UPPP 170 / PUB HEALTH 122 - Health Policy and Law

Comprehensive vocabulary flashcards covering health policy, public health law, the U.S. constitutional system, health insurance structures, and healthcare access and quality concepts.

Three conceptual frameworks

Topical domains, historical perspectives, and stakeholders.

Topical domains

Healthcare, public health, and bioethics.

Healthcare policy

Policies addressing healthcare access, quality, and financing.

Public health

Population-level efforts to prevent disease and protect community health.

Bioethics

Ethical questions about medical treatment, research, and individual rights.

Professional autonomy

Historical view that physicians should largely regulate their own profession.

Social contract

An unofficial, unwritten agreement in a society where people give up a small amount of their individual freedom in exchange for safety, order, and protection from their government.

Free market perspective

Emphasizes competition, consumer choice, and less government regulation.

Stakeholders

People and organizations affected by or influencing health policy.

Examples of stakeholders

Patients, providers, insurers, employers, governments, and advocacy groups.

Police powers

State authority to regulate for public health, safety, and welfare.

Public policy

Authoritative government decisions and actions intended to address societal problems.

Mandatory policy

Government requirement or prohibition backed by authority.

Voluntary or incentive-based policy

Encourages rather than mandates behavior, often through resources or education.

Legislative branch

Makes statutes, appropriates funds, and oversees government activities.

Executive branch

Carries out laws through the president, governors, and administrative agencies.

Judicial branch

Interprets and applies laws and resolves disputes.

How a federal bill becomes law

House and Senate pass identical text.

Presidential veto

President rejects a bill passed by Congress. Veto override requires House of Representatives and the Senate vote by two-thirds majority.

House of Representatives

Congressional chamber with state representation based on population.

Senate

Congressional chamber with two senators per state.

Conference committee

Congressional group that reconciles House and Senate bill differences.

HHS

Department of Health and Human Services; central federal health department.

CMS

Centers for Medicare & Medicaid Services; administers major federal coverage programs.

CDC

Centers for Disease Control and Prevention; public health surveillance and prevention.

FDA

Food and Drug Administration; regulates food, drugs, and medical products.

NIH

National Institutes of Health; major federal biomedical research agency.

Interest groups

Organizations that influence policy through advocacy and lobbying, but do not enact laws.

Four primary sources of law

Constitutions, statutes, regulations, and common law.

Secondary legal sources

Commentary and analysis such as scholarly articles and legal treatises.

Statutory construction

Process courts use to determine the meaning and scope of a written law when its language is unclear, ambiguous, or applied to an unexpected real-world situation.

Living Constitution

Interpretive view that constitutional meaning can evolve with society.

Originalism

Interpretive view grounding constitutional meaning in its historical origins.

Strict constructionism

Constitutional interpretation emphasizing the text's narrow or literal meaning.

Moral constitutionalism

Constitutional interpretation informed by moral principles.

Checks and balances

Each branch has mechanisms to limit the power of the others.

Federalism

Division of governing authority between federal and state governments.

Tenth Amendment

Any power not specifically delegated to the federal government—nor prohibited to the states—belongs to the states or to the people.

5th Amendment

Protects individual rights in legal proceedings and limits government power.

14th Amendment

Guarantees birthright citizenship, fair legal processes, and equal protection under the law for all people in the United States.

Marbury v. Madison (1803)

Established the principle of judicial review—the power of federal courts to declare legislative and executive acts unconstitutional.

Due Process

Fair treatment through the normal judicial system, especially as a citizen's entitlement.

Procedural due process

If the government follow proper, fair, and legal procedures before taking away someone's life, liberty, or property.

Substantive due process

If the government has a valid, compelling reason to take away or restrict a fundamental right, regardless of how fair the procedures are.

Appellate Courts

Review lower federal court decisions for legal errors.

Stare decisis

Legal rule that courts must follow past decisions (called precedents) when they face the same or a very similar legal issue.

Rational basis review

Judicial review used by U.S. courts to test the constitutionality of a statute using 5/14 amendment.

Intermediate scrutiny

Heightened review requiring a substantial relation to an important government interest.

Strict scrutiny

Highest standard of judicial review for laws.

Fragmented healthcare system

No single unified system; different payers and providers operate under different rules.

Healthcare iron triangle

Cost, access, and quality: three goals of healthcare policy.

Employer-sponsored insurance

Health insurance obtained through an employer, often with shared premium payments.

Self-funded employer plan

Employer directly finances employees' covered health claims.

Fully insured employer plan

Employer pays premiums to an insurer that assumes covered claims risk.

Medicare

Federal health insurance mainly for adults 65+ and certain younger eligible people.

Medicaid

Joint federal-state health coverage program for eligible low-income and other groups.

CHIP

Children's Health Insurance Program for eligible children in qualifying families.

Affordable Care Act (ACA)

2010 federal law expanding coverage through Medicaid, marketplaces, and insurance reforms. Eligible children may remain on a parent's health plan until age 26.

Three ACA coverage strategies

Insurance requirements, Medicaid expansion, and health insurance marketplaces.

Health Insurance Marketplace (HIMs)

Exchange where people compare and purchase qualifying health plans.

Individual mandate

Requirement to maintain qualifying coverage.

Employer mandate

ACA coverage obligations for certain large employers.

Essential health benefits

Ten categories of services that applicable ACA plans must cover.

Premium tax credit

Refundable tax credit established by the ACA to help low- and middle-income individuals and families pay for health insurance.

Health insurance premium

Monthly amount taken out of paycheck for insurance coverage.

Deductible

Out of pocket cost before insurance covers the rest.

Copayment

Fixed amount a patient pays for a covered service.

Coinsurance

Shared percentage of a covered healthcare cost that you pay after you have met your annual deductible.

Direct service programs

Programs where an organization helps people directly and face-to-face, providing immediate support, goods, or services to the individuals who need them.

Federally Qualified Health Center (FQHC)

Underserved-area primary care center offering sliding-fee (charges adjusted to patient income) discounts.

Ryan White HIV/AIDS Program

Provides services for people with HIV lacking adequate coverage or resources.

Title X

Federal family-planning funding program supporting related preventive services.

Uninsured

Person without health insurance coverage.

Underinsured

Person with insurance that still cannot afford the out-of-pocket costs.

Major predictors of uninsurance

Income, employment, age, education, race/ethnicity, geography, and immigration status.

Federal Poverty Level (FPL)

Income benchmark used in eligibility rules for various assistance programs.

MAGI

Modified Adjusted Gross Income; method for determining many Medicaid and ACA subsidy eligibilities.

Safety-net providers

Organizations providing substantial care to uninsured, Medicaid, and vulnerable populations.

Safety-net provider examples

Public hospitals, community health centers, family-planning clinics, public health agencies.

Geographic provider maldistribution

Unequal distribution of clinicians, especially shortages in rural communities.

Six domains of healthcare quality (STEEP)

Safe, effective, patient-centered, timely, efficient, and equitable.

Canada healthcare model

National Health Insurance: public single-payer coverage administered by provinces.

United Kingdom healthcare model

Beveridge model: tax-funded National Health Service (NHS).

Germany healthcare model

Bismarck model: regulated social health insurance through sickness funds.

Beneficiary

The individual/consumer who is covered by the plan.

Gatekeeper (Care Management)

Managed care organization uses a primary care provider to make sure only necessary and appropriate care is provided.

No-duty-to-treat principle

Healthcare providers generally have no legal duty to accept every person seeking care.

Hurley v. Eddingfield (1901)

Illustrates that a medical license does not by itself obligate a physician to treat a patient.

EMTALA

Federal law requires covered emergency departments to perform a medical screening and stabilize condition of the patient.

Welfare rights

Claims that government must provide minimum necessities such as food, shelter, or medical care.

Negative Constitution

A legal and political framework where the government is structured to limit what it can do to individuals rather than mandate what it must provide for them.

Positive rights

Require others or the state to actively provide goods, services, or assistance.

Negative rights

Require others and the government to refrain from interference.

Informed consent

A patient's right to make treatment decisions with appropriate information about risks and options.

Title VI of Civil Rights Act (1964)

Prohibits race, color, and national-origin discrimination in federally funded programs.

Hill-Burton Act (1946)

Funded hospital construction; historically permitted separate facilities under specified conditions.

Jacobson four standards

Public health necessity, reasonable means, proportionality, and harm avoidance.

Public health authority

Government has the legal power to take action to protect public health, safety, and welfare.

Public health duty

Government generally does not have a constitutional obligation to provide public health services or protection.

Health disparity

A difference in illness or disability burden between population groups.