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Kameron J. Copeland 《Journal of homosexuality》2018,65(5):687-689
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This Issue Brief provides an overview of the issues relating to the Employee Retirement Income Security Act of 1974 (ERISA) and health benefit plans, the major case law relating to ERISA and health plans, and the implications of the preemption of state regulations for health plan sponsors and participants. It also presents the latest data on the number of health plan participants in self-funded ERISA plans. Finally, it presents a summary of current legislative proposals that would attempt to amend ERISA. Under the framework ERISA established for employee benefit plans, the regulation of employment-based health benefit plans has evolved into a two-tiered system in which both federal and state laws play important roles. The Supreme Court has interpreted ERISA's "savings" and "deemer" clauses to mean that insured plans are subject to regulations directly at the federal level and indirectly at the state level, while self-funded plans are regulated exclusively at the federal level. The ERISA statute and the courts' interpretations of the Act have created a sharp controversy over how employee health benefit plans are provided and administered, with state regulators and consumer advocates on one side of the debate and plan sponsors (e.g., employers and unions) on the other. State regulators and consumer advocates tend to favor more regulation, and in many instances greater regulation at the state level, which they argue would provide more protections for consumers. However, employers and unions (or any plan sponsors) think ERISA preemption is very important to their ability to provide innovative and cost-effective health benefits for their employees, and assert that ERISA's present structure should be preserved. The U.S. General Accounting Office (GAO) found that 44 million individuals (39 percent of those in ERISA plans) were enrolled in self-funded ERISA plans in 1993, up from 39 million (33 percent of those in ERISA plans) in 1989. The Employee Benefit Research Institute (EBRI), using the same methodology as GAO with 1995 data, estimated that 48 million individuals (39 percent of those in ERISA plans) were enrolled in self-funded ERISA plans in 1995. When policymakers look to amend ERISA, they should consider whether the change to ERISA will produce a higher level of quality for consumers than is being provided under the present system and will continue to do so in the future. Policymakers must also decide whether quality of care is better enhanced by health plans' greater exposure to liability or by market forces. If policymakers decide that increased exposure to liability is the route to go, will consumers be able to enjoy any potential improvement in quality or will more individuals end up uninsured because of increased costs and not be able to get any care regardless of the quality? 相似文献
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Jay Williams Claudeline Lewis Florence Copeland Landrum Tucker Laurie Feagan 《Clinical Social Work Journal》1978,6(1):21-32
The paper describes the group therapy model which has evolved over the past two years on the Child Psychiatry Inpatient Unit of North Carolina Memorial Hospital. It begins with a brief review of the literature concerning group therapy with latency-aged children. The setting and patient population are described. Vignettes from group sessions are used to illustrate techniques which have evolved to deal with this particular setting and population. These include a leadership style characterized by much clarification, modeling, and limit setting; extensive focus on beginning and terminating; clearly defined behavioral limits; the use of time out; and use of play materials requiring little skill or attention as anxiety binders as well as projective media; and observation and supervisory discussions open to all members of the treatment team. The paper concludes with a discussion of the potentials and limitations of group therapy in such a setting. The thesis is that this model is effective in diagnosing developmental levels, in developing interpersonal skills, in substituting verbalization for action, and in mastering separation anxieties, though the setting limits the extent to which controlled regression, transference, and group pressures can develop and be used to produce change. 相似文献
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Rachel J. Copeland 《Journal of Family Social Work》2017,20(5):416-432
ABSTRACTAdolescent pregnancy is often thought of as a social problem, one that can cause the adolescent mother hardship, including poverty, low-educational attainment, and housing instability. Although much research has been conducted about adolescent pregnancy in the developed world, less has considered adolescent pregnancy in the developing world. This qualitative study focuses on women who were impoverished in Costa Rica who had been pregnant in adolescence. The goal of the study was to gain a better understanding of the lived experiences of the mothers, as well as the kinds of support they received during and after the pregnancy. The research sample consisted of 22 female participants who were impoverished and had experienced an unintended pregnancy in adolescence. The key finding from this study was that parental support was the most important factor in mitigating adolescent experiences of stress and negative feelings about their choices related to the pregnancy. The study has implications for the understanding of the experiences of women who are vulnerable with respect to adolescent pregnancies in Latin America and for Latina migrants to the United States. 相似文献
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