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Preemption and the MLR Provision of the Affordable Care Act

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This Note focuses on the medical loss ratio provision (“MLR Provision”) of the Patient Protection and Affordable Care Act (ACA).1 The MLR Provision states that health insurance companies must spend at least a certain percentage of their premium revenue on “activities that improve healthcare quality” (in other words, meet a minimum threshold medical loss ratio) and comply with reporting requirements determined by the Secretary of the United States Department of Health and Human Services (HHS).2 Because states have historically had authority over the regulation of health insurance, there is an outstanding question as to whether or not the MLR Provision has legal authority to preempt conflicting state MLR regulations.3 Part II of this Note outlines the major requirements in the MLR Provision and discusses the history of MLR regulation in the United States. Part III discusses the likelihood that the courts will soon resolve the question of preemption regarding the MLR Provision. Part IV considers the question of preemption from the perspective of the Health Insurance Portability and Accountability Act (HIPAA) and the Employee Retirement Income Security Act (ERISA). To do so, Part IV begins by showing that ERISA and HIPAA preemption case law is a suitable reference for the issue of preemption under the MLR Provision. Part IV then analyzes case law for both ERISA and HIPAA preemption, then concludes by applying these analyses to preemption in the context of the MLR Provision and showing that, should the courts consider HIPAA and ERISA preemption in deciding the fate of the MLR Provision, state MLR regulation would likely survive preemption. Finally, Part V summarizes the arguments made and show that the evidence available strongly supports the likelihood that state MLR regulation will survive potential preemption challenges by the MLR Provision.

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Ketersediaan

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Informasi Detail

Judul Seri

Law & Medicine

No. Panggil

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Penerbit

Boston : SAGE., 2014

Deskripsi Fisik

American Journal of Law & Medicine, 40 (2014): 280-297

Bahasa

English

ISBN/ISSN

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Klasifikasi

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Tipe Isi

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Tipe Media

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Tipe Pembawa

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Edisi

(2014) 40

Subjek

LAW & MEDICINE

Info Detail Spesifik

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Pernyataan Tanggungjawab

deliza

Versi lain/terkait

Lampiran Berkas

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