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May 19, 1993, Vol 269, No. 19 >
ARTICLE | May 19, 1993

What's Wrong With the ERISA Vacuum?: Title and subTitle BreakEmployers' Freedom to Limit Health Care Coverage Provided by Risk Retention Plans FREE

Lawrence O. Gostin, JD; Alan I. Widiss, LLB, LLM
[+] Author Affiliations

Reprint requests to the Office of the Executive Director, American Society of Law, Medicine, and Ethics, 765 Commonwealth Ave, 16th Floor, Boston, MA 02215 (Mr Gostin).


JAMA. 1993;269(19):2527-2532. doi:10.1001/jama.1993.03500190071038
Text Size: A A A
Published online
Article
References

THROUGHOUT the political campaigns waged during 1992, health care for Americans was one of the major issues. Candidates repeatedly expressed concern for the 30 to 65 million individuals who are not insured or who have inadequate coverage for their health care needs.1 Ironically, as the fall election campaigns were concluding, the Supreme Court of the United States was deliberating on whether to hear an appeal from a decision of the Fifth Circuit Court of Appeals2 that may result in more individuals being cast into the ranks of the uninsured or inadequately insured. Just a few days after Americans elected a presidential candidate committed to providing universal health care, the Supreme Court—with two justices dissenting—decided not to accept an appeal,2,3 by the executor of the estate of John McGann, from the lower court judgment, which allowed an employer to reduce health care benefits radically for one of its

REFERENCES

1 +
American College of Physicians.  Universal insurance for American health care: a proposal of the American College of Physicians. Ann Intern Med . 1992;;117:511-519.
2 +
McGann v H & H Music Company, 946 F2d 401 (5th Cir 1991), cert denied sub nom, Greenberg v H & H Music Company, 113 SCt 482 (1992).
3 +
Pear R.  Justices leave intact ruling that lets business cut health benefits. New York Times . (November 10) , 1992;:A9.
4 +
Pear R.  Insurance-liability curb poses a problem for Bush. New York Times . (May 19) , 1992;:A12.
5 +
Phillips CG, Haddad ME. Letter to the Hon Kenneth W. Starr, Solicitor General of the United States, on behalf of American Association of Retired Persons, American Hospital Association, American Medical Association, National Commission on AIDS, US Conference of Mayors, and National Governors' Association, August 10, 1992.
6 +
McCormick B.  Bush administration stance on self-insurance raises concern. Am Med News . (November 2) , 1992;:1, 46-47.
7 +
Letter to the Hon Kenneth Starr, Solicitor General of the United States from Robert Evans, American Bar Association, July 8, 1992.
8 +
 House Democrats ask Justice Department to reconsider recommendation in AIDS case. Daily Labor Rep . (November 4) , 1992;;214:A8.
9 +
Congressional Office of Technology Assessment. Medical Testing and Health Insurance . Washington, DC: Congressional Office of Technology Assessment; 1988;:114.
10 +
US Census Bureau. Statistical Abstract . Washington, DC: US Census Bureau; 1990;:413.
11 +
Scherzer M.  After McGann: policy implications of the decision authorizing discriminatory benefit caps for treatment of AIDS. AIDS Public Policy J . 1992;;7:96-98.
12 +
Clinton W.  The Clinton health care plan. N Engl J Med . 1992;;327:804-806.
13 +
Starr P, Zelman WA.  A bridge to compromise: competition under a budget. Health Aff . 1993;;12( (suppl) ):7-23.
14 +
Turner R.  ERISA and employer capping of medical benefits for treatment of AIDS and related illnesses. AIDS Public Policy J . 1992;;7:89-91.
15 +
Shay EF.  Discrimination in health benefits: ERISA and beyond. AIDS Public Policy J . 1992;;7:92-95.
16 +
29 USC §1140.
17 +
Folz v Marriott Corp, 594 F Supp 1007 (WD Missouri 1984).
18 +
McGann v H & H Music Company, brief amicus curiae of American Association of Retired Persons in support of plaintiff-appellant, US Court of Appeals for the Fifth Circuit. 1991.
19 +
Keeton RE, Widiss AI. Insurance Law . Practitioners ed. Minneapolis, Minn: West Publishing Co; 1988;.
20 +
Aronson v Servus Rubber Div of Chromalloy, 730 F2d 12, 16 (1st Cir 1984).
21 +
Owens v Storehouse, US App 1993 LEXIS 3066 (11th Cir February 25, 1993).
22 +
Shaw v Delta Air Lines, 103 SCt 2890, 2897 (1983).
23 +
Shaw v Delta Air Lines, 463 US 85, 96-97 (1983).
24 +
Pilot Life Insurance Co v Dedeaux, 481 US 41, 46-48 (1987).
25 +
Fort Halifax Packing Co v Coyne, 482 US 1, 8 (1987).
26 +
Ingersoll-Rand Co v McClendon, 111 SCt 478 (1990).
27 +
Cathey v Metropolitan Life Ins Co, 805 SW2d 387, 390 (Tex 1991).
28 +
Pilot Life Ins Co v Dedeaux, 481 US 41, 45 (1987).
29 +
Metropolitan Life Ins Co v Massachusetts, 471 US 724, 747 (1985).
30 +
Shaw v Delta Air Lines Inc, 463 US 85, 91 (1983).
31 +
Fox DM, Schaffer DC.  Health policy and ERISA: interest groups and semi-preemption. J Health Polit Policy Law . 1989;;14:239-260.
32 +
Freudenheim M.  Employers winning right to cut back medical insurance. New York Times . (March 29) , 1992;:1, 26.
33 +
Corlin R. Statement to the Select Committee on Aging, Subcommittee on Retirement Income and Employment. July 28, 1992.
34 +
Moore v Metropolitan Life Insurance Co, 856 F2d 488, 492 (2d Cir 1988).
35 +
Sullivan LW.  The Bush administration's health care plan. N Engl J Med . 1992;; 327:801-804.
36 +
Prospective Payment Assessment Commission. Medicare and the American Health Care System: Report to Congress . Washington, DC: Prospective Payment Assessment Commission; 1992;.
37 +
Ginzberg E.  Health care reform: where are we and where should we be going? N Engl J Med . 1992;;327:1310-1312.
38 +
Enthoven AC.  Measuring the candidates on health care. N Engl J Med . 1992;;327:807-809.
39 +
Reinhardt UE.  Politics and the health care system. N Engl J Med . 1992;;327:809-811.
40 +
Blendon RJ, Edwards JN, Hyams AL.  Making the critical choices. JAMA . 1992;; 267:2509-2520.
41 +
Greaney TL.  Health care law: no painless way to cut high costs. Natl Law J . 1992;;15:26-29.
42 +
Sohlgren EC.  Group health benefits discrimination against AIDS victims: falling through the gaps of federal law: ERISA, the Rehabilitation Act, and the Americans With Disabilities Act. Loyola of Los Angeles Law Rev . 1991;;24:1247-1300.
43 +
Schatz B.  The AIDS insurance crisis: underwriting or overreaching? Harvard Law Rev . 1987;;100:1782-1805.
44 +
Clifford KA, Iuculano RP.  AIDS and insurance: the rationale for AIDS-related testing. Harvard Law Rev . 1987;;100:1806-1825.
45 +
Wortham L.  The economics of insurance classification: the sound of one invisible hand clapping. Ohio State Law J . 1986;;47:835-890.
46 +
Bartlett L.  Financing health care.  In: Gostin LO, ed. AIDS and the Health Care System . New Haven, Conn: Yale University Press; 1990;:211.
47 +
Stoddard TB.  Now you're insured, now you're not. New York Times . (May 23) , 1992;;1:2.
48 +
HR 6147. Introduced by Reps William Hughes (D, NJ) and Sherwood Boehlert (R, NY).
49 +
Hughes WJ.  Preventing discrimination in group health plans. Congressional Record . (October 5) , 1992;;E3049-E3050.
50 +
Kimbro v Atlantic Richfield Co, 889 F2d 869, 881 (9th Cir, 1989), cert denied, 111 SCt 53 (1990).
51 +
Dister v Continental Groups Inc, 859 F2d 1108, 1111 (2d Cir 1988).
52 +
Gilbert E.  ADA could bar AIDS benefits caps.  In: Special Report: Employee Benefits Review: The National Underwriter Company . National Underwriter Co; March 30, 1992;:15.
53 +
Fox DM, Thomas EH.  The cost of AIDS: exaggeration, entitlement, and economics.  In: Gostin LO, ed. AIDS and the Health Care System . New Haven, Conn: Yale University Press; 1990;:197-210.
54 +
American Council on Life Insurance. 1990 Life Insurance Fact Book . Washington, DC: American Council on Life Insurance; 1990;.
55 +
Pear R.  US to argue employers can cut health insurance: White House backs move. New York Times . (October 16) , 1992;:A1, A18.
56 +
In the Supreme Court of the United States, October term 1992, No. 91-1283, Greenberg, Executor of Estate of John W. McGann v H & H Music Co, brief for the United States as amicus curiae, Kenneth W. Starr, Solicitor General.
57 +
Americans With Disabilities Act of 1990, Pub L No. 101-3361, 104 Stat 327.
58 +
S Rep No. 116, 101st Cong, 1st Sess 7, 22, 24 (1989).
59 +
Equal Employment Opportunities Commission. Americans With Disabilities Act Handbook . Washington, DC: Equal Employment Opportunities Commission; 1991;.
60 +
Severino v North Fort Myers Fire Control Dist, 935 F2d 1179,1182, n4 (11th Cir 1991).
61 +
29 CFR §1630.2(j) (1992).
62 +
Gostin L.  Genetic discrimination: the use of genetically based diagnostic and prognostic tests by employers and insurers. Am J Law Med . 1991;;17:109-144.
63 +
Gostin L.  The Americans With Disabilities Act and the US health care system. Health Aff . 1992;;11:248-257.
64 +
S Rep No. 116, 101st Cong, 1st Sess 84 (1990).
65 +
HR Rep No. 485, 101st Cong, 2d Sess 3, 71 (1990).
66 +
S Rep No. 101-116, 101st Cong, 1st Sess 85 (1989).
67 +
S Rep No. 116, 101st Cong, 1st Sess 29 (1989).
68 +
Ackourey KA.  Insuring Americans with disabilities: how far can Congress go to protect traditional practices? Emory Law J . 1991;;40:1183-1225.
69 +
29 USC §621-634 (1988).
70 +
Public Employees Retirement System of Ohio v Betts, 492 US 158 (1989).
71 +
 Health insurance: ADA's effect on plans remains a puzzle. Pension Rep . 1992;;19: 824.
72 +
Terrence Donaghey Jr v Mason Tenders District Council Trust Fund, charge No. 160-93-0419, January 27, 1993.
73 +
Bourgeois v Garner Fast Foods Inc, complaint under the Americans With Disabilities Act. Before the Equal Employment Opportunity Commission. 1993.
74 +
Rumeld MD, Brook R.  ADA may widen HIV coverage. Natl Law J . 1992;;15:26-29.
75 +
HR Rep No. 485, 101st Cong, 2d Sess 2, 136-138 (1990).
76 +
Judiciary Committee, 101st Cong, 2d Sess 71 (1990).
77 +
136 Congressional Record H4614, 4623, 4627 (daily ed, July 13, 1990).
78 +
29 CFR §1630.16(f) (1992).
79 +
Scandlen G.  The changing environment of mandated benefits. Employment Benefit Notes . (June) 1987;:6-9.
80 +
Faden R.  Health insurance and AIDS: the status of state regulatory activity. Am J Public Health . 1988;;78:437.
81 +
Lamel L. State regulation of the insurance industry. Ins Law J. 1978;;665:336-358.
82 +
Scherzer M.  Insurance and AIDS-related issues.  In: AIDS Practice Manual . 2nd ed. 1988;:5-27.
83 +
Greene MR, Trieschmann JS. Risk and Insurance . 5th ed. Cincinnati, Ohio: South-Western Publishing Co; 1981;:11, 38-43.
84 +
Musto v American Gen Corp, 861 F2d 897, 912 (6th Cir 1988).

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
American College of Physicians.  Universal insurance for American health care: a proposal of the American College of Physicians. Ann Intern Med . 1992;;117:511-519.
2 +
McGann v H & H Music Company, 946 F2d 401 (5th Cir 1991), cert denied sub nom, Greenberg v H & H Music Company, 113 SCt 482 (1992).
3 +
Pear R.  Justices leave intact ruling that lets business cut health benefits. New York Times . (November 10) , 1992;:A9.
4 +
Pear R.  Insurance-liability curb poses a problem for Bush. New York Times . (May 19) , 1992;:A12.
5 +
Phillips CG, Haddad ME. Letter to the Hon Kenneth W. Starr, Solicitor General of the United States, on behalf of American Association of Retired Persons, American Hospital Association, American Medical Association, National Commission on AIDS, US Conference of Mayors, and National Governors' Association, August 10, 1992.
6 +
McCormick B.  Bush administration stance on self-insurance raises concern. Am Med News . (November 2) , 1992;:1, 46-47.
7 +
Letter to the Hon Kenneth Starr, Solicitor General of the United States from Robert Evans, American Bar Association, July 8, 1992.
8 +
 House Democrats ask Justice Department to reconsider recommendation in AIDS case. Daily Labor Rep . (November 4) , 1992;;214:A8.
9 +
Congressional Office of Technology Assessment. Medical Testing and Health Insurance . Washington, DC: Congressional Office of Technology Assessment; 1988;:114.
10 +
US Census Bureau. Statistical Abstract . Washington, DC: US Census Bureau; 1990;:413.
11 +
Scherzer M.  After McGann: policy implications of the decision authorizing discriminatory benefit caps for treatment of AIDS. AIDS Public Policy J . 1992;;7:96-98.
12 +
Clinton W.  The Clinton health care plan. N Engl J Med . 1992;;327:804-806.
13 +
Starr P, Zelman WA.  A bridge to compromise: competition under a budget. Health Aff . 1993;;12( (suppl) ):7-23.
14 +
Turner R.  ERISA and employer capping of medical benefits for treatment of AIDS and related illnesses. AIDS Public Policy J . 1992;;7:89-91.
15 +
Shay EF.  Discrimination in health benefits: ERISA and beyond. AIDS Public Policy J . 1992;;7:92-95.
16 +
29 USC §1140.
17 +
Folz v Marriott Corp, 594 F Supp 1007 (WD Missouri 1984).
18 +
McGann v H & H Music Company, brief amicus curiae of American Association of Retired Persons in support of plaintiff-appellant, US Court of Appeals for the Fifth Circuit. 1991.
19 +
Keeton RE, Widiss AI. Insurance Law . Practitioners ed. Minneapolis, Minn: West Publishing Co; 1988;.
20 +
Aronson v Servus Rubber Div of Chromalloy, 730 F2d 12, 16 (1st Cir 1984).
21 +
Owens v Storehouse, US App 1993 LEXIS 3066 (11th Cir February 25, 1993).
22 +
Shaw v Delta Air Lines, 103 SCt 2890, 2897 (1983).
23 +
Shaw v Delta Air Lines, 463 US 85, 96-97 (1983).
24 +
Pilot Life Insurance Co v Dedeaux, 481 US 41, 46-48 (1987).
25 +
Fort Halifax Packing Co v Coyne, 482 US 1, 8 (1987).
26 +
Ingersoll-Rand Co v McClendon, 111 SCt 478 (1990).
27 +
Cathey v Metropolitan Life Ins Co, 805 SW2d 387, 390 (Tex 1991).
28 +
Pilot Life Ins Co v Dedeaux, 481 US 41, 45 (1987).
29 +
Metropolitan Life Ins Co v Massachusetts, 471 US 724, 747 (1985).
30 +
Shaw v Delta Air Lines Inc, 463 US 85, 91 (1983).
31 +
Fox DM, Schaffer DC.  Health policy and ERISA: interest groups and semi-preemption. J Health Polit Policy Law . 1989;;14:239-260.
32 +
Freudenheim M.  Employers winning right to cut back medical insurance. New York Times . (March 29) , 1992;:1, 26.
33 +
Corlin R. Statement to the Select Committee on Aging, Subcommittee on Retirement Income and Employment. July 28, 1992.
34 +
Moore v Metropolitan Life Insurance Co, 856 F2d 488, 492 (2d Cir 1988).
35 +
Sullivan LW.  The Bush administration's health care plan. N Engl J Med . 1992;; 327:801-804.
36 +
Prospective Payment Assessment Commission. Medicare and the American Health Care System: Report to Congress . Washington, DC: Prospective Payment Assessment Commission; 1992;.
37 +
Ginzberg E.  Health care reform: where are we and where should we be going? N Engl J Med . 1992;;327:1310-1312.
38 +
Enthoven AC.  Measuring the candidates on health care. N Engl J Med . 1992;;327:807-809.
39 +
Reinhardt UE.  Politics and the health care system. N Engl J Med . 1992;;327:809-811.
40 +
Blendon RJ, Edwards JN, Hyams AL.  Making the critical choices. JAMA . 1992;; 267:2509-2520.
41 +
Greaney TL.  Health care law: no painless way to cut high costs. Natl Law J . 1992;;15:26-29.
42 +
Sohlgren EC.  Group health benefits discrimination against AIDS victims: falling through the gaps of federal law: ERISA, the Rehabilitation Act, and the Americans With Disabilities Act. Loyola of Los Angeles Law Rev . 1991;;24:1247-1300.
43 +
Schatz B.  The AIDS insurance crisis: underwriting or overreaching? Harvard Law Rev . 1987;;100:1782-1805.
44 +
Clifford KA, Iuculano RP.  AIDS and insurance: the rationale for AIDS-related testing. Harvard Law Rev . 1987;;100:1806-1825.
45 +
Wortham L.  The economics of insurance classification: the sound of one invisible hand clapping. Ohio State Law J . 1986;;47:835-890.
46 +
Bartlett L.  Financing health care.  In: Gostin LO, ed. AIDS and the Health Care System . New Haven, Conn: Yale University Press; 1990;:211.
47 +
Stoddard TB.  Now you're insured, now you're not. New York Times . (May 23) , 1992;;1:2.
48 +
HR 6147. Introduced by Reps William Hughes (D, NJ) and Sherwood Boehlert (R, NY).
49 +
Hughes WJ.  Preventing discrimination in group health plans. Congressional Record . (October 5) , 1992;;E3049-E3050.
50 +
Kimbro v Atlantic Richfield Co, 889 F2d 869, 881 (9th Cir, 1989), cert denied, 111 SCt 53 (1990).
51 +
Dister v Continental Groups Inc, 859 F2d 1108, 1111 (2d Cir 1988).
52 +
Gilbert E.  ADA could bar AIDS benefits caps.  In: Special Report: Employee Benefits Review: The National Underwriter Company . National Underwriter Co; March 30, 1992;:15.
53 +
Fox DM, Thomas EH.  The cost of AIDS: exaggeration, entitlement, and economics.  In: Gostin LO, ed. AIDS and the Health Care System . New Haven, Conn: Yale University Press; 1990;:197-210.
54 +
American Council on Life Insurance. 1990 Life Insurance Fact Book . Washington, DC: American Council on Life Insurance; 1990;.
55 +
Pear R.  US to argue employers can cut health insurance: White House backs move. New York Times . (October 16) , 1992;:A1, A18.
56 +
In the Supreme Court of the United States, October term 1992, No. 91-1283, Greenberg, Executor of Estate of John W. McGann v H & H Music Co, brief for the United States as amicus curiae, Kenneth W. Starr, Solicitor General.
57 +
Americans With Disabilities Act of 1990, Pub L No. 101-3361, 104 Stat 327.
58 +
S Rep No. 116, 101st Cong, 1st Sess 7, 22, 24 (1989).
59 +
Equal Employment Opportunities Commission. Americans With Disabilities Act Handbook . Washington, DC: Equal Employment Opportunities Commission; 1991;.
60 +
Severino v North Fort Myers Fire Control Dist, 935 F2d 1179,1182, n4 (11th Cir 1991).
61 +
29 CFR §1630.2(j) (1992).
62 +
Gostin L.  Genetic discrimination: the use of genetically based diagnostic and prognostic tests by employers and insurers. Am J Law Med . 1991;;17:109-144.
63 +
Gostin L.  The Americans With Disabilities Act and the US health care system. Health Aff . 1992;;11:248-257.
64 +
S Rep No. 116, 101st Cong, 1st Sess 84 (1990).
65 +
HR Rep No. 485, 101st Cong, 2d Sess 3, 71 (1990).
66 +
S Rep No. 101-116, 101st Cong, 1st Sess 85 (1989).
67 +
S Rep No. 116, 101st Cong, 1st Sess 29 (1989).
68 +
Ackourey KA.  Insuring Americans with disabilities: how far can Congress go to protect traditional practices? Emory Law J . 1991;;40:1183-1225.
69 +
29 USC §621-634 (1988).
70 +
Public Employees Retirement System of Ohio v Betts, 492 US 158 (1989).
71 +
 Health insurance: ADA's effect on plans remains a puzzle. Pension Rep . 1992;;19: 824.
72 +
Terrence Donaghey Jr v Mason Tenders District Council Trust Fund, charge No. 160-93-0419, January 27, 1993.
73 +
Bourgeois v Garner Fast Foods Inc, complaint under the Americans With Disabilities Act. Before the Equal Employment Opportunity Commission. 1993.
74 +
Rumeld MD, Brook R.  ADA may widen HIV coverage. Natl Law J . 1992;;15:26-29.
75 +
HR Rep No. 485, 101st Cong, 2d Sess 2, 136-138 (1990).
76 +
Judiciary Committee, 101st Cong, 2d Sess 71 (1990).
77 +
136 Congressional Record H4614, 4623, 4627 (daily ed, July 13, 1990).
78 +
29 CFR §1630.16(f) (1992).
79 +
Scandlen G.  The changing environment of mandated benefits. Employment Benefit Notes . (June) 1987;:6-9.
80 +
Faden R.  Health insurance and AIDS: the status of state regulatory activity. Am J Public Health . 1988;;78:437.
81 +
Lamel L. State regulation of the insurance industry. Ins Law J. 1978;;665:336-358.
82 +
Scherzer M.  Insurance and AIDS-related issues.  In: AIDS Practice Manual . 2nd ed. 1988;:5-27.
83 +
Greene MR, Trieschmann JS. Risk and Insurance . 5th ed. Cincinnati, Ohio: South-Western Publishing Co; 1981;:11, 38-43.
84 +
Musto v American Gen Corp, 861 F2d 897, 912 (6th Cir 1988).

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