Caution!  Caution!  I'm kicking the legal geekery up to 12 here.  You have been warned.  I'll put this below the fold due to length. 

(There may be a reward for those who read skim to the end)



1.  Most of the public was horrified to discover that if their insurance plan wrongfully delayed or denied covered treatment which led to increased harm and, in some cases, death, the plan was only liable for the cost of the treatment rather than that as well as damages for pain and suffering, wrongful death, etc.  This led to calls for the Patient's Bill of Rights as well as discussions about amending ERISA to allow claims for non-economic damages in those circumstances.

The Federal government has immunity from civil suit due to the doctrine of sovereign immunity.  Sovereign immunity is waived for only those matters that fall under the ambit of the Federal Tort Claims Act (FTCA).  A public plan would result in an individual needing to bring suit against the Federal government if that person believes that treatment is being wrongly denied.  Will the FTCA be amended to permit individuals to bring suit for wrongful denial of coverage or will the Federal government claim that such decisions fall under the ambit of discretionary decision making, thus making such determinations immune from suit?

2.  Will the HIPAA privacy protections extend to all administrative functions implicated by a public plan?  If the Federal government chooses to contract out the ministerial functions of a public plan, such as routine payment of bills, will the HIPAA protections extend to that contractor?  Currently, HIPAA violations are to be reported to the state Department of Health.  To whom will a HIPAA violation on the part of a public plan be reported?  In the case of a HIPAA violation, to whom will a fine be paid and what funds will be used to pay the fine?  Will the public plan even be deemed to be included in HIPAA as a healthcare provider?

3.  Will treatment and coverage determinations under a public plan be subject to any kind of Sunshine Laws?  Will FOIA requests for information concerning the public plan be respected?   Will the budget process be subject to oversight by the CBO?  In the case of specific healthcare determinations, will the individual affected be allowed to obtain a full and complete copy of any and all documents created regarding his/her treatment determinations? 

4.  What type of appeal process will be available for coverage determinations under a public plan?  Will the appeal process be subject to the rules currently in place for administrative hearings?  Will a denial of treatment in the public plan create a private cause of action or will the participant be limited only to administrative hearings? 

5.  Will all physicians who accept payment under a public plan be eligible for protection under the FTCA?  If not, what factors will determine such eligibility?  If yes, what steps will be taken to ensure that sufficient funds are set aside for the payment of potential claims? 

6.   Will policy determinations by a public plan be subject to the publication and notice requirements the same as for other Federal regulations?  If not, why not?

For those who endured the tl;dr, here.  Have some Milla.  Yes, I've posted it before but can this picture ever be posted enough?  I think no.



Okay fiiiiiiiiiiine I'll be bipartisan you whiny whiny things. 



Holy hell, Jensen, you're officially *trying* to kill me with that.

Posted by: alexthechick at 12:18 PM | Comments (10) | Add Comment
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