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?     

Health care futures. Part 2: The future of physician executives? Panel discussion

What is the future of health care in America? This is Part 2 of The Physician Executive panel discussion that explores the future of health care in America. To narrow this ambitious focus somewhat, the future is defined as five to 10 years hence. In Part 1, which was published in the May/June issue, Russell C. Coile, Jr., Barbara LeTourneau, MD, MBA, FACPE, James Reinertsen, MD, Uwe Reinhardt, PhD, Marshall Ruffin, MD, MPH, MBA, FACPE, and David Vogel, MS, shared their opinions about what the future holds in managed care, information technology, and biotechnology. In Part 2, Susan Cejka, Barbara LeTourneau, MD, MBA, FACPE, John Henry Pfifferling, PhD, Uwe Reinhardt, PhD, and James Todd, MD, share their views on the future of medical education and physician executives.     

Making borders stick: population transfer and resettlement in the Trans-Curzon territories, 1944-1949

"Designed in 1919-20 by the British mediator Lord Curzon as an armistice proposal between the then warring powers Poland and Soviet Russia, the Curzon Line served to identify the maximum territorial reach of Soviet political influence in Europe....[The author discusses] a program of resettlement which would target communities on both sides of the new border, a policy eventually affecting some 1.4 million individuals...." The implementation and impact of this population exchange are described.     

Comparing measures of poverty and relative deprivation: an example for Belgium

This paper presents three different poverty standards. A first approach takes the disposable income as an indicator of poverty. A second approach uses the Leyden approach. Finally an aggregate index of deprivation, based on the observation of consumption events, is constructed through a particular econometric procedure proposed by Desai and Shah (1988). These alternative measures are then compared on a sample composed of 6380 Belgian households. Such an analysis can be expected to provide some further insight into the problem of measuring poverty, which has been the subject of a recent controversial debate.We thank the participants of the Second Annual Meeting of the European Society for Population Economics, June 23–25, 1988, Mannheim (FRG), L. Gevers, J. Lindsey, P. Pestieau, B. Sak, K. Van den Bosch and two anonymous referees for their comments and suggestions.     

阿拉贡:成长与变化

去年,为了庆祝法共作家阿拉贡的八十岁生日,法共通过它的报刊发表文章,对他的创作展开评价.在新里昂大学组织的"阿拉贡月"的一次报告会上,法共作家普列伏斯特作了这个题目的演说,对阿拉贡在创作道路上经历的三个阶段进行了分析.《新评论》杂志1977年6、7月号刊登了这篇演说,摘译如下.     

经济理论的第二次危机

1971年12月27日,英国经济学家琼·罗宾逊在美国经济学协会第八十四届年会的理查德·艾黎讲座上作了一篇题为《经济理论的第二次危机》的讲演.罗宾逊夫人在讲演中提出了资产阶级经济理论正在经受第二次危机,并对美国凯恩斯派经济理论展开了猛烈的抨击.我国学术界对此讲演曾作过介绍.鉴于这场论争有助于我们了解垄断资产阶级经济理论的发展和演变,现将罗宾逊夫人的《经济理论的第二次危机》和美国凯恩斯派代表人物詹姆斯·托宾的《英国剑桥与美国剑桥之间的论战》两篇文章的摘要一并刊出;同时,我们请中国社会科学院经济研究所黄范章同志写了一篇文章:《从"两个剑桥之争"谈起》,对这场论争的背景和意义,作了扼要的评论.     

The four-parameter logit life table system

Summary Brass's model life table system, which is a two parameter system based on the logit transformation of survivorship values, has been widely and successfully used to describe age patterns of mortality in many populations. As more reliable information has become available for populations with mortality patterns which differ in important ways from the assumed standard pattern of mortality, a more flexible model system is needed. This paper shows how Brass's system can be expanded into a four-parameter model, and evaluates the performance of the new system by examining how well it can fit observed life table data.