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Sam Heldman


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Monday, January 13, 2003
No. 00-1471 Kentucky Assn. of Health Plans v. Miller

This case contains an acronym with which I hope never to become too familiar: ERISA. ERISA is a federal law that has something to do with employee benefit plans. I'm not sure what. What I do know is that at issue in this case is ERISA's provisions that preempt state-law regulation of plans covered by the act. Basically, Kentucky enacted a law, known as the "any willing provider" law, that requires health insurers like HMOs to include all providers in their plans that are willing to abide by the plan's terms. While this seems like a nice, all-inclusive, let's all be friends sort of statute, it apparently makes it difficult for HMO's to guarantee volume to their providers. The question here is whether ERISA preempts the "any willing provider" law. ERISA's preemption provisions are quite complex, on the one hand preempting laws that "relate to" ERISA plans, but on the other hand excepting laws from preemption that "regulate insurance." On a third hand, ERISA states that an employee benefit plan may not be considered to be an insurance company for the purposes of state laws that regulate insurance, thus creating an exclusion from the exception. The court below held that the "any willing provider" law regulated insurance, and thus was not preempted by ERISA.

Because my knowledge of the law of employee benefit plans is even more limited than my knowlege of employee benefit plans themselves (in which I have at least had an occasion to participate), it seems to me that a managed health care provider is more of an insurance company than a benefit plan. Thus, I predict that the Court will AFFIRM, even though Goldstein Howe filed an excellent amicus brief in favor of the petitioner (with which I had nothing to do I might add).