ERISA and health plans

This Issue Brief is designed to provide a basic understanding of the relationship of the Employee Retirement Income Security Act of 1974 (ERISA) to health plans. It is based, in part, on an Employee Benefit Research Institute-Education and Research Fund (EBRI-ERF) educational briefing held in March 1995. This report includes a section by Peter Schmidt of Arnold & Porter, a section about multiemployer plans written by Judy Mazo of The Segal Company; and a section about ERISA and state health reform written by Kala Ladenheim of the Intergovernmental Health Policy Project. Starting in the late 1980s, three trends converged to make ERISA a critical factor in state health reforms: increasingly comprehensive state health policy experimentation; changes in the makeup of the insurance market (including the rise in self-insurance and the growth of managed care); and increasingly expansive interpretations of ERISA by federal courts. The changing interpretations of ERISA's relationship to three categories of state health initiatives--insurance mandates, medical high risk pools, and uncompensated care pools--illustrate how these forces are playing out today. ERISA does have a very broad preemptive effect. Federal statutes do not need to say anything about preemption in order to preempt state law. For example, if there is a direct conflict, it would be quite clear under the Supremacy Clause [of the U.S. Constitution] that ERISA, or any federal statue, would preempt a directly conflicting state statute. States can indirectly regulate health care plans that provide benefits through insurance contracts by establishing the terms of the contract. And they also raise money by imposing premium taxes. But they cannot do the same with respect to self-funded plans. That is one of the factors that has caused a great rise in the number of self-funded plans. State regulation [of employee benefits] can create three kinds of problems: cost of taxes, fees, or other charges; cost of dealing with substantive, possibly inconsistent, benefit standards; and cost of identifying, understanding, and complying with the regulations themselves.     

Implications of ERISA for health benefits and the number of self-funded ERISA plans

This Issue Brief provides an overview of the issues relating to the Employee Retirement Income Security Act of 1974 (ERISA) and health benefit plans, the major case law relating to ERISA and health plans, and the implications of the preemption of state regulations for health plan sponsors and participants. It also presents the latest data on the number of health plan participants in self-funded ERISA plans. Finally, it presents a summary of current legislative proposals that would attempt to amend ERISA. Under the framework ERISA established for employee benefit plans, the regulation of employment-based health benefit plans has evolved into a two-tiered system in which both federal and state laws play important roles. The Supreme Court has interpreted ERISA's "savings" and "deemer" clauses to mean that insured plans are subject to regulations directly at the federal level and indirectly at the state level, while self-funded plans are regulated exclusively at the federal level. The ERISA statute and the courts' interpretations of the Act have created a sharp controversy over how employee health benefit plans are provided and administered, with state regulators and consumer advocates on one side of the debate and plan sponsors (e.g., employers and unions) on the other. State regulators and consumer advocates tend to favor more regulation, and in many instances greater regulation at the state level, which they argue would provide more protections for consumers. However, employers and unions (or any plan sponsors) think ERISA preemption is very important to their ability to provide innovative and cost-effective health benefits for their employees, and assert that ERISA's present structure should be preserved. The U.S. General Accounting Office (GAO) found that 44 million individuals (39 percent of those in ERISA plans) were enrolled in self-funded ERISA plans in 1993, up from 39 million (33 percent of those in ERISA plans) in 1989. The Employee Benefit Research Institute (EBRI), using the same methodology as GAO with 1995 data, estimated that 48 million individuals (39 percent of those in ERISA plans) were enrolled in self-funded ERISA plans in 1995. When policymakers look to amend ERISA, they should consider whether the change to ERISA will produce a higher level of quality for consumers than is being provided under the present system and will continue to do so in the future. Policymakers must also decide whether quality of care is better enhanced by health plans' greater exposure to liability or by market forces. If policymakers decide that increased exposure to liability is the route to go, will consumers be able to enjoy any potential improvement in quality or will more individuals end up uninsured because of increased costs and not be able to get any care regardless of the quality?     

Compliance with ERISA’s disclosure provisions

A sample of large employee-benefit plan sponsors revealed that while respondents each paid plan consultants about $769,000 per year to help them comply with the Employee Retirement Income Security Act of 1974 (ERISA), more than half did not comply with selected provisions of the law. Across the sample, differential levels of spending on compliance were not associated with the likelihood of compliance. Rather, benefit directors’ human capital as measured by years of experience, along with government audits, were the chief determinants of compliance. The presence of unions did not contribute to compliance with ERISA in the single employer plans studied herein, possibly because industrial unions, like plan sponsors, face information blockages. The author thanks Ann Bartel, Victor Goldberg, Frank Lichtenberg, Eli Noam. Donna Sockel, and Gene Martin. This article is derived from the author’s doctoral dissertation.     

Modifying retirement benefits: problems under ERISA.

Discretionary communications to employees regarding retirement benefits must be closely monitored--or else the employer may find its right to modify benefits has been damaged.     

声音

“目前,户籍制度的最大问题在于,它是门槛式的,即在没有获得户口的时候,什么权益都不能享有;而你一旦有了户口,就享有了所有权益。因此,户籍制度改革应从原来的‘门槛式’过渡到‘阶梯式’。”     

声音

“农村孩子不愿跃‘龙门’,症结在于城乡教育资源不均衡,竞争不公平。这些年,教育投入越来越给力,但教育嫌贫爱富的现象依然存在。一步落后,步步落后,再加上一些招生制度的影响,农村孩子难跟城里孩子比拼,失去了上更好大学的机会。”
　　--《人民日报》发文谈教育公平,称农村孩子弃考传递出一个信号,“底层上升通道受阻,社会阶层固化趋势加剧,贫穷将会代际传递,一代穷世代穷”。     

声音

“现行养老保险制度存在很多问题,归根到底是由于统筹层次太低造成的。政府迫于现实跨省转续的障碍等原因,不得不千方百计声称要提高统筹层次。但事实上,对‘下级政府’而言,‘上级政府’并没有提高统筹层次的真正动力。”
　　--中国社科院世界社保研究中心主任郑秉文直言,在财政分灶吃饭体制下,养老保险制度财权事权不明晰,立法不明确,大家都是模模糊糊,统筹提到哪一级,哪一级实际就成为最终的“出资人”和“兜底人”,所以养老保险提高统筹层次的责任就成了“皮球”。     

声音

“没有百姓可承受的房价,就没有新城镇化。”
　　--国家发改委规划司副司长袁喜禄认为,房价是除户籍之外另一个横亘在中国人进城路上的巨大障碍,不仅抑制了内需的潜力,而且容易引发社会矛盾。他强调,新城镇化绝不应该走房地产化的道路,尤其是不能高房价化,而必须围绕人生存、发展的需求而进行。     

声音

“随着居民收入的提高,消费在其收入中所占的比率下降。由于间接税的征收是建立在消费行为上的,所以富人并没有因为富有而更多地为国家交税。穷人因为有比较固定的消费行为,也并没有因为穷而少交税。”     

Voice

ON July 11 an exciting sceneunfolded in the Beijing ConcertHall:Jiang Ying,professor ofthe Central Conservatory of Music(CCM),praised by the Chinese Vocal music circleas a person of authority in the European     

声音

“推进城镇化不能取代新农村建设。中国人口多,主要是农民多;农民要进城,但不可能都进城,更不可能都进大城市;城乡一体化不是城乡同样化,搞所谓‘去农村化’。城镇和农村应当和谐一体,各具特色,相互辉映,不能有巨大反差,也不能没有区别。”
　　--农业部部长韩长赋强调,新农村是升级版的农村,不是缩小版的城市。城镇化要加快推进,但新农村建设也不能忽视。     

The change of the litigation Industry

When the Tang and Song dynasties met, the litigation litigation industry gradually emerged as a group, and became a relatively fixed legal profession. But betwe...     

A Missing Voice

Abstract

Contemporary gay and lesbian social service literature still heavily focuses on White middle/upper-class issues and uses an isolated and fixed concept of homosexuality. As a result, the discourse has only a limited applicability to people with “dual” or “multiple” identities, accentuating the power of those who control the discourse and the oppression of those with “dual” or “multiple” identities. Using Asians as a case example, I argue that the lack of published articles about Asians in contemporary gay and lesbian social service literature is the result of the different worldviews of Asian and White queers. However, this deficiency is sustained by social structures that are saturated with White middle/upper-class values. Implications of this situation and some directions for social change are discussed.     

Voice and Cure: The Significance of Voice in Repairing Early Patterns of Disregulation

This paper illustrates the value of the analyst’s awareness of the importance of her voice with its various intonations in the telephone treatment of a patient with early infant/mother attachment patterns of disregulation. The authors describe the significance of a particular kind of pervasive verbal intrusion by the patient’s mother and how through the use of voice pattern, tone, and rhythm in an extended period of telephone therapy, the patient was able to solidify a more secure attachment. Finally, the authors demonstrate how the verbal music in the analyst/patient and the mother/child dyads enhances self and interactive regulation.