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Justice and the Struggle for the Soul of Medicaid
Get PDFThe soul of Medicaid is and always has been to achieve justice in health care. Medicaid at its inception was designed to ensure that the most vulnerable members of society are not excluded from access to good health that all others enjoy. Yet, as the title of this symposium aptly reflects, “The Struggle for the Soul of Medicaid” remains vulnerable to repeated and relentless political attacks. Why is this so, given that the program finances care for nearly sixty-four million Americans?
This article posits that Medicaid is vulnerable because our nation’s commitment to justice in health care remains uncertain. Historically, our commitment to justice in America has been limited by our willingness to bear the cost required to achieve justice. Moreover, our commitment has often been further limited by our inability to empathize with people who need Medicaid assistance in order to gain access to health care. We have limited the program to the “categorically” needy. Those who “deserve” help gaining access to health care. And more recently, some have used work requirements to ensure that Medicaid health benefits are meted out only to those worthy of receiving them. In contrast, the legislative purpose of the Act was so clear to its proponents, and so aligned with their shared foundational values as well as the values upon which our democracy rests, that in 1965, little more needed to be said in defense of Medicaid. That it provided a nationwide safety net for many of society’s poor and destitute to receive health care, regardless of their ability to pay, may have been justification enough for the program.
However, simply identifying justice as the ethical value that lies at the soul of the Medicaid program cannot save it. Justice takes many forms, and its many expressions can serve to justify competing and even mutually exclusive ends where Medicaid is concerned. Egalitarian conceptualizations inspire Medicaid’s communitarian commitment to provide access to health care for society’s neediest to equalize the opportunity to participate in society. Utilitarian justice may aim to maximize societal health but might not accomplish these ends by identifying some poor or needy members of society as more deserving than others. And libertarian justice ideals counsel minimizing the cost burden that Medicaid places on non-beneficiaries. Notwithstanding the epistemological struggle, the Medicaid program remains quite popular with Americans, regardless of party affiliation. Republicans learned this during their failed multiple efforts to repeal-and-replace the Affordable Care Act.
This article argues that the justice that originally motivated the Medicaid mission has survived as the program’s chief animating principle. That egalitarian vision of justice compels policymakers to stretch Medicaid’s already scarce and over-burdened resources far beyond the clinical setting to rectify inequitable distribution of the social and environmental risk factors that disproportionately threaten the health of Medicaid-eligible populations. The unfairness of this additional burden on the program is not trivial. We already ask far too much of the program. Yet, the point of this article is to clarify why and how Medicaid can do even more than it does today to fulfill the mandates of justice, and thereby contribute substantially to nation-wide health equity
Will the President Succeed in Ending Birthright Citizenship?
Get PDFPresident Trump declared that he intends to eliminate birthright citizenship for non-citizens. Recognizing that an executive order to that effect would be challenged in the courts, this article by Lindsay Gilmore analyzes Supreme Court precedent and predicts the manner in which the courts would respond.https://scholarship.law.slu.edu/lawjournalonline/1019/thumbnail.jp
The Beginning of the Next BAC Revolution?
Get PDFIn 1983, Utah led the charge in drunk-driving enforcement, lowering its legal BAC from 0.10 to 0.08. Now the Beehive State has once again lowed legal BAC limits. Ginny Hogan discusses whether this is the start of another BAC revolution.https://scholarship.law.slu.edu/lawjournalonline/1017/thumbnail.jp
Missouri: The Puppy Mill Capital of the World
Get PDFSome suggest Missouri should adopt a law like California’s banning the retail sale of non-rescue dogs. Jared Jones argues that this would do little to change the state\u27s reputation as the puppy mill capital of the world. Instead, Missouri must regulate breeders more restrictively.https://scholarship.law.slu.edu/lawjournalonline/1014/thumbnail.jp
The Right to Deregulate: The CFPB’s Authority to Remove the Ability-to-Pay Requirement as it Pertains to Payday Lenders
Get PDFThe Consumer Financial Protection Bureau is proposing to rescind the rule requiring payday lenders to assess a borrower\u27s ability to repay the loan. This article by Ben Davisson explores the Bureau\u27s authority to rescind its own rule despite the potentially harmful effects on vulnerable low-income consumers.https://scholarship.law.slu.edu/lawjournalonline/1005/thumbnail.jp
Knowledge of Practicing Physicians about Their Legal Obligations When Caring for Patients with Disability
Get PDFdoi: 10.1377/hlthaff.2018.05060 HEALTH AFFAIRS 38, NO. 4 (2019): 545–55
The Costs of Uncertainty: The DOJ’s Stalled Progress on Accessible Medical Equipment Under the Americans with Disabilities Act
Get PDFImagine seeking medical care for serious pressure sores for a year, but your doctor never examining the sores because you could not get on the examination table in her office. Or imagine going more than fifteen years without an annual well-woman examination for the same reason, or your doctor guessing at the right dosage for a prescription because there was no scale that she could use to weigh you.
Although these scenarios may be difficult for many to imagine, they are common experiences for individuals with mobility disability.1 The Trump administration’s attacks on the Patient Protection and Affordable Care Act (ACA) and its aggressive deregulatory agenda have made headlines.2 This Article brings attention to an underappreciated story at the nexus of these two efforts—the Department of Justice’s (DOJ) decision to abandon progress toward legal standards for accessible medical equipment necessary to provide health care for millions of Americans
From Venetian Glass to Contemporary Intellectual Property: Revisiting Tailored Patent Regimes (Book Review)
Get PDFThis piece reviews Stefania Fusco\u27s “Murano Glass Vase and Lessons from the Past. In Murano Glass Vase, Fusco recounts the history of the glassmaking industry in Venice, framing it as the natural experiment from which the patent system sprang into the world. Fusco emphasizes the mix of exclusionary rights and trade secrecy that formed the backbone of Venetian innovation policy against the backdrop of a heavily regulated and protectionist economy. In “Lessons from the Past,” Fusco draws on original research performed at the Venetian State Archives to further the Murano narrative by looking at how the Venetian government fueled an ad hoc patent regime across industries by tailoring it to specific technologies