ERISA: Los Angeles Times Calls For Fix
An editorial in today's Los Angeles Times says a "fix is needed at the federal level" to eliminate a loophole that leaves many HMO patients unprotected from "fraud and abuse" and without the guarantee of certain rights. "An unintended quirk in a federal benefits law called ERISA, the Employment Retirement Income Security Act, exempts most employer-sponsored health plans from state consumer protections." The Times writes that originally the law was designed to exempt only multistate employers who "would have been unduly hurt by having to follow different laws in each state." Now, however, almost all employer plans "are ERISA plans, with all the pertinent exemptions." According to the Times, to provide additional consumer protections, a change needs to be made at the federal level, and can begin when Congress considers several patients' "bill of rights" next week. Congress should "recognize two rights as fundamental: The right to appeal to an independent review board when an HMO denies coverage recommended by one of its doctors" and "[t]he right to obtain useful information about a health plan's doctors, practices and policies." According to the Times, Congress should consider a third-party review board similar to the one outlined by Gov. Pete Wilson's managed care task force.
Only So Far
However, the Times does not advocate going beyond these measures, including allowing malpractice suits against HMOs, because, it says, further changes could cause health care premiums to rise or employers to drop health care coverage. The Times concludes: "The key to fixing ERISA is not in radical measures like more lawsuits, at least not for now. The key lies in giving consumers fair and swift means to resolve disputes and access to the right information about their HMO plans" (2/19).