Experts: Climate Might Be Wrong For Health Plan Right-To-Sue Bills
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Timing might help protect the health insurance industry against quick passage of major federal patients right-to-sue bills, experts say.
"I think there will be some right to sue," says Bradley Ellis, a credit analyst in the Chicago office of Fitch Ratings. "But I also think there will be some level of caps on the judgments."
The U.S. Supreme Court granted the managed care industry a clear-cut, 9-0 victory in June when it ruled in favor of protecting employer-sponsored health maintenance organization plans against state lawsuits involving benefit determinations.
Justice David Souter and Justice Ruth Bader Ginsburg argued in a concurrent opinion that Congress ought to amend the Employee Retirement Income Security Act of 1974 to give injured health plan members a chance to sue plans in state court for actual and punitive damages. But even Souter and Ginsburg agreed with the other justices that ERISA preempts efforts by states to let plan members sue over benefit determination disputes in state courts.
Instead, members must file claims in the federal courts. ERISA limits members who sue in federal court to enforcing plan contract terms and seeking reimbursement for the cost of care.
Members of Congress immediately responded to the ruling, which resolved the Aetna Health Inc. vs. Davila and CIGNA Healthcare Inc. vs. Calad cases, by announcing plans to introduce new versions of the right-to-sue bill that died in conference committee Sept. 11, 2001, when terrorist attacks forced the government to focus on other issues.
