Tag Archives: erisa

06.29.10

Sure enough, Supreme Court denies cert in ERISA case

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The Supreme Court declined to review a case in which a restaurant owners group attempted to invalidate a San Francisco requirement that local businesses either offer health insurance benefits to their employees or pay the city a fee that is used to fund a program offering medical services to low-income restaurants. In Golden Gate Restaurant […]

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06.24.10

Meanwhile, back at the Supreme Court, the pay or play debate continues (but maybe not for long)

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Today the Supreme Court is scheduled to decide whether to grant cert in Golden Gate Restaurant Ass’n v. City and County of San Francisco, No. 08-1515. Actually, the Court has had the case on  its cert docket for months.  Last October, the Court voted to solicit the views of the solicitor general (SVSG), but the […]

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03.31.10

How Does the Health Reform Legislation Affect Self-Insured Plans?

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Analysis of the application of the Patient Protection and Affordable Care Act to self-insured plans must begin with section 1562 of the Act, which adds section 715 to ERISA and section 9815 to the Internal Revenue Code. These provisions state that all of the provisions of Part A of Title XXVII of the Public Health […]

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02.12.10

Could Health Reform Create “A Litigation Explosion”?

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Nothing apparently excites the readers of the Wall Street Journal more than a threatened “litigation explosion.” Perhaps this is because so many of their readers are lawyers. It was only a matter of time, therefore, before they published an opinion column ominously titled, “Health-Care Reform Could Create a Litigation Explosion.” (See the February 11 issue, […]

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12.04.09

Remedies Against Health Plans Under the Senate Bill

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Section 2719 of the Senate Patient Protection and Affordable Care Act, HR 3590, provides for appeals of coverage determinations and claims. This section explicitly applies to group health plans and health insurance issuers offering group or individual insurance coverage. Section 1551(a) of the bill incorporates the definitions found in 42 U.S.C. § 300gg-91, which defines […]

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11.17.09

ERISA Tort Preemption and HR 3962, Take Four

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In recent days, Mark Hall, Richard Johnson, and Peter Jacobson have all offered opinions as to how HR 3962, if enacted, would affect ERISA preemption of state tort claims against insurers. Let me offer a fourth opinion. First, remember that ERISA tort liability preemption is based primarily on section 502 of ERISA (29 USC 1132). […]

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11.15.09

ERISA Preemption Redux

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In a recent post, Mark Hall raises an interesting issue regarding ERISA preemption and the proposal in HR 3962, the recently enacted House of Representatives’ health reform bill. Mark suggests that: “1) for insurance sold outside of the exchange, ERISA law and its preemption remains the same; 2) for insurance sold inside the exchange, ERISA […]

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11.10.09

What About ERISA’s Tort Liability Pre-Emption?

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In addition to largely ignoring tort reform, the health reform process is ignoring the hash that Congress and courts previously have made of ERISA’s pre-emption of state tort suits against health insurers.  Readers will recall that, according to AETNA v. Davila, 542 U.S. 200 (2004), personal injuries caused by insurance claims denials cannot be adequately […]

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11.02.09

HR 3962, ERISA, HIPAA, McCarran-Ferguson, and State Law. How Does the Puzzle Fit Together?

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Congress is not writing on a clean slate in enacting health care financing reform legislation. We already have, of course, massive federal health care programs: Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Hundreds of pages of the bills Congress is considering are consumed by amendments to the statutes governing these programs. The legislation […]

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10.13.09

ERISA Preemption and Health Reform: Should the Department of Justice Switch Sides?

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In my article on ERISA preemption for the O’Neill Institute’s Legal Solutions in Health Reform, I argued that pay-or-play initiatives, such as those enacted in Maryland, San Francisco, and Massachusetts, are vulnerable to an ERISA preemption challenge.  Two Circuit Court opinions present the issue directly.  The 4th Circuit overturned the Maryland law based on ERISA […]

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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