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Boston University, School of Law




In recent years, the Supreme Court has narrowed or eliminated private rights of action in many legal regimes, much to the chagrin of the legal academy. That trend has had a significant impact on health law; the Court’s decisions have eliminated the private enforcement mechanism for at least four important healthcare regimes: Medicaid, employer-sponsored insurance, and medical devices. In a similar trend outside the courts, state legislatures have capped noneconomic and punitive damages for medical malpractice litigation, weakening the tort system’s deterrent capacity in those states. This Article points out that the trend of eliminating private rights of action in the four stories I consider is actually a trend of shifting regulatory authority from state judicial forums to federal executive forums, which is (I argue) a wise reallocation of authority for healthcare regulation. In all four stories, federal executive regulators are (and have been, throughout the stories’ timelines) poised to take over the regulatory job, but they have not yet done so. The Article urges completion of the shift - a consolidation of regulatory authority in the federal executive and a full disarming of state judicial enforcement power.

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