Chapter 8.C: ERISA Preemption

To insert after Ch. 8.C (p. 787):

ERISA Preemption Quiz

The following questions are supposed to have clear, settled answers for those who understand this complex law. See how you do.

Due to ERISA preemption, are any of the following true? Why or why not?

A. States may not force employers to purchase insurance.

B. States may not require self-insured employers to cover mental health services.

C. States may not regulate the rates that hospitals charge (i) insurers and HMOs, or (ii) self-insured employers.

On the history of ERISA’s adoption (note 1), see James A. Wooten, The Employee Retirement Income Security Act of 1974: A Political History (2004); Daniel Fox & Daniel Schaffer, Health Policy and ERISA: Interest Groups and Semiprotection, 14 J. Health Pol. Pol’y & L. 239 (1989).

For discussions of the Travelers decision (note 1), see Note, 13 Yale L. & Pol’y Rev. 339 (1995); Catherine Fisk, The Last Article About the Language of ERISA Preemption?, 33 Harv. J. Leg. 35 (1996); Karen Jordan, Travelers Insurance: New Support for the Argument to Restrain ERISA Preemption, 13 Yale J. on Reg. 255 (1996). Discussing whether ERISA preempts state-managed care regulation, see Donald T. Bogan, Protecting Patient Rights Despite ERISA: Will the Supreme Court Allow States to Regulate Managed Care?, 74 Tul. L. Rev. 951 (2000); Margaret Farrell, ERISA Preemption and Regulation of Managed Health Care, 23 Am. J. L. & Med. 251 (1997). For discussions of how the ACA might have shifted the ERISA terrain somewhat, see Brendan S. Maher, The Affordable Care Act, Remedy, and Litigation Reform, 63 Am. U. L. Rev. 649 (2014); Katherine T. Vukadin, Hope or Hype?: Why the Affordable Care Act’s New External Review Rules for Denied ERISA Healthcare Claims Need More Reform, 60 Buff. L. Rev. 1201 (2012); Katherine T. Vukadin, ERISA’s Fiduciary Fantasy and the Problem of Mass Health Claims, 57 U. Rich. L. Rev. 1325 (2023).

For discussions of Gobeille v. Liberty Mutual (note 2), see Erin C. Fuse Brown & Jamie King, The Double-Edged Sword of Health Care Integration: Consolidation and Cost Control, 92 Ind. L. J. 55 (2016); Elizabeth Y. McCuskey, Body of Preemption: Health Law Traditions and the Presumption Against Preemption, 89 Temp. L. Rev. 95 (2016); Edward Zelinsky, Gobeille v. Liberty Mutual: An Opportunity to Correct the Problems of ERISA Preemption, 100 Cornell L. Rev. Online 24 (2015).

For discussions about employers using stop-loss coverage to take advantage of ERISA (note 3), see Timothy Jost & Mark Hall, Self Insurance for Small Employers Under the Affordable Care Act: Federal and State Regulatory Options, 69 N.Y.U. Ann. Surv. Am. L. 539 (2013); K. Caster, The Future of Self-Funded Health Plans, 79 Iowa L. Rev. 413 (1994); J. Lenhart, ERISA Preemption: The Effect of Stop-Loss Insurance on Self-Insured Health Plans, 14 Va. Tax Rev. 615 (1995).

For discussions of play-or-pay laws (note 5), see Peter D. Jacobson, The Role of ERISA Preemption in Health Reform: Opportunities and Limits, 37 J. L. Med. & Ethics 88 (2009); Amy B. Monahan, Pay or Play Laws, ERISA Preemption, and Potential Lessons from Massachusetts, 55 Kan. L. Rev. 1203 (2007); Christen Linke Young, Note, Pay or Play Programs and ERISA Section 514: Proposals for Amending the Statutory Scheme, 10 Yale J. Health Pol’y, L. & Ethics 197 (2010)

For discussions of mandated benefits (note 6), see the several articles by Amy Monahan at 2007 U. Ill. L. Rev. 1361; 80 U. Colo. L. Rev. 127 (2009); and 2012 U. Ill. L. Rev. 139. See also Amy B. Monahan. The Regulatory Failure to Define Essential Health Benefits, 44 Am. J.L. & Med. 529 (2018); Nicholas Bagley & Helen Levy, Essential Health Benefits and the Affordable Care Act: Law and Process, 39 J. Heath Pol., Pol’y & Law 441 (2013); Stacy Tovino, A Proposal for Comprehensive and Specific Essential Mental Health and Substance Use Disorder Benefits, 38 Am. J. L. & Med. 471 (2012).

For discussions of federalism in health care (note 7), see Nicholas Bagley, Federalism and the End of Obamacare, 127 Yale L. J. Forum 1 (2017); Patricia J. Zettler, Toward Coherent Federal Oversight of Medicine, 52 San Diego L. Rev. 427 (2015); Brendan S. Maher & Radha A. Pathak, Enough About the Constitution: How States Can Regulate Health Insurance Under the ACA, 31 Yale Law & Pol’y Rev. 275 (2013); Michael Doonan, American Federalism in Practice: The Formulation and Implementation of Contemporary Health Policy (2013); Lars Noah, Ambivalent Commitments to Federalism in Controlling the Practice of Medicine, 53 U. Kan. L. Rev. 149 (2004); Richard P. Nathan, Federalism and Health Policy, 24(6) Health Aff. 1458 (Nov. 2005); John D. Blum, Overcoming Managed Care Regulatory Chaos Through a Restructured Federalism, 11 Health Matrix 327 (2001).