Them Wacky Californians Are At It Again

IN THIS ISSUE:


? Them Wacky Californians Are At It Again

? ERISA to the Rescue

? NPR on California’s Mandate

? San Diego Hopes Few Will Be Affected

? Silicon Valley Predicts $7.2 Billion in Costs

? “Business Insurance” Anticipates ERISA Fight

 

Them Wacky Californians are at it Again


California is not just the source of wacky news about gubernatorial recalls and screwball court decisions, it is also the source of wacky legislation and screwball mandates. The current case-in-point is the recently enacted mandate that all employers with more than 20 employees provide health insurance coverage (SB 2).


Don’t get too excited. This bill doesn’t have a snowball’s chance in Hell of surviving an ERISA (Employee Retirement Security Act) challenge even if it is signed by the embattled governor, but it is an interesting glimpse of how the political mind works in the Golden State. It would require every covered employer to provide coverage to every worker employed for at least three months and working at least 100 hours a month, and pay at least 80% of the costs of the worker. Larger employers (over 200 workers) must also cover 80% of the cost of dependents (which include domestic partners). The workers themselves would have to pay no more than 20% of the cost of coverage, and the state would pay that 20% for those who are eligible for Medicaid (“Medi-Cal” in California parlance).


Covered employers include all those with over 20 employees, except the ones with between 20 and 50 would only be included if the state passes a tax credit to offset 20% of their costs.


The bill doesn’t specify benefit design, leaving that to a board to figure out, except it does say that deductibles, coinsurance, and copayments shouldn’t “deter enrollees from receiving appropriate and timely care.”

SOURCE: For a copy of the law as considered by California’s conference committee (thanks to Neil Trautwein for passing this along): http://info.sen.ca.gov/pub/bill/sen/sb_0001-0050/sb_2_bill_20030909_proposed.pdf

 

ERISA to the Rescue


State irresponsibility like this is precisely why Congress enacted ERISA in 1974. Employers said they needed predictability and consistency in their benefit programs, without having every other state forcing them to comply with some politically motivated regulation.


I know people’s eyes glaze over when ERISA is mentioned, but you need to know a few things about it to put this law into context:

1. ERISA covers all employers except churches and governments – “any employer engaged in commerce or in any industry or activity affecting commerce? (unless) such plan is a government plan (for its own employees) (or) such plan is a church plan (for its own employees).” (Section 4 (a) and (b)). It is not confined to large employers and it is not confined to self-insured employers.

2. It is unambiguous in scope. It says, “?the provisions of this title? shall supercede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan?” (Section 514(a)). That is about as broad a preemption as is possible to write.

3. ERISA “saves” from preemption state laws regulating “the business of insurance.” And it “deems” that an employee welfare benefit plan is not in the business of insurance (Section 514 (b)(2)(A and B)).


In a nutshell, California is allowed to regulate insurance companies until it is blue in the face, but it is not allowed to pass “any law relating to” how employers provide benefits. It could require insurance companies to sell policies for $10 a year, and it could require residents to buy them. But it cannot require employers to provide or pay for those benefits.


Some people suppose that recent court decisions on HMO restrictions (such as a recent case that upheld state laws requiring HMOs to contract with “any willing provider,” or other cases extending malpractice liability to HMOs) have weakened the ERISA preemption. They are mistaken. HMOs are regulated insurance companies. ERISA has never prevented states from imposing requirements on them. Similarly, ERISA has never preempted the states’ authority to regulate the practice of medicine, including malpractice remedies. To the extent an HMO is practicing medicine (e.g. substituting its judgment for that of a physician’s), a state is free to regulate that practice.


But the courts have never wavered an inch from the core idea of ERISA, which is that states are not allowed to tell employers what to do regarding the provision of health or pension benefits to their employees.


There is only one example to the contrary and that is Hawaii’s employer mandate. But that took an act of Congress to allow, and even that exception would have never been granted but for the fact that Hawaii passed its mandate about the same time as ERISA was being enacted, so a case could be made that Hawaii’s law should be grandfathered.

SOURCE: For a copy of a paper I did on ERISA for the Cato Institute go to http://www.cato.org/pubs/briefs/bp-057es.html

 

NPR on California’s Mandate


The media has been pretty quiet about the ERISA preemption, perhaps because of wishful thinking by the reporters or because of ignorance. For instance, an otherwise pretty fair report by Patricia Neighmond on NPR doesn’t even mention ERISA. She talks about the uninsured and has a heart-wrenching tale of a woman dying because she didn’t have coverage for her blood pressure and couldn’t afford a dollar-a-day for medication (it’s not clear that this mandate would have helped her in any case). And the story balances that with an example of a man who owns some pizza shops with 65 employees. He calculates it would cost him $2,000 each to provide coverage — $130,000 per year — for which he would have to sell 130,000 more pizzas to gain the $1.3 million in gross revenues from which he could take a 10% mark-up to pay the health insurance bill.

SOURCE: http://www.npr.org/features/feature.php?wfId=1439111

 

San Diego Hopes Few Will be Affected


An article by Leslie Berestein in the “San Diego Union Tribune” also fails to mention ERISA, and minimizes the impact of the bill. “Mandated Insurance May Affect Few Here,” says the headline. The article goes on to say only 4,320 companies in San Diego County are big enough to be covered by the bill, and it quotes an analyst with the Kaiser Family Foundation as saying, “Almost everybody is already doing what the law would require.” (Actually, it is doubtful that very many are paying 80% of the coverage for dependents including domestic partners). The story says the sectors that would be hit the hardest would be restaurants and manufacturing.

SOURCE: http://www.signonsandiego.com/news/business/20030921-9999_1b21health.html

 

Silicon Valley Predicts $7.2 Billion in Costs


A story by Troy May in the “Silicon Valley Business Journal” also omits any mention of ERISA, though it is not as sanguine about the legislation. This article cites KFF numbers that say employers with 20 to 49 workers are currently paying an average of $2,800 for single workers and $6,786 for families. “Medium to large firms in California could pay an additional $5.7 billion in premiums and employees would have to pay an additional $1.5 billion,” according to the article. One business owner is quoted as saying she already is paying the “highest rates of workers’ comp in the country. This legislature is hostile to business.”

SOURCE: http://sanjose.bizjournals.com/sanjose/stories/2003/09/22/story2.html

 

Business Insurance Anticipates ERISA Fight


Not surprisingly, “Business Insurance” doesn’t pass over ERISA, saying “observers expect litigation over whether large employers would be exempt from the mandate’s provisions under the Employee Retirement Income Security Act” (though, again, it isn’t just large employers who are covered by ERISA, but all employers). This article by Judy Greenwald cites a number of commentators, including one from the Segal Co. consulting firm in San Francisco who says the bill will only “level the playing field” between employers who do and do not offer benefits. But a consultant with the Mercer Company says, “The financial implications of this legislation are enormous.” A WalMart executive claims the bill, by exempting collectively bargained plans, will give unionized companies an advantage (not an argument that is likely to sway many Democratic legislators in Sacramento). An Aon consultant in Los Angeles predicts that California will once again be a trend setter, “Certainly whatever happens here in California is watched carefully throughout the country.” Watched, maybe, like watching a train wreck. But it has been a while since the rest of the country looked upon California as a place worth emulating.

SOURCE” http://www.businessinsurance.com/cgi-bin/article.pl?articleId=13444

 

Please send all comments/questions directly to me at gmscan@aol.com.


“Consumer Choice Matters” is a free weekly newsletter published by the Galen Institute, a not-for-profit public policy organization specializing in research and education on health policy. Visit our website at http://www.galen.org for more information.


If you wish to subscribe/unsubscribe or update your address, please send an e-mail to galen@galen.org.


The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors.

 

 

 


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IN THIS ISSUE:


? Them Wacky Californians Are At It Again

? ERISA to the Rescue

? NPR on California’s Mandate

? San Diego Hopes Few Will Be Affected

? Silicon Valley Predicts $7.2 Billion in Costs

? “Business Insurance” Anticipates ERISA Fight

 

Them Wacky Californians are at it Again


California is not just the source of wacky news about gubernatorial recalls and screwball court decisions, it is also the source of wacky legislation and screwball mandates. The current case-in-point is the recently enacted mandate that all employers with more than 20 employees provide health insurance coverage (SB 2).


Don’t get too excited. This bill doesn’t have a snowball’s chance in Hell of surviving an ERISA (Employee Retirement Security Act) challenge even if it is signed by the embattled governor, but it is an interesting glimpse of how the political mind works in the Golden State. It would require every covered employer to provide coverage to every worker employed for at least three months and working at least 100 hours a month, and pay at least 80% of the costs of the worker. Larger employers (over 200 workers) must also cover 80% of the cost of dependents (which include domestic partners). The workers themselves would have to pay no more than 20% of the cost of coverage, and the state would pay that 20% for those who are eligible for Medicaid (“Medi-Cal” in California parlance).


Covered employers include all those with over 20 employees, except the ones with between 20 and 50 would only be included if the state passes a tax credit to offset 20% of their costs.


The bill doesn’t specify benefit design, leaving that to a board to figure out, except it does say that deductibles, coinsurance, and copayments shouldn’t “deter enrollees from receiving appropriate and timely care.”

SOURCE: For a copy of the law as considered by California’s conference committee (thanks to Neil Trautwein for passing this along): http://info.sen.ca.gov/pub/bill/sen/sb_0001-0050/sb_2_bill_20030909_proposed.pdf

 

ERISA to the Rescue


State irresponsibility like this is precisely why Congress enacted ERISA in 1974. Employers said they needed predictability and consistency in their benefit programs, without having every other state forcing them to comply with some politically motivated regulation.


I know people’s eyes glaze over when ERISA is mentioned, but you need to know a few things about it to put this law into context:

1. ERISA covers all employers except churches and governments – “any employer engaged in commerce or in any industry or activity affecting commerce? (unless) such plan is a government plan (for its own employees) (or) such plan is a church plan (for its own employees).” (Section 4 (a) and (b)). It is not confined to large employers and it is not confined to self-insured employers.

2. It is unambiguous in scope. It says, “?the provisions of this title? shall supercede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan?” (Section 514(a)). That is about as broad a preemption as is possible to write.

3. ERISA “saves” from preemption state laws regulating “the business of insurance.” And it “deems” that an employee welfare benefit plan is not in the business of insurance (Section 514 (b)(2)(A and B)).


In a nutshell, California is allowed to regulate insurance companies until it is blue in the face, but it is not allowed to pass “any law relating to” how employers provide benefits. It could require insurance companies to sell policies for $10 a year, and it could require residents to buy them. But it cannot require employers to provide or pay for those benefits.


Some people suppose that recent court decisions on HMO restrictions (such as a recent case that upheld state laws requiring HMOs to contract with “any willing provider,” or other cases extending malpractice liability to HMOs) have weakened the ERISA preemption. They are mistaken. HMOs are regulated insurance companies. ERISA has never prevented states from imposing requirements on them. Similarly, ERISA has never preempted the states’ authority to regulate the practice of medicine, including malpractice remedies. To the extent an HMO is practicing medicine (e.g. substituting its judgment for that of a physician’s), a state is free to regulate that practice.


But the courts have never wavered an inch from the core idea of ERISA, which is that states are not allowed to tell employers what to do regarding the provision of health or pension benefits to their employees.


There is only one example to the contrary and that is Hawaii’s employer mandate. But that took an act of Congress to allow, and even that exception would have never been granted but for the fact that Hawaii passed its mandate about the same time as ERISA was being enacted, so a case could be made that Hawaii’s law should be grandfathered.

SOURCE: For a copy of a paper I did on ERISA for the Cato Institute go to http://www.cato.org/pubs/briefs/bp-057es.html

 

NPR on California’s Mandate


The media has been pretty quiet about the ERISA preemption, perhaps because of wishful thinking by the reporters or because of ignorance. For instance, an otherwise pretty fair report by Patricia Neighmond on NPR doesn’t even mention ERISA. She talks about the uninsured and has a heart-wrenching tale of a woman dying because she didn’t have coverage for her blood pressure and couldn’t afford a dollar-a-day for medication (it’s not clear that this mandate would have helped her in any case). And the story balances that with an example of a man who owns some pizza shops with 65 employees. He calculates it would cost him $2,000 each to provide coverage — $130,000 per year — for which he would have to sell 130,000 more pizzas to gain the $1.3 million in gross revenues from which he could take a 10% mark-up to pay the health insurance bill.

SOURCE: http://www.npr.org/features/feature.php?wfId=1439111

 

San Diego Hopes Few Will be Affected


An article by Leslie Berestein in the “San Diego Union Tribune” also fails to mention ERISA, and minimizes the impact of the bill. “Mandated Insurance May Affect Few Here,” says the headline. The article goes on to say only 4,320 companies in San Diego County are big enough to be covered by the bill, and it quotes an analyst with the Kaiser Family Foundation as saying, “Almost everybody is already doing what the law would require.” (Actually, it is doubtful that very many are paying 80% of the coverage for dependents including domestic partners). The story says the sectors that would be hit the hardest would be restaurants and manufacturing.

SOURCE: http://www.signonsandiego.com/news/business/20030921-9999_1b21health.html

 

Silicon Valley Predicts $7.2 Billion in Costs


A story by Troy May in the “Silicon Valley Business Journal” also omits any mention of ERISA, though it is not as sanguine about the legislation. This article cites KFF numbers that say employers with 20 to 49 workers are currently paying an average of $2,800 for single workers and $6,786 for families. “Medium to large firms in California could pay an additional $5.7 billion in premiums and employees would have to pay an additional $1.5 billion,” according to the article. One business owner is quoted as saying she already is paying the “highest rates of workers’ comp in the country. This legislature is hostile to business.”

SOURCE: http://sanjose.bizjournals.com/sanjose/stories/2003/09/22/story2.html

 

Business Insurance Anticipates ERISA Fight


Not surprisingly, “Business Insurance” doesn’t pass over ERISA, saying “observers expect litigation over whether large employers would be exempt from the mandate’s provisions under the Employee Retirement Income Security Act” (though, again, it isn’t just large employers who are covered by ERISA, but all employers). This article by Judy Greenwald cites a number of commentators, including one from the Segal Co. consulting firm in San Francisco who says the bill will only “level the playing field” between employers who do and do not offer benefits. But a consultant with the Mercer Company says, “The financial implications of this legislation are enormous.” A WalMart executive claims the bill, by exempting collectively bargained plans, will give unionized companies an advantage (not an argument that is likely to sway many Democratic legislators in Sacramento). An Aon consultant in Los Angeles predicts that California will once again be a trend setter, “Certainly whatever happens here in California is watched carefully throughout the country.” Watched, maybe, like watching a train wreck. But it has been a while since the rest of the country looked upon California as a place worth emulating.

SOURCE” http://www.businessinsurance.com/cgi-bin/article.pl?articleId=13444

 

Please send all comments/questions directly to me at gmscan@aol.com.


“Consumer Choice Matters” is a free weekly newsletter published by the Galen Institute, a not-for-profit public policy organization specializing in research and education on health policy. Visit our website at http://www.galen.org for more information.


If you wish to subscribe/unsubscribe or update your address, please send an e-mail to galen@galen.org.


The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors.

 

 

 


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