State Regulation of Managed Care and the Employee Retirement Income Security Act

Mariner, Wendy K.

doi:10.1056/nejm199612263352610

Cited by 33 publications

(16 citation statements)

References 11 publications

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“…27,28 Congress enacted ERISA in 1974 to safeguard employees' pension and other employment benefit plans and to ease the compliance efforts of national corporations by creating a single federal law. ERISA preempted a broad group of state laws pertaining to employee-benefit plans.…”

Section: Changes In the Law Concerning Liability Of Managed-care Orgamentioning

confidence: 99%

Is It Time to Give Influenza Vaccine to Healthy Infants?

McIntosh¹,

Lieu²

2000

N Engl J Med

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Section: Changes In the Law Concerning Liability Of Managed-care Orgamentioning

confidence: 99%

Is It Time to Give Influenza Vaccine to Healthy Infants?

McIntosh¹,

Lieu²

2000

N Engl J Med

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“…The reach of state regulatory structures is far less than it used to be, at the same time that the challenges of regulation are expanding. Under the federal Employee Retirement Income Security Act of 1972 (ERISA), the federal government has oversight authority over many employee benefit plans; when such purchasers offer self-funded plans, they are not considered to be "insurance" and are not subject to regulation by states (Mariner 1996). Estimates by the US General Accounting Office (1995a) indicate that 114 million individuals were covered by ERISA-regulated plans in 1993, of whom 40 percent-40 million individuals-were in self-insured (i.e., self-funded) plans.…”

Section: The Growth Of Self-funded Plans Under Erisamentioning

confidence: 99%

The Changing US Health Care System: Challenges for Responsible Public Policy

Gold

1999

Milbank Quarterly

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The “managed care backlash” arguably topped the list of media and policy concerns in 1998. Yet, against the background of the highly charged environment in which the future of our health care system continues to be debated, there is a dearth of concrete, “objective” facts on the nature of the changes, the reasons for them, and their meaning. An analysis of five important themes that emerged from a review of the recent literature on health system change concludes that an inherent tension exists between the interest in rapidly driving down health care costs through organizational change and the long time frames that are required to make fundamental changes in structure, process, and orientation. Unfortunately, in an environment in which purchasers are driven to seek cost savings and the political will supports a pluralistic and mixed public/private system, the health system may chart an alternative course, with the result that purchasers may rely increasingly on individual cost sharing and continue to cut back the amount of coverage they are willing to offer. The real challenge for public policy makers is to confront the issues directly, avoiding political incentives to adopt easy and fast solutions for these complex matters.

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“…Such funding should avoid preemption under the Employee Retirement Income Security Act, because it does not tax group health insurance benefits or premiums. 21 Relying solely on the ability of patients to leave one health plan and move to another is not sufficient to ensure either the rights of patients in managed-care plans or improvement in the quality of care. Improving opportunities for enrollees to voice their objections can both enhance patients' rights and highlight areas of potential concern with respect to quality.…”

Section: Dispute-resolution Mechanismsmentioning

confidence: 99%

Patients' Rights in Managed Care -- Exit, Voice, and Choice

Annas¹

1997

N Engl J Med

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State Regulation of Managed Care and the Employee Retirement Income Security Act

Cited by 33 publications

References 11 publications

Is It Time to Give Influenza Vaccine to Healthy Infants?

Is It Time to Give Influenza Vaccine to Healthy Infants?

The Changing US Health Care System: Challenges for Responsible Public Policy

Patients' Rights in Managed Care -- Exit, Voice, and Choice

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