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February 2005, Vol 95, No. 2 | American Journal of Public Health 217-223
© 2005 American Public Health Association
DOI: 10.2105/AJPH.2004.037895

GOVERNMENT, POLITICS, AND LAW

Health Plan Liability and ERISA: The Expanding Scope of State Legislation

Fred J. Hellinger, PhD and Gary J. Young, PhD, JD

Fred J. Hellinger is with the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, Md. Gary J. Young is with the Center for Organization, Leadership, and Management Research, Department of Veterans Affairs, and the Program on Health Policy and Management, Boston University School of Public Health, Boston, Mass.

Correspondence: Requests for reprints should be sent to Fred J. Hellinger, PhD, Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Room 5319, 540 Gaither Rd, Rockville, MD 20850 (e-mail: fhelling{at}ahrq.gov).

The federal Employee Retirement Income Security Act of 1974 (ERISA) supersedes state laws as they relate to employer-based health care plans. Thus, cases brought under ERISA are heard in federal courts.

We examined the intent, scope, and impact of recent laws passed in 10 states attempting to expand the legal rights of health plan enrollees to sue their plans. In June 2004, the US Supreme Court ruled that state-law causes of action brought under the Texas Health Care Liability Act involving coverage decisions by Aetna Health Inc and CIGNA Health Care of Texas were preempted by ERISA. The full implications of this decision are not evident at present.






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