The Department of Health and Human Services has issued far-reaching regulations to implement the nondiscrimination requirement of the Affordable Care Act. Now commonly called “Section 1557,” this ACA provision prohibits discrimination by “any health program or activity, any part of which is receiving Federal financial assistance,” on grounds prohibited under previously enacted federal antidiscrimination statutes. The DHHS Office of Civil Rights enforces Section 1557. These new regulations and accompanying commentary give warning of the standards the agency will use in its (...) enforcement efforts. Courts will also give some deference to the DHHS regulations in interpreting the statute in lawsuits by individuals claiming damages against covered health care providers for illegal discrimination under Section 1557. Three central issues are the nature of the rights created in Section 1557 and their relation to the listed federal antidiscrimination statutes, the sorts of health care programs and activities that are covered by Section 1557, and the definition of the personal characteristics, including sexual orientation and gender identity, against which discrimination is prohibited. (shrink)

Tras señalar que la actual política indígena divide a la sociedad chilena en posiciones antagónicas, el artículo plantea una mirada de superación quienes la ven como una amenaza al orden institucional y a la unidad de la nación chilena, y quienes la consideran meras modificaciones cosméticas al modelo etnocida del Estado chileno. Se señala que los compromisos del Pacto de Nueva Imperial tienen niveles parciales de cumplimiento que dejan a Chile por debajo en estas materias en el concierto latinoamericano, lo (...) que ha llevado a que la relación entre el gobierno y la CONADI con el movimiento indígena está atravesada por contradicciones y conflictos difíciles de solucionar. (shrink)

John Rawls posited that we could determine the nature of justice if we imagined ourselves observing conditions in society from behind a hypothetical “veil of ignorance.” Not knowing how or where we would end up—rich, poor, empowered, disabled—we would choose governing principles that did not leave one disadvantaged because of his or her circumstances. Rawls's concepts are implicitly embedded in the Affordable Care Act, which guarantees that vastly more Americans can obtain health insurance. The law effectively closed down the de (...) facto lottery that awarded coverage to most but left out millions of others. (shrink)

The Affordable Care Act survived the Supreme Court—but “just barely”—according to Mark Hall, a contributor to the Report's At Law column. That “just barely” leaves much to ponder, and in this issue a special installment of At Law, appearing as a set of essays, looks into it.

El tema de la autonomía de la música se ha debatido al interior del desarrollo de la misma, en términos de géneros musicales por una parte, y de parámetros estructurales por otra. El artículo expone las fases históricas que conducen al concepto de música de la tradición clásica y la reflexión sobre la música instrumental, que consolida la idea de música absoluta. Esta idea tiene a su vez dos acepciones: música libre de textos y afectos, y música como lenguaje absoluto (...) y supremo. Finalmente el artículo se ocupa de la nueva forma como se comprende la autonomía de la música en la actualidad: música surgida de la estructura misma del sonido, sin el recurso inmediato del modelo retórico o de la lógica armónica. (shrink)

The only part of the Patient Protection and Affordable Care Act (hereafter, ‘the ACA’) struck down in National Federation of Independent Business (NFIB) et al. v. Sebelius, Secretary of Health and Human Services, et al. was a provision expanding Medicaid. We will argue that this was a mistake; the provision should not have been struck down. We’ll do this by identifying a test that C.J. Roberts used to justify his view that this provision was unconstitutional. We’ll defend that test against (...) some objections raised by J. Ginsburg. We’ll then go on to argue that, properly applied, that test establishes the constitutionality of the Medicaid provision. (shrink)

We provide an overview of the characteristics of those who have gained insurance coverage due to the ACA as well as the characteristics of the remaining uninsured. We also describe the implications for the broader sharing of health care risks required under the law, and how they vary by individuals' health status. Finally, we assess the implications of state decisions to expand or not expand Medicaid eligibility under the law, how those decisions affect state finances, health care providers, residents, and (...) how the effects may vary for those states using waivers to expand eligibility using strategies designed to be more broadly politically acceptable. (shrink)

It is no exaggeration to say that American health policy is frequently subordinated to budgetary policies and procedures. The Affordable Care Act was undeniably ambitious, reaching health care services and underlying health as well as health insurance. Yet fiscal politics determined the ACA’s design and guided its implementation, as well as sometimes assisting and sometimes constraining efforts to repeal or replace it. In particular, the ACA’s vulnerability to litigation has been the price its drafters paid in exchange for fiscal-political acceptability. (...) Future health care reformers should consider whether the nation is well served by perpetuating such an artificial relationship between financial commitments and health returns. (shrink)

Dialogar con Quimey Ramos es mínimamente una invitación a preguntarnos, a repensarnos, a emocionarnos, a debatir… a cuestionarlo todo. Entrevistarla fue una experiencia transformadora en los términos que ha enseñado Alessandro Portelli: involucrando nuestra subjetividad como historiadores/as, aumentando nuestras responsabilidades en el oficio; pero también y sobre todo, desde lo primero y más simple que es nuestra humanidad. Cada una de las reflexiones que Quimey nos compartió caló un poco más hondo, llegando al hueso de cada una de las preguntas, (...) pero para encontrarnos con mas inquietudes; como en un juego de Mamushkas interminable que nos topaba con sentidos más profundos cada vez. Con la capacidad de entrar en un laberinto pero saliendo cada vez con más claridad, afirmando aquellas certezas con la convicción que sólo las verdades vividas te dan. Hablamos, de memorias, de verdades, de in-justicias, de historias, de derechos, de subversión, de educación, hablamos del "más allá" y el "más acá" de una sociedad que divide, hablamos de la necesidad de reconocernos, de sincerarnos y del cambio urgente que queremos. (shrink)

Study of the fundamentals of Buddhist civilization.

The Affordable Care Act did not start the consolidation rapidly occurring with hospitals/health systems and medical groups, but it most definitely accelerated the movement to combine. In the last five years, the number and size of consolidations have been at an all-time high. This comment reviews the degree to which consolidation has occurred and explores the key reasons behind these consolidations. It then posits that consolidations should be evaluated in light of the Triple Aim goals of enhancing access to care, (...) reducing cost, and strengthening quality, and looks at the evidence to date in light of these goals. (shrink)

Este artículo interroga el lugar de la felicidad en un pensamiento sobre la historia. La constatación respecto de su ausencia en un pensamiento filosófico político nos lleva a revisitar críticamente dos modalidades del relato que han acogido su llamado: el pensamiento utópico y la teoría crítica. El..

The Patient Protection and Affordable Care Act of 2010 (ACA) contains many provisions intended to increase access to and lower the cost of health care by adopting public health measures. One of these promotes the use of at-work wellness programs by both providing employers with grants to develop these programs and also increasing their ability to tie the price employees pay for health insurance for participating in these programs and meeting specific health goals. Yet despite ACA's specific alteration of three (...) different statues which had in the past shielded employees from having to contribute to the cost of their health insurance based on their achieving employer-designated health markers, it chose to leave alone recently enacted rules implementing the Genetic Non-Discrimination Act (GINA), which prohibits employers from asking employees about their family health history in any context, including assessing their risk for setting wellness targets. This article reviews how both the changes made by ACA and the restrictions recently put place by GINA will affect the way employers are likely to structure Wellness Programs. It also considers how these changes reflect the competing social goals of both ACA, which seeks to expand access to the population by lowering costs, and GINA, which seeks to protect individuals from discrimination. It does so by analyzing both positive theories about how these new laws will function and normative theories explaining the likelihood of future friction between the interests of the population of the United States as a whole who are in need of increased and affordable access to health care, and of the individuals living in this country who risk discrimination, as science and medicine continue to make advances in linking genetic make-up to risk of future illness. (shrink)

The passing of the Patient Protection and Affordable Care Act is a triumph for the field of public health. Its inclusion of many provisions intended to prevent illness and promote health endorses the core belief of public health as expressed by Dr. Georges Benjamin, the long-time executive director of the American Public Health Association, in a Washington Post opinion piece praising ACA for “provid[ing] care as far upstream as possible… [in order to] reduce costs by identifying problems early and then (...) managing them to reduce or eliminate the need for more costly care in the future.” In this article, I consider the conflict between ACA’s adoption of public health goals seeing population health and societal interests in protecting individuals from discrimination based on their health. The article focuses on one aspect of ACA which seeks to lower the costs to employers who provide health insurance for their employees by making it easier for them to offer their employees substantial incentives for participating in and meeting the goals of employer-sponsored Wellness Programs. (shrink)

We show that a version of Ramsey’s theorem for trees for arbitrary exponents is equivalent to the subsystem ${{\sf ACA}^\prime_{0}}$ of reverse mathematics.

In the struggle over the durability of the Affordable Care Act, defenders of the ACA stand guard at many fronts. A major contribution of the ACA to nondiscrimination law, however, appears increasingly vulnerable. The ACA established significant new nondiscrimination protections for patients under section 1557 and its implementing regulations. Several of these regulations—including protections on the basis of gender identity and pregnancy termination—are now under reconsideration at the Department of Health and Human Services, after a nationwide injunction lasting almost a (...) year. Nondiscrimination laws matter, of course, because they promote equal access to health care. But focusing on discriminatory behavior alone is a narrow view of the purpose and potential of nondiscrimination rules—and underestimates the stakes of softening section 1557. To evaluate these protections, we must consider not only their impacts on discriminatory behavior but also their behavioral and attitudinal impacts on patients and communities. This is because supportive or stigmatizing rules can exert an expressive effect: laws communicate information about prevailing social norms, they give some norms greater authority by virtue of the state's support, and they can shape community values. Through these expressive impacts, nondiscrimination laws may affect not only discriminatory behavior in health activities but also the attitudes, beliefs, and decisions of people who are legally protected. (shrink)

Congress implemented the Medicaid Act in 1965, acting pursuant to its Spending Clause authority to “provide for the…general Welfare.” Over time, the Act has been amended more than 50 times. Most recently, as part of the Patient Protection and Affordable Care Act, Congress required participating states to extend Medicaid eligibility to childless, non-disabled, and non-elderly adults with incomes below roughly 133% of the federal poverty level.Within hours of President Obama signing the ACA into law, four lawsuits were filed challenging the (...) con-stitutionality of the ACA, including a case in Florida that eventually made its way to the Supreme Court as National Federal of Independent Business v. Sebelius. As part of this case, officials from 26 states argued that Congress was improperly coercing them into participating in the Medicaid expansion. (shrink)

Work on Nyaya philosophy; includes Siddhāntamuktāvalī autocommentary and Dinakarī of Dinakarabhaṭṭa, 18th cent.

We show that a version of Ramsey’s theorem for trees for arbitrary exponents is equivalent to the subsystem \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${{\sf ACA}^\prime_{0}}$$\end{document} of reverse mathematics.

This article addresses two components of the new governing architecture that help to reform the delivery of health care and to control costs of the health care system: the Center for Medicare and Medicaid Innovation and the Independent Payment Advisory Board. The republican controlled federal government has partially disassembled these two components, threatening the effectiveness of federal delivery system reform and cost control initiatives.

En Chile, la sociología de la religión protestante siempre habla de protestantismo y pentecostalismo; aún no se ha escrito sobre el fenómeno neopentecostal, como en los países vecinos: Perú, Bolivia, Brasil, Argentina, etc. El neopentecostalismo ha significado una redefinición del discurso religioso, en sus contenidos, ritos y medios difusivos; concordando con los fenómenos políticos, sociales, económicos y culturales que ha vivido nuestro país, a partir de la última década del siglo XX. Entre los cambios más visibles encontramos el énfasis de (...) una teodicea de la felicidad y la incorporación tecnológica. Esto ha significado transformar los espacios cúlticos en “cultos electrónicos” o “cibercultos” con un enfoque teatralizante y escenas dramatúrgicas. Transformándose en una religiosidad de la técnica y la imagen e insertando los contenidos y la oferta religiosa en la industria cultural, mercantilizando la música sagrada en un amplio mercado interno. Impactando fuertemente en los espacios religiosos, en la concepción del cuerpo, la movilidad social y las emociones. (shrink)

Intentando responder por el cambio que significa la filosofía contemporánea occidental respecto a su pasado, y a través del análisis de nociones tradicionales de movimiento y cuerpo, mostramos el lazo que une dirección, coreografía y las propias expectativas actorales del danzante, a ciertas concepciones muy particulares de verdad y fidelidad, arraigadas en ideas de tiempo y espacio que son desactivadas en la práctica de la danza, sobre todo en sus fases de investigación corporal, donde aparecen más bien danzas insignificantes y (...) espacios vividos, refractarios a las lógicas del espacio objetivo, el escenario y el espectador. (shrink)

We present and analyze \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${F_\sigma}$$\end{document}-Mathias forcing, which is similar but tamer than Mathias forcing. In particular, we show that this forcing preserves certain weak subsystems of second-order arithmetic such as \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\mathsf{ACA}_0}$$\end{document} and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\mathsf{WKL}_0 + \mathsf{I}\Sigma^0_2}$$\end{document}, whereas Mathias forcing does not. We also show that the needed reals for \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} (...) \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${F_\sigma}$$\end{document}-Mathias forcing (in the sense of Blass in Ann Pure Appl Logic 109(1–2):77–88, 2001) are just the computable reals, as opposed to the hyperarithmetic reals for Mathias forcing. (shrink)

"Esta investigación evidencia descripciones detalladas que identifican la socialización de la naturaleza en la actividad de los curanderos pames de Agua Puerca y La Manzanilla, en la Región de La Palma, San Luis Potosí. Los espacios rituales de estas prácticas y los que se les asocian son las cumbres de los cerros, el cementerio y la milpa. Y los seres a quienes se les ofrenda son aludidos bajo el nombre en español de animales, término que desgina al diablo, al Primer (...) Muerto y al Trueno"--Publisher's website. (shrink)

El presente trabajo, en diálogo con la reflexión de Jean Baudrillard, intenta reconsiderar ontológicamente el no ser para que la oquedad del simulacro no se autoproclame más real que lo real debido a que, como la nada ha sido expropiada y vaciada, el intercambio del mundo y de la vida con ella es imposible. Solo un pensamiento trágico, animado por la agónica energía de su contradicción, puede volver a replantear la reversibilidad de la vida y la muerte.

ACAS reports increasing disciplinary action against employees over expression that employers dislike. Given the prominence of social media in contemporary life, this is a significant current legal issue yet one which has attracted relatively little academic comment. This article examines the compatibility of unfair dismissal doctrine in this context with traditional liberal principle. Arguably, doctrine provides only flimsy protection. Although the common law recognises the importance of individual autonomy generally when determining rights claims, this well-established liberal value appears to have (...) little influence on unfair dismissal doctrine. The dominant academic view on realising greater workplace human rights protection through greater application of the proportionality principle is unlikely to address this problem; reconceptualisation of the substantive free speech right at stake is required. This article offers a strategy on how this might be achieved--and so how differences between practice and principle might be reconciled--through a sympathetic reading of the Strasbourg and UK jurisprudence and potential policy-maker intervention. (shrink)

The ACA shifted U.S. health policy from centering on principles of actuarial fairness toward social solidarity. Yet four legal fixtures of the health care system have prevented the achievement of social solidarity: federalism, fiscal pluralism, privatization, and individualism. Future reforms must confront these fixtures to realize social solidarity in health care, American-style.

State prescription drug monitoring programs (PDMPs) use proprietary, predictive software platforms that deploy algorithms to determine whether a patient is at risk for drug misuse, drug diversion, doctor shopping, or substance use disorder (SUD). Clinical overreliance on PDMP algorithm‐generated information and risk scores motivates clinicians to refuse to treat—or to inappropriately treat—vulnerable people based on actual, perceived, or past SUDs, chronic pain conditions, or other disabilities. This essay provides a framework for challenging PDMP algorithmic discrimination as disability discrimination under federal (...) antidiscrimination laws, including a new proposed rule interpreting section 1557 of the Affordable Care Act. (shrink)

Under the UDHR, all persons have the right to "seek and to enjoy . . . asylum from persecution." From this designation as fundamental followed codification of the right in the 1951 Convention relating to the Status of Refugees and the 1967 Protocol Relating (collectively 'the Convention'), the "centrepiece" of treaties and customary norms that make up international refugee law. It defines and regulates the status and rights of refugees; its purpose is to safeguard the basic rights of persons "outside (...) their country of origin," who have fled due to a legitimate fear of persecution. Fundamentally, it guarantees that asylees and refugees enjoy rights without discrimination; without penalization for illegal territorial entry; and, without expulsion or return to "territories where . . . life or freedom would be threatened on account of . . . race, religion, nationality, membership of a particular social group or political opinion," —or 'non-refoulement'. What follows is background on development of the principle of non-refoulement, evasive US Asylum Cooperative Agreements ('ACAs') and implementing legislation, and the resulting erosion to the right to asylum. (shrink)

The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA’s provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither (...) uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the health care system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry. (shrink)

The Affordable Care Act (ACA) transforms the U.S.'s public and private health care financing systems into vehicles for promoting public health by making evidence-based preventive services available nationwide through individual and group health plans, Medicare, and Medicaid. The ACA accomplishes this transformation by breaking down two barriers: (1) the public health-health care divide, which led to a dominance of curative medicine over preventive health measures and (2) ERISA preemption, which created an obstacle to the provision of a uniform set of (...) evidence-based preventive services that could be made available to the U.S. population through individual and group health plans. As a result, prevention measures with proven effectiveness will now be provided on a national and uniform basis to a majority of Americans, with the potential to improve health outcomes and reduce costs. (shrink)

Let (M, X) ⊨ ACA₀ be such that P X, the collection of all unbounded sets in X, admits a definable complete ultrafilter and let T be a theory extending first order arithmetic coded in X such that M thinks T is consistent. We prove that there is an end-extension N ⊨ T of M such that the subsets of M coded in N are precisely those in X. As a special case we get that any Scott set with a (...) definable ultrafilter coding a consistent theory T extending first order arithmetic is the standard system of a recursively saturated model of T. (shrink)

In this paper, we introduce the systems ns-ACA₀ and ns-WKL₀ of non-standard second-order arithmetic in which we can formalize non-standard arguments in ACA₀ and WKL₀, respectively. Then, we give direct transformations from non-standard proofs in ns-ACA₀ or ns-WKL₀ into proofs in ACA₀ or WKL₀.