There's "private" and then there's "private": ERISA, its impact, and options for reform.

The Employee Retirement Income Security Act of 1974 (ERISA), a federal law regulating private employer-sponsored employee benefit plans, was primarily designed for pension plans, but has had a profound impact on state health care reform efforts. ERISA's broad preemption language has been judicially interpreted to preclude states from most forms of regulation of employer health plans, including benefit design (except through regulation of insurance products) and incorporating employer expenditure requirements in state health reform financing. But since 1974, Congress has never seriously returned to reexamine several fundamental questions: Should employers be required to offer or contribute to employee health coverage? Should ERISA preempt state efforts to take such actions? Or should ERISA incorporate more comprehensive regulation of health plans in these areas? Although the politics of ERISA preemption have thus far blocked federal reform, while allowing state reform activity to be simultaneously curtailed, new health reform efforts may force Congress to address these questions.

ERISA, agency costs, and the future of health care in the United States.

Because so many Americans receive health insurance through their employers, the Employee Retirement Income Security Act (ERISA) of 1974 plays a dominant role in the delivery of health care in the United States. The ERISA system enables employers and insurers to save money by providing inadequate health care to employees, thereby creating incentives for these agents to act contrary to the interests of their principals. Such agency costs play a significant role in the current health care crisis and require attention when considering reform. We evaluate the two major health care reform movements by exploring the extent to which each reduces agency costs. We find that agency cost analysis clarifies the benefits, limits, and uncertainties of each approach.

Expanded managed care liability: what impact on employer coverage?

Policymakers are considering legislative changes that would increase managed care organizations' exposure to civil liability for withholding coverage or failing to deliver needed care. Using a combination of empirical information and theoretical analysis, we assess the likely responses of health plans and Employee Retirement Income Security Act (ERISA) plan sponsors to an expansion of liability, and we evaluate the policy impact of those moves. We conclude that the direct costs of liability are uncertain but that the prospect of litigation may have other important effects on coverage decision making, information exchange, risk contracting, and the extent of employers' involvement in health coverage.

ERISA litigation: what every trustee should know.

ERISA litigation is complex and requires knowledgeable counsel. Trustees must have some working knowledge of ERISA litigation in order to understand the tactics and procedure involved. At a minimum, they should be able to determine whether fund counsel is adequately protecting the interests of both the trustees and the fund.

The struggle over retiree medical benefits: who's on top?

Over the past decade, there has been an explosion of litigation addressing an employer's right to unilaterally amend or terminate medical benefits provided to retirees. The sheer volume of these cases and the variety of facts and legal theories have combined to obscure the patterns and trends that actually are emerging from this litigation. This article will describe the context of the struggle over retiree benefits and discuss those leading decisions in which the federal courts of appeals have established their rules for deciding retiree benefits cases.