Audioconference 2: ERISA 101
March 12, 1999

News & commentary on ERISA preemption and HMO regulation 

• Appealing for Managed-Care Accountability Washington Post article by Jane Bryant Quinn. January, 21 1999. For true fans, a link to all of Jane Bryant Quinn's columns about health care, including managed care issues.
• Congress to Try to Cure HMO Ills, Protect Patient Privacy Article in Legi-Slate. January, 18 1999.
• Can Managed Care be Managed? Issue of the week from Policy.com. Includes a number of useful links. June 8, 1998.
• Federal judge rejects ERISA preemption Article by Ellen Beck in The Health Care News Server. April 6, 1998. At the same site: Senators consider cost of repealing ERISA preemption. May 14, 1998.

• 5 U.S.C., Chapter 89 (Health Insurance)
• 15 U.S.C., Chapter 20 (Regulation of Insurance)
• 29 U.S.C., Chapter 18 (ERISA)

• New York State Conference of Blue Cross & Blue Shield Plans v. Travelers Ins. Co., 514 U.S. 645 (1995).
• Dukes v. U.S. Health care, (3d Cir. 1995)
• CORPORATE HEALTH INSURANCE INC., ET AL. Versus THE TEXAS DEPARTMENT OF INSURANCE, ET AL. Text of the federal court decision on the Texas law allowing consumers to sue managed care plans. (Also known as the "AETNA case" on ERISA.)

• The Managed Care Dilemma: Can Theories of Tort Liability Adapt to the Realities of Cost Containment? by Barbara A. Noah.  Mercer Law Review 48: 1219. 1997.
• New York State Conference of Blue Cross & Blue Shield Plans v. Travelers Insurance Company: The United States Supreme Court Gives Commercial Insurers a Severe Case of "The Blues". Article by Mark A. Williams. 47 (4) Page 1181. 1996.
• ERISA: The Basics. Catherine Samuels and Glenn Butash. ABA Journal of the Section on Litigation. This article was originally published in American Bar Association's Litigation Section, Summer 1995. Good but out of date.

Collections of insurance links

• Health Hippo: HIPAA Page and Health Insurance Focuses on laws, cases and bills under consideration.
• Insurance Law Links from The Legal Pad ^(tm) U.S. and state insurance code links.
• HIPAA and Health Plan Policy Links collection from BenefitsLink ^(tm) "a free online publication about all kinds of employer-sponsored benefit plans in the United States, most of which are regulated by federal law ("ERISA"). "

Interest Groups

• Health Administration Responsibility Project The site has a lot of information and an excellent collection of legal links relating to liability, ERISA and preemption. The focus is on modifying ERISA: "HARP is a resource for patients, doctors, and attorneys seeking to establish the liability of Managed Health Care Organizations and Nursing Facilities for the consequences of their decisions".
• THE ERISA INDUSTRY COMMITTEE (ERIC) "Representing the Employee Benefits Interests of America's Largest Employers" is the premiere organization dedicated to retaining ERISA. They have a number of issue briefs related to retaining ERISA.

• National Conference of State Legislatures (http://www.ncsl.org/) and in particular its health index (http://www.ncsl.org/programs/health/list.htm) as well as ERISA 101 links collection
• NCSL's Health Policy Tracking Service (http://www.hpts.org/ ). Subscription required to access issue briefs.
• The National Governors Association (NGA) (http://www.nga.org/) policies EC-5. MANAGED CARE AND HEALTH CARE REFORM and issue briefs: State Strategies to Improve Managed Care Quality and Oversight in a Competitive Market Sarah Callahan, February 20, 1998 ; Issue Brief: Recent ERISA Developments: Implications of the Travelers Case for State Policy Initiatives (July 1995)
• The National Association of Insurance Commissioners (NAIC) (http://www.naic.org/). White Papers and Model Laws on Issues including External Grievance Review Procedures
• National Association of Attorneys General (NAAG) (http://www.naag.org/) including their Tobacco Settlement page
• Council of State Governments. Article ERISA and State Health Reform, Steve Kalmeyer, March 5, 1997. Good overview, although slightly out of date. Three States Working with ERISA describes innovations in Oklahoma, Massachusetts and Maryland.

State Insurance Departments

• Map of Insurance Regulators from the National Association of Insurance Commissioners (NAIC). Click on the state to access its insurance department.
• Or, try State and Local Government on the Net (http://www.piperinfo.com/state/states.html) to find your insurance commissioner.

• Agency for Health Care Policy Research (AHCPR) (http://www.ahcpr.gov/)
• Health Care Financing Administration (HCFA) (http://www.hcfa.gov/). HCFA was assigned new responsibilities for insurance under HIPAA. It maintains a page for continuing updates of HCFA HIPAA-related activities.
• Assistant Secretary for Planning and Evaluation (ASPE) (http://aspe.os.dhhs.gov/) Office of Health Policy (http://aspe.os.dhhs.gov/health/hphome.htm)
• The U.S. Department of Labor section with Consumer Information on Health Plans (http://www.dol.gov/dol/pwba/public/health.htm). They are the principal Federal agency with ERISA responsibility.
• General Accounting Office (GAO) (http://www.gao.gov/) Some recent reports on insurance include: Private Health Insurance: Millions Relying on Individual Market Face Cost and Coverage Tradeoffs (Chapter Report, 11/25/96, GAO/HEHS-97-8); Employment-Based Health Insurance: Costs Increase and Family Coverage Decreases (Letter Report, 02/24/97, GAO/HEHS-97-35); Private Health Insurance: Continued Erosion of Coverage Linked to Cost Pressures (Chapter Report, 07/24/97, GAO/HEHS-97-122). Health Insurance Standards: New Federal Law Creates Challenges for Consumers, Insurers, Regulators. (Letter Report, 02/25/98,GAO/HEHS-98-67).
• Congressional Budget Office (CBO) (http://www.cbo.gov/) provides cost estimates for measures such as S. 1890, Patients' Bill of Rights Act of 1998 July 1998, H.R. 3605, Patients' Bill of Rights Act of 1998 July 1998
• Congressional Research Service (CRS) Health Reports such as "Health Insurance Portability and Accountability Act of 1996: Guidance on Frequently Asked Questions, 96-805 "(PDF, ASCII) and Managed Health Care: Federal and State Regulation, 97-938 (PDF, ASCII) (http://www.senate.gov/~dpc/crs/index.html)
• U.S. Census reports on health insurance coverage and data: Health Insurance Historical Tables

• Urban Institute (http://www.urban.org/) and particularly their New Federalism project (http://www.urban.org/). For example, A Framework for Assessing Insurer Responses to Health Care Market Changes. Len M. Nichols, The Urban Institute, July 1997 HS Contract No. 100-95-0021
• The Center for Studying Health System Change (http://www.hschange.com/). Their description of change in New Jersey contains a piece of important ERISA history.
• The National Academy for State Health Policy (NASHP) (http://www.nashp.org/) . You can order a report on HIPAA by Elizabeth Mitchell, Cynthia Pernice, August, 1997 from them.
• Alpha Center (http://www.ac.org/) has done some evaluations of state insurance reforms, as well as State Implementation of the Health Insurance Portability and Accountability Act of 1996 (4/1/98) Michael L. Birnbaum. Mapping Health Insurance Markets: The Group and Individual Health Insurance Markets in 26 States (10/1/97) Deborah J. Chollet, Adele M. Kirk, Rachel D. Ermann .
• The Employee Benefit Research Institute (EBRI) has some Downloadable Issue Briefs (http://www.ebri.org/ListOfIssueBriefs.htm) on this and related issues. More recent issue briefs must be ordered directly.
• The Robert Wood Johnson Foundation funds two programs that are particularly relevant: Changes in Health Care Financing and Organization and State Initiatives in Health Care Reform with the Alpha Center for their national program office.
• The Commonwealth Fund has published a number of studies on health insurance (http://www.cmwf.org/programs/insurance/index.asp)
• The Henry J. Kaiser Family Foundation health archive (http://www.kff.org/archive/health.html) has a number of studies related to the health care marketplace (http://www.kff.org/kff/topiclist.html?topic=Health+Care+Marketplace&submit.x=36&submit.y=11) including External Review of Health Plan Decisions: An Overview of Key Program Features in the States and Medicare (full report: PDF format) Karen Pollitz, M.P.P., Geraldine Dallek, M.P.H., and Nicole Tapay, J.D. November, 1998; and Impact of Potential Changes to ERISA: Litigation and Appeals Experience of CalPERS, Other Large Public Employers and a Large California Health Plan Coopers & Lybrand, L.L.P., July 9 1998

Reports on Access to Insurance and Related Topics

• Employed But Not Insured: A State-by-State Analysis of the Number of Low-IncomeWorking Parents Who Lack Health Insurance by Jocelyn Guyer and Cindy Mann, Center on Budget and Policy Priorities February 9, 1999
• The Effect of Health Insurance on Transitions to Self Employment. Brigitte C. Madrian and Lars J. Lefgren February 1998. NORC/University of Chicago--Population Research Center.
• Medigap Insurance: Compliance With Federal Standards Has Increased (Letter Report, March 6, 1998, GAO/HEHS-98-66).
• State Regulatory Experience With Provider-Sponsored Organizations: Final Report. HHS Contract No. 100-93-0012 Office of the Assistant Secretary for Planning and Evaluation. The Lewin Group, Inc. June 27, 1997.

The Internet is constantly changing.

Please offer suggestions of other links dealing with ERISA and HIPAA,
and report broken links to Kala Ladenheim -- kala.ladenheim@ncsl.org.
Indicate "ERISA 101" as the subject of your e-mail.

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ERISA 101 Audioconference Agenda

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