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Healthcare Law: Patient Rights, Insurance, and HIPAA

Federal & State Law Editorial Team

Overview of healthcare law including patient rights, the Affordable Care Act, HIPAA privacy protections, Medicare, Medicaid, and medical malpractice.

Healthcare Law

Patient Rights

  • Emergency Treatment (EMTALA): Hospitals with emergency departments must screen and stabilize anyone who arrives, regardless of ability to pay
  • Informed Consent: Patients have the right to understand and authorize medical treatment before it is provided
  • Right to Refuse Treatment: Competent adults can refuse any medical treatment, including life-sustaining treatment
  • Medical Records: Patients have the right to access their medical records under HIPAA

    • HIPAA (Health Insurance Portability and Accountability Act)

    HIPAA protects the privacy and security of your health information:

  • Privacy Rule: Limits who can access your protected health information (PHI)
  • Security Rule: Requires safeguards for electronic PHI
  • Your Rights: Access your records, request corrections, receive an accounting of disclosures, file complaints
  • Permitted Disclosures: Treatment, payment, healthcare operations, public health, law enforcement (with limitations)
  • Penalties: Civil penalties up to $2.1 million per violation category per year; criminal penalties for knowing violations

    • The Affordable Care Act (ACA)

  • Individual Market: Prohibits denial of coverage based on pre-existing conditions
  • Essential Health Benefits: Plans must cover 10 categories of services
  • Marketplace/Exchange: Individuals can shop for plans and receive premium subsidies based on income
  • Medicaid Expansion: States can expand Medicaid to adults under 138% of the federal poverty level (not all states have opted in)

    • Medicare and Medicaid

  • Medicare: Federal health insurance for people 65+, certain disabled individuals, and those with end-stage renal disease
  • Medicaid: Joint federal-state program providing health coverage for low-income individuals and families

    • Medical Malpractice

    A healthcare provider is liable for malpractice when:

  • They owed a duty of care to the patient
  • They breached the standard of care (what a reasonably competent provider would have done)
  • The breach caused the patient's injury
  • The patient suffered damages