New Article Examines How Public Health Plans Affect Federal and State Regulations

Lexington, VA Thursday, July 16, 2009

Timothy S. Jost
On Wednesday, the Senate health committee approved a plan to revamp U.S. health care, setting the stage for intensified debate over health care reform as the bill comes before the full Congress.

Washington and Lee law professor and leading health law expert Tim Jost has been an active participant in the health care reform debate during the run-up to congressional action. He is participating in a discussion about health care reform in's Arena, the site's daily debate with policymakers and decision shapers, and recently appeared on CNBC's Closing Bell  to participate in a debate on public health care plans.

Now, in a new article published by Health Affairs, the leading journal of health policy, Jost examines how the interplay between federal and state health care regulations could affect reform efforts. Should Congress adopt a plan that includes a national health insurance purchasing exchange, as well as a public health insurance plan that would compete with private insurers through the exchange, Jost argues that Congress should establish federal coverage and underwriting rules that would preempt existing state standards.

Uniform federal coverage and underwriting rules may be necessary, Jost explains, because insurers participating in purchasing exchanges can end up with disproportionate numbers of older and sicker enrollees if coverage and underwriting standards are more liberal within the exchange than outside it. Similarly, if a new public plan applies less restrictive standards than the private plans it competes with in the exchange, the public plan could become the victim of "adverse selection" and end up with more than its fair share of expensive enrollees.

"As we prepare for health reform, it is important that we inventory and analyze state and federal laws that will affect reform so that we can proceed intelligently," Jost says. "Good groundwork now can spare us missteps if and when reform comes to pass."

Jost's article is available online at the Health Affairs website.

Tim Jost, holds the Robert L. Willett Family Professorship of Law at the Washington and Lee University School of Law. He is a coauthor of a casebook, Health Law, used widely throughout the United States in teaching health law and now in its sixth edition. He is also the author of Health Care at Risk, A Critique of the Consumer-Driven Movement, Health Care Coverage Determinations: An International Comparative Study, Readings in Comparative Health Law and Bioethics, and numerous articles and book chapters on health care regulation and comparative health law and policy. He has written or is writing monographs on legal issues in health care reform for a number of other organizations including the National Academy of Public Administration and National Academy of Social Insurance, the Fresh Thinking Project, the Urban Institute and New America Foundation, and Academy Health.

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