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Boston University School of Law




Today, health insurance is no longer simply a class of insurance that covers risks to health, and it has not been so for many years. Health insurance has become a unique form of insurance — a mechanism to pay for healthcare that uses risk spreading as one of several pricing methods. The Affordable Care Act builds on this important payment function to create a complex social insurance system to finance healthcare for (almost) everyone. This article examines how the ACA draws on various conceptions of insurance to produce a quasi-social insurance system. This system poses new challenges to laws governing insurance, not all of which are resolved by the ACA itself. Whether or not the ACA is fully implemented, health insurance has already changed — but more nuanced questions remain about whether and how laws governing insurance licensure and claims determinations should also change.

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