Congress Should Update ERISA to Clarify Authority of State Patient Protection Laws, Bee Says
Many California residents "can no longer rest assured" that they can request an independent review in disputes with their HMOs, a system established under a state law that "may face dismantling" by the U.S. Supreme Court, a Sacramento Bee editorial says. The court heard arguments yesterday (see related story) in a case that will determine whether the 1974 federal Employment Retirement Income Security Act, which regulates employee benefits, applies to "patient protections for many of the HMO enrollees who get their health insurance" through their employers. The editorial says, "If that's the case, then states such as California can't go beyond the letter of ERISA and give these enrollees the right to settle their treatment disputes via independent experts." The editorial adds, "Maybe this is a correct interpretation of ERISA, but it's lousy health policy. States regulate doctors; they should be able to regulate the health plans as well." According to the editorial, the "problem is Congress, which hasn't updated" ERISA since 1974, "when the term HMO wasn't a big part of the nation's health vocabulary." The editorial urges Congress to "get on with passing a health care reform package that clarifies the proper role of these state laws, and ERISA." The editorial concludes, "Independent experts provide peace of mind for both patients and health plans that disputes can be resolved based on the best available science, not on emotion or bean counting. Federal law shouldn't stand in the way of that happening" (Sacramento Bee, 1/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.