Graduate Prerequisites: (SPHPH719 OR SPHLW719) or instructor permission. - This seminar offers an in-depth examination of the pivotal role of public and private insurance in US health policy. Health insurance pays for almost all health care in the US, strongly influencing (often dictating) who gets what care and on what terms. The class explores how the Affordable Care Act affects the design, operation, and regulation of health benefit plans, including Medicare, Medicaid, employer-sponsored group plans, and commercial insurance. Investigating contemporary regulations, students learn fundamentals of insurance, where reforms do and do not alter such fundamentals, and whether reforms affect larger principles of law. Topics include state and federal regulation; ERISA plan requirements; ERISA preemption of certain state laws; accepting, managing and shifting financial risk; designing health insurance exchanges; contracting with providers, Accountable Care Organizations, employers, and individuals; designing and administering plans; defining benefits, including Essential Health Benefits; appeals and remedies; and state adaptations of health insurance exchanges, subsidy wrap-arounds, risk corridors, and Medicaid expansions.

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