Obamacare Seminar Syllabus
Spring 2016
Professor Seth J. Chandler
This seminar will cover a variety of issues related to the Affordable Care Act, also known as
“Obamacare.” This course will emphasize legal research and writing as well as the substance of
the ACA. Rather than use an assigned text -- there is not yet a particularly good one on the
ACA -- we will employ a core of material and ask students to take responsibility for reading,
presenting and discussing issues related to the topic at hand. During the final third of the
course, students will present drafts of their papers. Other students will be responsible for
reading the papers and presenting suggestions and criticisms to the presenter. Grading will be
based ⅓ on class participation and ⅔ on the paper. Students may attend this seminar remotely
up to ⅓ of the time.
Core topics that we will study are as follows:
The history of the ACA (background and issues arising to date) (including legislative history,
healthcare.gov, employer mandate delay, repeal of CLASS Act, constitutional litigation,
premium tax credit litigation, transitional insurance subsidies and the Cromnibus modification,
Medicaid expansion issues, small business issues)
Advanced premium tax credits and cost sharing reductions (26 USC 36B and 42 USC 18071)
Qualified Health Plans and Exchange Formation
The individual mandate (26 USC 5000A) and IRS remedies thereunder
The employer mandate (26 USC 4980H) and its evasions
Wellness and Disease Management (permissible scope)
Risk adjustment and enforcement mechanisms (42 USC 18063 and regulations)
The role of “Essential Health Benefits” and “Minimum Essential Coverage” under the ACA
Treatment of small business and self insured employers
Accountable Care Organizations
Other cost control measures under the ACA, including the Independent Payment Advisory
Board
The Cadillac Tax (26 USC 4980I) (and alternatives)
Medicaid Expansion and Medicaid Waivers
Claims appeals under the ACA
Eligibility Appeals under the ACA
Use of standing doctrine in ACA litigation
The ACA, RFRA and the First Amendment
Commonalities of Leftist alternatives to the ACA
Commonalities of Conservative alternatives to the ACA
Libertarian alternatives to the ACA
A non-exclusive list of paper topics is provided here:
https://docs.google.com/spreadsheets/d/1UZB0Zm2j_NtEDbzP0N7eUbGIPQyscrfLd96OkX6LJQ/edit?usp=sharing Students may also write on a paper
topic they create with the permission of the instructor.
Here is a list of potential paper subject areas
Area
Topic
Background and history of
enactment
Core Title I Issues
Advanced Premium Tax Credits and Cost Sharing Reductions
QHP and Exchange formation
Individual mandate
Employer mandate: penalties and vehicles for assuring quality insurance
Risk Adjustment and Enforcement mechanisms
EHB and MEC
Wellness Regulation: Theory and Implementation
Treatment of small business
Treatment of self insured employers
Constitutional issues in the religious hardship exemptions to the
individual mandate
Coop Regulation
State regulation of exchange provided insurance
Strategies that purport to
reduce cost
Accountable Care Organizations
Independent Payment Advisory Board and other forms of rationing
Hospital Payment Reforms: DSH, Quality metrics, UPC and more
Other Titles
Treatment of the Indian Public Health Service
Health Workforce Reforms (Title V)
Treatment and demise of public Long Term Care Insurance (the Class
Act)
Tax Issues
Charity Hospital Reforms (section 9007)
Cadillac Tax and Alternatives
Changing treatment of HSAs
IRS remedies for non-payment of individual mandate
Enforcement of employer mandate
Empirical Studies
Dynamics of the insurance markets (movement among plan types and
metal levels)
What happens with appeals; who handles them; results
Medicaid Expansion: the numbers and obligations (focus on Texas)
Procedural Issues and
Reforms
Eligibility and related appeals processes
Claims appeals processes
Legal challenges to Cost Sharing Reductions: Standing and Merits
Use of standing doctrine in disputes over the ACA
Administrative Law: Regulation by Black Box Calculator (the Actuarial
Value Calculator, Minimum Value Calculator)
FOIA requests under the ACA (the FOIA of FOIA)
Alternatives
Libertarian Alternatives
The Jeb Bush Alternative
Leftist Alternatives
Could Obamacare be simplified
Miscellaneous
Rural Health Reforms instituted by the ACA
Obamacare and the Collateral Source Rule
Cliff problems