Our Battlegrounds – Press, Courts, and the Government

National Injury Center offers more than legal guidance. We are an information repository featuring topics that are relevant to our battlegrounds – the press, courts, and government. We want to make sure that our readers and clients have up-to-date information that is relevant to the issues that injury victims face. We also want to ensure that our readers and clients have useful information about what they can do to fight for their legal rights.

Press

• Law Firms Seeing Uptick in Claims Involving Infant Formula and NEC
• Nationwide Law Firm Brings Awareness to Necrotizing Enterocolitis
• Healthcare Disparities for Black Americans: An Information Repository
• Nursing Home Blames Incapacitated Sexual Assault Victim
• Study Reveals Dramatic Inadequacy of Sepsis Care in Our Hospitals

---

Courts

Medical Malpractice Laws and Legislation

Medical Liability/Malpractice Laws

Every state has independent laws regarding medical malpractice. What all states have in common are the requirements for filing a medical malpractice claim. These requirements include:

1. The doctor owed the patient a duty of care
2. The doctor violated the standard of care
3. There was a compensable injury
4. The injury was caused by the doctor’s violation of the standard of care

Apology Laws

Apology laws are a controversial aspect of the healthcare system. Doctors who make mistakes often want to apologize to patients and their families, but often are afraid to. Doctors fear that apologizing and admitting a mistake will increase the risk that a patient and/or family will file a medical malpractice claim.

Apology laws exist in many states in an effort to reduce malpractice rates. Unfortunately, these laws have done little to protect patients or reduce malpractice rates. That’s because these laws do not protect error disclosure, and therefore, do not facilitate open communication and transparency.

Health Insurance Laws and Legislation

The Affordable Care Act 2010

In 2010, president Barack Obama enacted the Affordable Care Act (ACA). The ACA is a modified version of all-inclusive healthcare insurance coverage, which has been sought after by lawmakers since the 1900’s. When the ACA began, U.S. citizens were required to apply for healthcare coverage or face a penalty. The penalties have since been removed, but citizens are still encouraged to apply under the American Health Benefits Exchange – a system that allows citizens to view and compare insurance plans.

Under the ACA, many individuals and families qualify for subsidies that help pay for the cost of insurance premiums. There are also low-cost plans that have lower deductibles and lower out-of-pocket maximums making healthcare, by and large, more accessible and affordable.

Insurance Healthcare Laws

Insurance healthcare laws provide rights and protections for those covered under policies. Some laws apply to plans in the Health Insurance Marketplace, while others are exclusive to individual insurance or job-based plans. Healthcare laws protect patients in the following ways:

• Requiring insurance companies to cover pre-existing conditions
• Free preventative care
• More coverage options for young adults
• No lifetime or yearly dollar limits
• Holding insurance companies accountable
• Making it illegal for insurance companies to cancel your coverage because you get sick
• Gives more choices of doctors
• Prohibits employer retaliation

Health Insurance Portability and Accountability Act (HIPAA)

HIPAA laws are one of the most misunderstood areas of healthcare law. Situations that are often exclaimed as a “HIPAA violation,” may not actually be so. In fact, HIPAA is more limited in scope than most people are aware. The objectives of HIPAA are:

• Title I: Protects insurance coverage for people who have lost, or are changing, jobs.
• Title II: Directs the Department of Health and Human Services (HHS) to create national standards for how electronic healthcare transactions are processed.
• Title III: Dictates tax-related health provisions and how much people can save in tax-free medical savings accounts for qualifying expenses.
• Title IV: Details conditions related to coverage of people with pre-existing conditions.
• Title V: Provisions prohibit tax-deduction of interest on life insurance loans for employers that provide company-owned premiums.

Those who must comply with these objectives include anyone who provides medical or health services, such as healthcare providers, health insurance companies, and medical clearinghouses.

Children’s Health Insurance Program (CHIP)

In 2009, the Children’s Health Insurance Authorization Act (CHIPRA) was established to help more families and children qualify for health insurance. Now, the program is called the Children’s Health Insurance Program, or CHIP. This program serves children in low-income households, ensuring that children have access to routine and preventative healthcare. CHIP is administered individually in each state, and there are guidelines for eligibility.  

Medicaid and Medicare Laws and Legislation

Medicaid

Medicaid is a federal program that provides healthcare coverage to Americans who are low-income, have disabilities, are elderly, or are pregnant. There are currently around 75 million people enrolled in Medicaid. Medicaid is a federal program but it is administered by each state, and is funded both by states and the federal government.

While each state administers Medicaid benefits, there are certain mandatory benefits that eligible persons must be provided. These services include:

• Inpatient and outpatient hospital services
• Physician services
• Laboratory and imaging services
• Home health

There are also optional services, such as prescription drug coverage, physical therapy, and mental health services.

Medicare

Medicare is an insurance program for adults 65 and older. Some people with disabilities will qualify earlier, but 65 is the standard age to qualify. There are different parts to the Medicare program, each providing a different type of coverage. These parts are as follows:

• Part A (Hospital Insurance): Provides coverage for hospital costs, home health, hospice, and skilled nursing facility costs.
• Part B (Medical Insurance): Provides coverage for doctors and other healthcare providers, home health care, outpatient hospital costs, medical equipment, and preventative care.
• Part D (Drug Coverage): Provides coverage for prescription drugs and many vaccines.
• Medigap (Medicare Supplemental Insurance): Additional insurance that you can purchase from a private company. This coverage helps pay for costs of healthcare not covered under Original Medicare.

Healthcare Access Laws, Legislation and News

TIKES Act

A group of U.S. Senators and Representatives have proposed legislation called the Telehealth Improvement for Kids’ Essential Services Act (TIKES). This legislation would improve state telehealth options for low-income families, especially children. Telehealth use and support has increased since the start of the COVID-19 pandemic, and consumers increasingly support improved access to this method.

Unfortunately, many families using Medicaid or CHIP cannot access technology required for telehealth. The TIKES Act would help states resolve the disparity and ensure there is fair access to telehealth services for children in lower-income areas.

CMS Healthcare Access Provisions

In June 2021, the Centers for Medicare & Medicaid Services (CMS) proposed a series of provisions aimed at improving access to healthcare coverage. Building on the Affordable Care Act (ACA), the provisions sought to expand access to health insurance and also boost healthy equity. Among the provisions are:

• Expanding open enrollment period for 2022
• Creating a special enrollment period for low-income consumers
• Expanding assistance for consumers looking into enrolling in health coverage

Healthcare News

United Healthcare Focuses on Lasting Wellness

United Healthcare aims to meet the social needs of its members. With more than two million members lacking access to transportation, education, and food, the insurer is looking to continue improving the communities that they serve.

Aetna Establishes Institute for Quality

Aetna has partnered with Autism Comprehensive Educational Services (ACES) to establish the Institute for Quality. The Institute for Quality will target families affected by autism spectrum disorder (ASD) and other special needs. Aetna members will have access to autism care through ACES clinical providers. The new program will provide more specialized clinical services and will improve access to mental health services.

CMS Proposes Changes to Improve Health Equity

The Centers for Medicare & Medicaid Services (CMS) has proposed changes to address the wide – and seemingly widening – health equity gap. The COVID-19 pandemic has continuously highlighted healthcare disparities in low-income and minority communities. In response, CMS is looking to expand access to comprehensive care in underserved populations. Expanding on the Medicare program, CMS aims to improve policies geared toward health equity, including expanding access to healthcare, expanding access to telehealth, improving mental health options, and improving their Quality Payment Program (QPP).

---

Government

Government Duty to Protect and Advance Healthcare

The government can protect Americans and advance healthcare equity and fairness by doing the following:

• Purchasing and providing healthcare
• Ensuring access to quality healthcare
• Regulating healthcare markets
• Supporting the acquisition of new knowledge
• Evaluating and developing health technologies
• Monitoring health equity
• Informing decision makers in the healthcare industry
• Developing and supporting the healthcare workforce
• Convening with stakeholders across the healthcare industry

Healthy People 2030

Around one in 10 people in the United States do not have healthcare insurance. These individuals are less likely to have a primary care physician and get routine and preventative care. One of the reasons why so many people are uninsured is because of the cost of insurance premiums, deductibles, and out-of-pocket maximums.

Healthy People 2030 is an initiative designed to change that. Healthy People 2030 aims to address and resolve serious issues that plague Americans, such as a lack of access to healthcare in their communities, costs of care, and costs of insurance. The program has a variety of objectives that are continually monitored through research and analytics.