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John N. Maher

Abstract

The purpose of this Article is two-fold: first, to highlight two problems which threaten the effectiveness of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), and second, to invite civic and governmental dialogue to implement solutions to those problems. The Affordable Care Act is tailored to build upon what is good about the existing health care financing system in the United States. It is also calculated to maximize access to quality and affordable health care across the Nation. There remains, however, work that must be done to neutralize risks to the foundational requirements of consistency and predictability when it comes to payment for medical care. The balance of this article: i. discusses the drivers making American health care the most expensive in the world; ii. outlines the patchwork of public and private fiscal arrangements that comprise the American health care financing system; iii. reveals the legal means by which private insurance companies reduce or eliminate risk, through rescission, cancellation, coverage denials, and other methods; iv. evaluates the behind-the-scenes campaign America’s Health Insurance Plans (AHIP), the public relations and lobbying arm of the health insurance industry, waged to thwart reform without exposing its self-serving profit motive; v. explains how the Affordable Care Act was enacted despite stiff opposition; and vi. concludes with a call to open a dialogue with a view toward focusing efforts to implement solutions, among them:a. that Congress conduct hearings to develop the record and take action in light of the unvarnished facts; b. that states adopt licensing and enforcement procedures for public relations; c. that federal law require public relations practitioners to disclose the real-parties-in-interest who fund spin efforts and certify the good faith basis of claims placed into the media; and d. that law enforcement authorities evaluate the suitability of using existing laws to address apparent fraudulent misrepresentations.

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