On November 27, 1990 the Supreme Court carefully delineated the ERISA guidelines that any legislative initiative must follow if relief for the chiropractic profession under state insurance equality laws is to be achieved.
Over a period of several decades, chiropractors have succeeded in having state legislatures enact Insurance Equality Laws that assured chiropractors and their patients that, whenever insurance existed for a given condition, payment would be made, not withstanding the identity of the licensed health care provider that rendered the health care service.
In 1974, however, the United States Congress passed the Employee Retirement Income Security Act (ERISA) which allowed large corporate employers to avoid the use of insurance companies and to become self-sufficient in funding health care programs for their employees. This allowed large employers to act like parents of a family -- to solely determine just what health care coverage and what health care providers they would be willing to reimburse their employees for. As more and more employers opted to exempt themselves from "Insurance" Equality Laws, many health care providers begin to recognize a threat to their patients of a large mass of employers gaining exemption from the state laws. As usually happens in such a circumstance, litigation followed.
The benefit of litigation is that it defines the issue. All health care providers have been impacted by the ERISA law.
Numerous ill-conceived lawsuits and legislative initiatives at the state level have been commenced in an effort to clear the confusion surrounding this issue. The proposed remedies have, themselves, been subject to confusion because of lack of understandable guidelines for what had to be changed to correct the situation.
Finally, the Supreme Court in the case titled FMC Corp, vs. Holliday, ruled that the ERISA statutes clearly take self-funded plans (not utilizing insurance companies) out from under any conflicting state or local regulation. The court ruled that, by such an interpretation, employers that self-insure "will not face conflicting or inconsistent state and local regulations of employee benefit plans." As so often happens when the Supreme Court speaks, a dissent points the way for legislative remedy. Mr. Justice John Paul Stevens pointed out that:
"The notion that this disparate treatment of similarly situated beneficiaries is somehow supported by an interest in uniformity is singularly unpersuasive," he said. "If Congress had intended such an irrational result, surely it would have expressed it in straightforward English."
It is now incumbent on the chiropractic profession to propose well- thought-out legislative language ("straightforward English") to remedy the situation.
The American Chiropractic Association, which participated in the Supreme Court action as a friend of the court, is preparing such a legislative initiative and will, keeping in mind the budget consciousness of the current congress, make careful plans to have it adopted. The chiropractic profession should be aware, however, that the numerous large corporate entities, that have adopted ERISA plans, will not lightly surrender the perceived benefits to them resulting from the diminished rights of their employees, that resulted from the original ERISA Act.
