1,720,964 research outputs found
Health insurance subsidy standoff pits affordable care for millions against federal budget constraints
No full textAs the federal government entered a shutdown on Oct. 1, 2025, competing narratives quickly emerged about the cause.
Some Republican lawmakers objected to Democrats’ push to include an extension of the expanded Affordable Care Act premium subsidies in a short-term funding bill and cited concerns about long-term spending. Democratic leaders countered that the subsidies are not a new demand but rather the continuation of a program that has helped keep record numbers of Americans insured since the pandemic – and therefore that the issue could not be delayed.
The result is a standoff that blends fiscal and policy disagreements – a hallmark of contemporary budget politics.
As experts in health law, we see this issue as simple but consequential from a legal standpoint. Congress authorized the enhanced subsidies in 2021, originally to cushion the economic fallout from COVID-19 for families, and extended them through 2025 in the Inflation Reduction Act.
Without new legislation, the subsidies revert to pre-2021 levels on Jan. 1, 2026 – which would lead to a jump in the cost of health insurance and would make coverage unaffordable for millions of Americans
Private Law Alternatives to the Individual Mandate
Full text linkDespite excitement on the left about a move to universal health care and on the right about a more state-driven model, major policy changes in a time of divided government are not imminent. Yet with the recent repeal of the individual mandate, the current system may be crumbling. The Affordable Care Act guarantees coverage to people with pre-existing conditions and prohibits insurers from charging them more than healthy people. But the mandate was supposed to draw cheaper and healthier people into the risk pools to balance out costs. Without the mandate, healthy people can simply wait to buy insurance until they get sick. Insurers are left to cover an increasingly sicker, more expensive population, and premiums skyrocket, starting a chain reaction ending in the so-called “death spiral.” The model only works if healthy people purchase insurance, and now there is little to prompt them to do so. This Article relies on private law to solve the problem. It looks to both neoclassical economic theory and principles of behavioral economics to better understand what motivates (and deters) the purchase of health insurance. It then explores economic incentives and “nudges” that will encourage healthy individuals to sign up for policies without forcing them to do so. It suggests co-opting practices previously deployed for nefarious purposes to prompt behavior that policy now seeks, such as insurers offering low introductory rates, long-term contracts, and limited exit rights. Other options include insurers selling return of premium-style policies or policies with a generosity frame, simplifying plan offerings, or automatically enrolling the uninsured but giving a right to opt-out. These private law solutions—many of which would not require congressional action—hold the promise of ultimately lowering prices without the government forcing action or taking away the right to make autonomous choices
The Resurgence of Private Law in American Health Care
No full textAs the regulatory landscape of American health care undergoes a transformation, private law is poised to play an increasingly central role in the health care system. Public law — the work of legislatures and administrative agencies — has long governed health care access, quality, and accountability in the United States. But recent deregulatory moves by the Trump administration have diminished its reach. Even if a future administration seeks to restore regulatory capacity, structural and political constraints will limit how quickly and thoroughly these changes can be reversed.
State-level public law — which includes insurance mandates and consumer-protection laws that apply to state-regulated health plans — remains operative, but private law is already being used to fill governance gaps in a system under strain. This body of law, which includes provisions that are typically established by courts or negotiated by individual actors and corporations and enforced by courts, governs relationships between private parties. Private law encompasses contracts, torts, and fiduciary duties, among other mechanisms.1 Increased reliance on private law both presents opportunities for reform and raises concerns about the erosion of vital safeguards.
The Trump administration has aimed to stimulate innovation and economic growth in the United States by reducing regulatory burdens and increasing the reliance on markets in various domains. In January 2025, President Donald Trump signed an executive order mandating that federal agencies identify at least 10 existing regulations that can be repealed for every new regulation they introduce. The administration has also slashed the workforce at the Department of Health and Human Services, which will make it difficult to enforce health regulations that survive.2 These moves are in keeping with a trend seen in Supreme Court decisions in recent years that has lessened the power of — and reliance on — agencies. Together, these changes are causing a seismic shift in health care governance. In the context of public law’s decreasing influence, we expect the role of private-law mechanisms to be elevated in several ways
Can Legal Knowledge Save Lives? A Randomized Experiment in Preventive Health Screenings
Full text linkWhile the U.S. healthcare system typically imposes significant out-of-pocket costs, the Affordable Care Act (ACA) requires full insurance coverage for certain preventive health services (PHS), including cancer screenings, without cost-sharing. Despite this policy, one in four eligible Americans remains unscreened for breast, colorectal, and cervical cancer, which increases their risk of premature death. We hypothesize that a lack of awareness about the ACA’s free care requirement contributes to this gap and that explicitly informing patients could increase screening uptake. Additionally, we investigate whether prior experiences with medical debt deter individuals from seeking even cost-free care, reflecting a spillover effect of broader healthcare cost burdens.
We conducted an online survey experiment with 3,354 insured U.S. adults aged 30–74 with moderate household incomes (99k), and we determined whether each one was qualified for a free cancer screen based on age and sex. Among them, 1,406 had not received at least one recommended cancer screening. Participants were randomly assigned to one of four conditions in a 2×2 factorial design. In the “free care disclosure” (FCD) treatment, half were informed that ACA-required screenings are fully covered without copays or deductibles. In the “medical debt salience” (MDS) treatment, half were asked about their medical debt history before assessing screening intentions. In addition to measures of intention, the primary outcome was behavioral—whether participants requested a link to take a step toward screening, a proxy for screening behavior, which we were not able to observe directly. We also tracked self-expressed intentions to get screened.
As hypothesized, FCD increased screening-related action by 5 percentage points (p = .031). Effects varied by cancer type, with larger effects for colon and cervical cancers, but with no impact—and a potential negative (non-significant) effect—for breast cancer screening. Survey responses were consistent with this experimental finding for FCD overall, with “costs or coverage” being the third most common reason respondents cited for having not gotten screening (at 45% of respondents), and with large majorities agreeing that “going to the doctor or hospital can be dangerous financially” (80% agreeing), “the American healthcare system is full of tricks and traps” (65% agreeing) and “in America, healthcare is never really free” (91% agreeing). MDS had no direct effect on behavior, but contrary to hypothesis, individuals with medical debt were more likely to seek screening than those without (p = .011).
These findings suggest that lack of awareness about the law providing free preventive care is a significant barrier to screening. Proactive communication by clinicians or public health officials could save lives. The larger paradigm of cost-exposure has a negative spillover, and ignorance of this benefit may be a preventable cause of cancer-related mortality
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
The effects of price transparency and debt collection policies on intentions to consume recommended health care: A randomized vignette experiment
No full textNew laws promote price transparency in health care, though effects on patient decision-making are not known. Price disclosure may increase the salience of cost and cause lower-income patients to decline recommended care, worsening inequities in health outcomes. Whether patients perceive a disclosed cost as higher or lower than their expectations may also affect care decisions, but has not been studied. Scholars and policymakers have paid much less attention to the question of whether patients will have to pay the prices charged (whether disclosed or not), and how expectations regarding collections may also affect healthcare consumption. Some hospitals aggressively collect on unpaid medical bills. Others hospitals do not. Actively disclosing collection policies (whether aggressive or protective) could magnify or counteract effects of price disclosures, especially for low-income patients. To test the effect of price disclosure and debt-collection disclosures on willingness to obtain recommended care, we recruited a nationally representative sample (N = 2997) and deployed a full factorial, controlled experiment in a standardized clinical vignette model. We find that disclosing a higher-than-anticipated price increases the probability of declining recommended care (odds ratio = 1.900), with larger effects for low-income individuals. Even more, disclosing aggressive collections increases the risk of declining care (odds ratio = 4.493), at higher rates for low-income patients. Where patients fear collections, but do not know prices, they are most likely to decline care. Disclosure of an aggressive collections policy makes patients feel less informed, harms patient trust in providers, makes them feel that they were not treated fairly, and undermines their confidence in the value of their care. Mediation analysis shows that about half of the effect of collections risk is via these attitudinal variables
The effects of price transparency and debt collection policies on intentions to consume recommended health care: A randomized vignette experiment
No full textNew laws promote price transparency in health care, though effects on patient decision-making are not known. Price disclosure may increase the salience of cost and cause lower-income patients to decline recommended care, worsening inequities in health outcomes. Whether patients perceive a disclosed cost as higher or lower than their expectations may also affect care decisions, but has not been studied. Scholars and policymakers have paid much less attention to the question of whether patients will have to pay the prices charged (whether disclosed or not), and how expectations regarding collections may also affect healthcare consumption. Some hospitals aggressively collect on unpaid medical bills. Others hospitals do not. Actively disclosing collection policies (whether aggressive or protective) could magnify or counteract effects of price disclosures, especially for low-income patients. To test the effect of price disclosure and debt-collection disclosures on willingness to obtain recommended care, we recruited a nationally representative sample (N = 2997) and deployed a full factorial, controlled experiment in a standardized clinical vignette model. We find that disclosing a higher-than-anticipated price increases the probability of declining recommended care (odds ratio = 1.900), with larger effects for low-income individuals. Even more, disclosing aggressive collections increases the risk of declining care (odds ratio = 4.493), at higher rates for low-income patients. Where patients fear collections, but do not know prices, they are most likely to decline care. Disclosure of an aggressive collections policy makes patients feel less informed, harms patient trust in providers, makes them feel that they were not treated fairly, and undermines their confidence in the value of their care. Mediation analysis shows that about half of the effect of collections risk is via these attitudinal variables
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