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  • Summarize the basic elements of the legal environment for health-care delivery for medically underserved populations in the United States, including the Affordable Care Act.

  • Identify the major laws and legal concepts that govern health-care organization, financing, and delivery of health care for medically underserved populations.

  • Describe the basic legal duties of health-care providers toward individuals and patients.

  • Review laws that prohibit discrimination in health care.

  • Review concepts of health-care quality and patient rights applicable to all patients regardless of economic or personal circumstances.


Understanding the laws and regulations governing the care of medically underserved populations is critical for clinicians serving these patients. Federal and state laws address barriers to health care and create a legal duty to furnish health care under limited circumstances. The law also shapes and drives the public and private health insurance arrangements that pay for most health care, including care delivered to low-income and vulnerable populations.

This chapter examines three major bodies of US law that govern health-care practice for medically underserved populations: (1) access to health care; (2) insurance coverage for low-income populations through Medicaid and state health insurance exchanges; and (3) health-care quality and patient rights.


John Pool is a person with human immunodeficiency virus (HIV). He is struck by a car and is brought by ambulance to the closest trauma center, bloodied and semiconscious. His partner, who accompanies him to the hospital, explains that John is HIV positive. Hospital personnel advise John’s partner that John would be best served if—rather than receiving care at their facility—the partner were to drive John to the public hospital 20 minutes away, given its expertise in caring for persons with HIV.


Whether there is a right to health care has long been a subject of debate in the United States, a nation that places significant emphasis on the concept of individual legal rights. This cultural emphasis on individual rights is exemplified, of course, in the US Constitution’s Bill of Rights, which defines the legal relationship between individuals and government. The right to health care is not among the rights set forth, although some legal scholars have attempted to argue that the right to health care at least to preserve life should be considered an element of constitutional due process.

The Affordable Care Act (ACA) moves the United States significantly toward a system of national health insurance, although one made up of disparate sources of coverage (Medicare, Medicaid, employer-sponsored group plans, and coverage bought on an individual basis) and not subject to any uniform regulatory scheme governing cost, access, and quality. In addition, the US health-care system continues to rest on a fundamental value of freedom—one in which people remain free to say “no” to coverage ...

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