Jennifer: Could the federal government pre-mept state
regulations? Maybe, but I'm not so sure.
You point to ERISA (Employee Retirement and Income Security Act
for those who are not policy wonks) but it does not actually
pre-empt state mandates. Rather, it prevents state
governments from imposing any regulations on employers health care
benefit plans. That's why the federal courts threw out Maryland's
Wal-Mart Law, for example.
However, ERISA does not prevent states from regulating the
policies that health insurance companies sell. Thus, if you are a
small employer, the state can't tell you what type of health care
benefits, if any, that you decide to offer your employees. However,
if you buy your insurance from a carrier like Blue Cross, Assurant,
etc., then you will have to buy a policy that covers in-vitro
fertilization, alcoholism treatment and whatever else the state
legislature, in all its wisdom, has decided it must cover.
The reason people often think ERISA pre-empts state mandates is
that employers who self-insure -- i.e., they do not purchase their
insurance from a carrier but, instead, run their own health
insurance program -- can offer insurance with whatever types of
benefits it wants, regardless of state regulations. Of course, only
large employers (firms with at least 100 employees) have enough
resources to make self-insuring feasible, so if you are a small
employer or an individual, you are pretty much at the mercy of the
state legislature.
The only surefire way to deal with state mandates is to let
people buy insurance out of state. That will encourgate states to
reduce their regulations so that in-state insurance carriers do not
lose business. Unfortunately, the Giuliani plan only moves in that
direction slightly.
topics:
Health Care, Business, Law
