson Act/ERISA) • Pilot Life v. Dedeaux (1987) • Pegram v. Herdrich (2000) • Rush Prudential v. Moran (2002) • Kentucky Assn. Health Plans v. Miller (2003) • Davila v. Aetna/Prudential (2004) • Malpractice • Competition Law (Antitrust) • Fraud/Abuse

  3. What’s at stake? • Federalism • Tort v. Contract • Lawyers/Doctors v. MCOs • Fundamental Structural Issues • Politics

  4. How Do Courts Affect The Medical Market? • Market Entry/Exit (CON, AWP, FOC, Licensure, SSH) • Structure/Substantive Content • Mergers • Fiduciary Obligations (PBMs) • Class Actions • Licensure/Malpractice • Price/Quality

  5. Sources of Regulatory Oversight 1/6 Federal (Medicare) 1/6 None (Uninsured) 1/4 Federal/State: Insured (Employment-based and Individual) 1/4 Federal: Self-Funded 1/6 Federal/State: Medicaid

  6. What Role for HSR? • Quality as an empirical proposition • Quality from a population perspective • Study ERISA plans • Get Involved!

  7. What if Better Information Was Available from HSR?

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