Parmet W E
Cornell University.
Am J Law Med. 1993;19(1-2):121-44.
In recent years, many states have attempted to address the cost and access problems that face their health care systems. Such efforts, however, are significantly impeded by a variety of federalism doctrines that limit the ability of states to regulate the health care market. This Article surveys some of those federalism barriers, including the constitutional restraints imposed by the Commerce Clause, the Privileges and Immunities Clause, and the Fourteenth Amendment, and the statutory hurdles created by ERISA, the Social Security Act, and the Americans with Disabilities Act of 1990. This Article concludes that the restraints that these doctrines and statutes place on states reflect not only federalism concerns, but also deeper ambivalence about governmental regulation of the health care market. Only when that ambivalence is resolved can a proper division of labor between the states and federal government be determined.
近年来，许多州都试图解决其医疗保健系统面临的成本和可及性问题。然而，这些努力受到各种联邦制原则的严重阻碍，这些原则限制了各州监管医疗保健市场的能力。本文审视了其中一些联邦制障碍，包括《商业条款》《特权与豁免条款》以及第十四条修正案所施加的宪法限制，以及《雇员退休收入保障法》《社会保障法》和1990年《美国残疾人法》所造成的法定障碍。本文的结论是，这些原则和法规对各州的限制不仅反映了联邦制关切，还反映了对政府监管医疗保健市场更深层次的矛盾态度。只有当这种矛盾态度得到解决，才能确定州和联邦政府之间恰当的分工。
