2. 3 The Source of Law and Regulations shutterstock.com/Mike Flippo

3. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Chapter Outline The Federal Government –The Constitution of the United States The Preamble of the Constitution The Articles of the Constitution The Amendments of the Constitution The Constitution and the Hierarchy of Law –The Federal Government’s Authority to Regulate Healthcare State Governments Local Governments shutterstock.com/Paul Fleet

4. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Discussion Do you know of any government healthcare programs? What is the role of government in the administration of healthcare? What is the role of local governments in healthcare? shutterstock.com/Minerva Studio

5. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Introduction to Laws and Regulations Laws and ethical rules have been established to, in part, encourage delivery of the best healthcare possible In the United States, society’s rules and regulations are derived from a complex variety of sources The United States Constitution is “the supreme law of the land,” which defines and limits the powers of the federal government The federal government has a pervasive influence on healthcare but plays a relatively minimal role in actually providing care to patients shutterstock.com/Flashon Studio

6. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Laws and Regulations in the United States States retain the authority to train, license, and deliver actual medical care Local governments affect healthcare providers through city planning, business licensing, and other practices Professional associations establish their own independent rules and sanctions Common law, derived from individual case law from England and predating US laws, affects healthcare shutterstock.com/Niyazz

7. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. The Constitution of the United States The US Constitution creates a federal government of limited power with one national government and many individual state governments Any power not delegated to the federal government in the Constitution is reserved for the states or the people The Constitution defines and limits the authority of government but does not limit the rights of the individual citizen shutterstock.com/Zerbor

8. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. The Preamble of the Constitution Sets forth the purpose of establishing the government Healthcare itself is not specifically mentioned but can be found in the purpose to promote the general welfare The provision to “promote the general welfare” has served as justification for extensive government healthcare programs shutterstock.com/Luis Louro

9. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. The Articles of the Constitution Describe the authority and limitations of the three branches of government—legislative, executive, and judicial This separation of powers (aka checks and balances) was established so that each branch of government had the ability to perform specific, separate functions that can be limited by one of the other two branches Article I: creates the legislative branch (Congress) composed of the House of Representatives and the Senate –Section 8 of Article I of the Constitution enumerates the powers of Congress Article II: creates the executive branch of government, headed by the President, who enforces Congress’ laws Article III: establishes the judicial branch, which interprets the laws of the United States and acts as the final mediator of major disputes shutterstock.com/David Evison

10. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Think Further As a patient, do you think it is a good idea that national healthcare laws are written by Congress rather than the President? Explain your answer. shutterstock.com/Bobrov Kirill

11. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Executive Departments Carry out the day-to-day administration of the federal government Department of Health and Human Services –The principle agency for protecting the health of all Americans –Performs a wide variety of tasks and services, affecting research, public health, food and drug safety, grants and other funding, data collection, regulations, health insurance, and Indian Health Services Other departments affecting healthcare –Department of Agriculture (food and nutrition) –Department of Veterans Affairs shutterstock.com/Mark Van Scyoc

12. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. The Constitution and the States Article IV: addresses relations between and among the states and ensures that laws enacted in one state are given full faith and credit (equal recognition) in each of the other states States do not need to recognize licensing from other states In some instances, such as nursing, interstate compact agreements among the states have created reciprocity rights that allow recognition of out-of- state licenses shutterstock.com/Anetta

13. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Critical Thinking Why do states have the power to set their own rules about delivery of healthcare? Explain your answer. Except for certain powers granted to the federal government, each state retains full sovereignty to govern its territory and protect its own state residents through laws and regulations enforced by its retained police powers. This includes healthcare-related laws. shutterstock.com/Bee Su; shutterstock.com/Pressmaster

14. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. The Amendments of the Constitution The first 10 amendments are referred to as the Bill of Rights Designed to protect people from government infringement on fundamental individual rights The government must respect any objections that you may have to certain types of medical care based on your religious beliefs shutterstock.com/Derek Hatfield

15. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Civil Rights of Citizens Amendment XIV: contains the Due Process Clause and the Equal Protection Clause –The Due Process Clause: a citizen shall not be deprived of life, liberty, or property without due process of law –The Equal Protection Clause: states that no person is to be denied equal protection of the laws These clauses mean that a citizen’s fundamental rights may not be infringed upon unless the government has a compelling interest in the area, and its actions are necessary shutterstock.com/Paul Matthew Photography

16. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Critical Thinking What do equal protection and due process have to do with healthcare? If you are going to be dropped by a healthcare program such as Medicare, due process entitles you to “notice and a fair hearing” first. While providing such due process, the government must treat each recipient equally under the law and cannot make decisions based on a discriminatory basis such as race, gender, or national origin. How are these concepts connected to liberty and autonomy? Explain your answer. shutterstock.com/vectornice The right to notice and a fair hearing is connected to the right of liberty. Liberty is directly related to the ethical concept of autonomy, or the right to individual self-determination.

17. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. The Constitution and the Hierarchy of Law The Supremacy Clause of the Constitution (Article 6, clause 2) asserts that federal law takes precedence over any conflicting state law Hierarchy of law 1.Constitutional law (both federal and state) 2.Statutory law (federal, state, and local laws and ordinances) 3.Regulatory law (administrative agency rules for implementing statutory law) shutterstock.com/Brandon Bourdages

18. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. The Hierarchy of Law Constitutional law –The US Constitution is superior to all other law in the country –All other laws must be formed within constitutional requirements and comply with constitutional concepts Statutory law –Statutes: laws established by a legislative body –Laws –Legislation Regulatory law –Administrative agency regulations –Local governments shutterstock.com/Roman Motizov

19. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Think Further Does it make sense to you that the different level of governments generally govern different aspects of the healthcare system? Explain your answer. shutterstock.com/Lewis Tse Pui Lung

20. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. The Federal Government and Healthcare All federal laws, state legislation, and local ordinances can be enforced by government through the “police power” –Police power: the basic right of state and local governments to make laws and regulations for the benefit of their communities –A state exercises police power when it creates licensing laws for hospitals or healthcare providers, or enacts public health laws related to contagious diseases Congress has the authority to regulate transactions that are involved in, or impact, interstate commerce, which can include healthcare transactions shutterstock.com/Andrey_Popov

21. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. State Governments State government structures generally parallel the structure of the federal government, including their own legislatures States are deeply involved in healthcare regulation and delivery of direct services State court systems are involved in healthcare lawsuits –Malpractice –Battery –Assault –Wrongful death –Other claims against practitioners shutterstock.com/kurhan

22. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Local Governments Local governments include cities and counties County health departments may be direct or indirect providers of healthcare Local governments initiate health-related ordinances –Smoking regulations –School health programs –Public health activities –Ownership and operation of hospitals and clinics shutterstock.com/Joseph Sohm

23. Copyright Goodheart-Willcox Co., Inc. May not be posted to a publicly accessible website. Chapter Summary The US Constitution is the “supreme law of the land.” States and local governments have major influences on the healthcare industry, as they have the retained authority to regulate healthcare. The complexity of the healthcare delivery system is a reflection of the intricate relationships among levels of government in the United States. The framework of laws and regulations established by governments at all levels must be considered in healthcare. shutterstock.com/Gustavo Frazao