Discrimination in Health Care and Health Insurance - March 11 & 13 Flashcards
How does Title VI of the Civil Rights Act apply to health care law? (Q)
Under Title VI, any program receiving federal financial assistance may not discriminate based on race, color, or national origin. Therefore, under Title VI, any hospital that wants to receive federal Medicare payments can’t discriminate based on race.
What is one way to allege a Title VI violation? (Q)
Intentional discrimination is one of two ways to allege a Title VI violation.
Who may bring a Title VI violation? (Q)
Private individuals and the government may both file intentional-discrimination claims.
What does a person have to prove under Title VI? (Q)
A person has to prove both that the (priority) was discriminatory and that the discrimination was intentional.
What is a disparate impact claim? (Q)
Disparate-impact claims hold defendants liable for facially neutral policies that have discriminatory effects.
Who may bring disparate impact claims? (Q)
Only the government, not private individuals, may bring Title VI disparate-impact claims.
What is the burden-shifting framework of disparate impact claims? (Q)
In this framework, the government has the initial burden of presenting a prima facie case of discrimination. Commonly, the government uses statistical evidence to show that a facially neutral policy or practice has a disparate, negative impact on members of a protected class. If the government succeeds, the burden shifts to the defendant to prove that it has a legitimate, nondiscriminatory purpose for the challenged policy or program. If the defendant doesn’t meet this burden, then it’s liable for violating Title VI. If the defendant succeeds, then the burden shifts back to the government. If the government then shows that the defendant could’ve used less discriminatory methods to achieve the same purpose, the defendant is still liable for violating Title VI.
What does EMTALA do to prohibit discrimination? (Q)
Under EMTALA, if someone goes to a hospital’s emergency department, the hospital and its physicians must screen, stabilize, and transfer that patient as appropriate, without discriminating based on insurance status, health status, or other factors.
What is the American’s with Disabilities Act’s (ADA’s) public-accommodations provision? (Q)
The ADA’s public-accommodations provision prohibits places of public accommodation from discriminating based on a disability, as that term is defined in the statute.
For the purposes of the ADA’s public-accommodations provision, what is a place of public accommodation? (Q)
A place of public accommodation includes public businesses and private businesses that are open to the public. Under the ADA’s own terms, private healthcare providers are places of public accommodation.
Can a healthcare provider be found to discriminate under the ADA if it fails to take reasonable steps to remove physical or communication barriers to the provider’s services? (Q)
Yes.
Ex: Suppose a pediatrician refused to provide an American Sign Language interpreter to allow a deaf parent to communicate directly with the doctor about the child. The pediatrician likely violated the ADA.
Can a healthcare provider be found to discriminate under the ADA if it refuses to treat a patient due to an existing health condition? (Q)
Yes.
Ex: Assume a mental-health provider refused to treat a patient because the patient was infected with HIV. The mental-health provider likely violated the ADA.
What does the Employee Retirement Income Security Act (ERISA) do to prohibit discrimination? (Q)
ERISA prohibits discriminating against the beneficiary of an employer-sponsored insurance plan either (1) in retaliation for exercising an insurance right or (2) to deprive the beneficiary of an insurance benefit.
What does the Health Insurance Portability and Accountability Act (HIPAA) do to prohibit discrimination? (Q)
HIPAA prevents an employer from denying a new employee access to the employer’s insurance plan based on the employee’s or a dependent’s preexisting health condition or health status.
How do HIPAA and the Affordable Care Act (ACA) work together to prohibit discrimination? (Q)
HIPAA and the ACA work together to prohibit insurance companies from charging different premiums or deductibles to similarly situated individuals based on individual health status or most risk factors.
When does the ACA allow premium differences? (Q)
The ACA allows premium differences only if based on an individual’s age, geography, or tobacco usage. Indeed, the ACA generally prohibits any health-insurance discrimination that’s based on an individual’s medical history, claims experience, preexisting conditions, and other health-status factors.
How does the ACA protect civil rights? (Q)
If a healthcare provider or health insurer receives federal funding, the ACA’s civil-rights provision prohibits that provider or insurer from discriminating based on race, color, national origin, sex, age, or disability.
