Hiring more attorneys may be the prescription needed to manage the headaches and growing pains of putting the federal health care law into effect.
Hospitals, law firms and state agencies involved in implementing the Affordable Care Act have seen a sizable bump in workload — and in some cases, staff sizes — as they prepare for the major overhaul mandated by the 2010 law and to adjust to other industry changes.
“We’ve just been incredibly busy,” says Mary Antoine, chair of the health care practice group at Sacramento firm Nossaman, which in recent months has hired several new associates as well as seasoned health care attorneys to keep up with “a significant uptick in work on all fronts” from impacted clients.
It’s not the only local firm beefing up. Covered California, the state agency running California’s insurance marketplace, brought on eight attorneys for its budding department and is planning on adding three more attorneys and two analysts in the coming months. The Department of Insurance added 13 temporary positions in light of added workload related to the health care law, growing its team of attorneys tasked with that issue from two to 15. Murphy Austin Adams Schoenfeld anticipates “growing strategically” to meet increased demand. Some hospitals and insurance providers have also expanded their in-house legal departments, though one, Sutter Health, says such a move was intended to increase efficiency and cut costs, not to address changes in the health care law.
Some observers are predicting an even bigger increase in demand for health care-related legal services as enrollment in plans offered through the state-run marketplace starts and other aspects of the law take effect.
“A lot of the work up until this point has been, broadly speaking, education and compliance, a lot of [human resource] compliance,” says Micah Weinberg, a senior policy adviser for the Bay Area Council who specializes in health care. “But once everything comes online, there’s going to be a lot of potential issues. Everything from employment law actions, given the new rights and responsibilities of employers and all the reporting requirements; to issues associated with the merging of hospital chains in response to what they see as the perceived risk of implementing health care reform.”
It isn’t just Obamacare driving business for attorneys specializing in the area. Hospital mergers, Medicare audits and elder care issues all create demand for more health care lawyers.
“The demand for work in these areas has been strong and growing over the past few years because there are inevitably disputes between providers and plans over the terms of their managed care agreements, and also generally because of the overall growth of the health care industry and the continual changes in the complex network of state and federal regulations,” wrote Kathryn Doi, a partner in the health care law team at Murphy Austin Adams Schoenfeld, in an email.
While the uptick isn’t limited to Sacramento — The Wall Street Journal reported on a national surge in activity earlier this year — some involved in the legal field believe attorneys in the region are uniquely positioned to benefit from the trend. In addition to housing the state agencies tasked with setting up California’s health insurance marketplace, the Sacramento region is home to more than half a dozen major hospitals, several large firms specializing in health care litigation and two law schools, Pacific McGeorge School of Law and UC Davis Law School, producing young, policy-minded attorneys.
“Off the top of my head, I can’t think of a better place to be in the U.S., really, unless you’re in Washington dealing with the feds,” says Pacific McGeorge’s dean, Francis J. Mootz III.
The demand for more attorneys able to navigate the complex area has been stressed to Mootz by both alumni and local leaders in the health care industry. BlueCross held a recruiting event on campus earlier this year, a partnership that lead to nine hires.
“When I go out and talk with (alumni), what I’m getting back from them is, ‘Yeah, we really need students who have these capacities.’ We are going to need well-trained lawyers to deal with these issues,” he says. “The business is growing.”
The law school is trying to give students the tools they need to fill that demand, offering courses taught by the former head of health care for California’s prison system, maintaining an elder-law clinic where students can get hands-on experience and launching a new master’s track that allows students to buff up on law and regulatory policy without pursuing a full law degree.
UC Davis has also seen an increasing interest in students with experience in the field, particularly at the state-agency level. At least one 2013 graduate has already received an offer from the Department of Insurance, while other recent alumni have been hired in-house by Dignity Health and Sutter, according to Craig Compton, assistant dean of career services at UC Davis Law School.
While the trend has been fairly recent, Compton sees “potential future growth” in job opportunities for local law students, with a broader hiring blitz facing the next graduating class.
“I think it is a little bit of law firms figuring out exactly what the changes are going to mean, how much more work its going to mean,” he says.
Still, it’s not yet clear how much recent law school graduates, who have faced dimming job prospects in recent years, will benefit from the trend. Some firms in Sacramento are so far gravitating to attorneys already versed in the complex field, a pattern Compton says he has seen nationally. Covered California is seeking applicants with “backgrounds in insurance regulation and individual and small-group insurance markets,” a spokeswoman said.
“The challenge is that the work is very sophisticated, high level, fast paced and a moving target,” says Antoine. “We don’t have time to train a new graduate.”
Still, opportunities in the profession have led some students to seek training ahead of entering the job market. Karl Schweikert, a Sacramento cargo pilot who used to work in the tech industry, saw enough potential in the market to pursue a law degree in his early 40s. He graduated from McGeorge earlier this year and is now looking for jobs related to health care regulations.
“I really think that it’s a growing market, and it warranted taking three years and making that shift,” he says.
Meanwhile, the email list for the McGeorge Health Law Association has grown to about 80 students, with 25 to 30 members attending most of the group’s events.
“I think there’s growing awareness on the part of students that health care law is going to be a growing if not booming field because of the Affordable Care Act,” says Schweikert, who served as president of the group last year. “I think there is actually a sense of excitement among the students who are interested in health care law that it really is going to be a very hot market, and I think once the ACA got passed, people who may have been on the fence solidified their interest.”
Schweikert predicts student interest will continue to grow as the exchanges get up and running, saying students will “go and study in that area to get an opportunity” once they realize there are jobs waiting for them after graduation.
The extent of those opportunities in the future is closely tied to the success of the state-run insurance marketplace and other aspects of the law, some say.
“I think it will continue to grow until we actually see what the public’s response is to the exchange and what the enrollment number are,” Antoine says. “If this looks like a great business opportunity, there’s going to be even more companies trying to get into the market. If, on the other hand, it ends up being a very costly endeavor and not cost effective … I would expect to see a slow down on that work.”
Still, law school officials say students are smart to focus on complex regulatory issues, including, but not limited to, health care. Major changes to immigration, energy and banking policies will also demand attorneys who can navigate the laws behind those changes, according to Mootz.
“To me, the message I like to convey to students is, maybe the health care field will change 15 years from now. But if you’re educated as a lawyer, you understand how regulations and compliance works, you’ll be able to work in the next item, too,” he says.
Think of your best friend, a friend that knows all your ticks, hobbies and vices. Now imagine this friend happens to be a doctor, and she’s your doctor.