Q&A With Professor Allison Hoffman: A Definitive Look at Healthcare Law

Hoffman Oxford Health Guide Book Cover

Healthcare law is one of the most prominent and hotly debated topics of policymaking and regulatory activity in the United States, and it promises to remain so. Into this fray comes the authoritative Oxford Handbook of U.S. Health Law (Oxford University Press, 2017), which UCLA School of Law Professor Allison K. Hoffman co-edited with Professor I. Glenn Cohen of Harvard Law School and Professor William M. Sage of the University of Texas at Austin.

The book’s 50 chapters and 1,232 pages are written by leading scholars, including Hoffman and fellow UCLA Law Professor Jill R. Horwitz, offering a comprehensive overview of issues related to access, ethics, insurance, provider regulation, public health, and even the intersection of immigration and healthcare policy. Former U.S. Secretary of Health and Human Services Kathleen G. Sebelius wrote the foreword.

“Health law has become a robust field in recent years,” says Hoffman, who adds that lawmakers face challenges both anticipated and unforeseen as they seek to alter or repeal the Affordable Care Act, also known as Obamacare. “In fact, I think a lot of them could benefit from reading the chapters in this book.”

What was your vision when you jumped into editing such a massive volume?
I was excited to capture the importance and complexity of the field. Somebody who is interested in practicing health law, or an academic or practitioner in one area who wants to get a rounded-out view of another, can, in a 30-page chapter, get a really good sense from experts on everything from FDA regulation of drugs and devices to state and federal regulation of doctors and hospitals.

Healthcare law is so politicized. Did you aim to include authors with diverse points of view?
We sought diversity in a number of ways. We have chapters by academics, practitioners and regulators. We wanted to have interdisciplinary diversity — lawyers, sociologists, economists, political scientists. We also thought about diversity in terms of number of years in the field — newer scholars and more seasoned ones — as well as gender and racial diversity.

The chapter you wrote addresses healthcare reform. In it, you write, “No one thinks the ACA is the ideal health reform law.” Did editing this book reveal a consensus on what the ideal might be?
No. When you’re regulating healthcare, you’re regulating people. So you get dynamic effects. And in healthcare, there is great potential for profit, which means people have a strong incentive to figure out how to retain profit and power in the face of regulation. It’s a little bit of a pessimistic bottom line, but editing the book affirmed to me ways in which health regulation and reform is and will always be a moving target.

Professor Horwitz focuses her chapter on the role of nonprofit healthcare organizations, which are major players in the healthcare field.
Her chapter is a really nice example of these rich capsules of knowledge in the book. She identified differences in how nonprofits and analogous for-profits are treated under health law and examined why. Then, she looked at nonprofit entities in and outside of the healthcare world, and showed the inconsistencies in the way the law treats them. By uncovering these kinds of inconsistencies in the law, her chapter tees up valuable questions for future research.

Your book was published just months after the 2016 elections, but you started work on it in 2012. Did you feel like there was a ticking clock all along?
By the time most of the chapters were coming in, it started to feel like ACA was here to stay. So — naively, in retrospect — it did not feel as if we were in limbo. But despite the rhetoric, in reality total repeal is politically unwise. Republicans are going to have to skate a very fine line between repealing some of the more unpopular parts of the law and figuring out how to leave gains in health insurance coverage in place. That's what the book captures — the importance of understanding the technicalities of how regulation works and what pieces are intertwined. You can't just pull some pieces out and expect others to stay in place. Health law is such a quickly changing field that it was not going to be stagnant, regardless of the result of the 2016 elections.