The supreme court federalizes managed care liability

Journal of Law, Medicine and Ethics

Volumn 32, Issue 3, 2004, Pages 528-531

  Ruger, Theodore W ^a  

^a UNIVERSITY OF PENNSYLVANIA LAW SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

COURT; HEALTH CARE; HEALTH CARE SYSTEM; HEALTH INSURANCE; LAW; LEGAL LIABILITY; PUBLIC HEALTH; REVIEW; UNITED STATES; ARTICLE; GOVERNMENT; HUMAN; JURISPRUDENCE; LEGAL ASPECT; PENSION;

EMPLOYEE RETIREMENT INCOME SECURITY ACT; HUMANS; LIABILITY, LEGAL; MANAGED CARE PROGRAMS; STATE GOVERNMENT; SUPREME COURT DECISIONS; UNITED STATES;

EID: 4944251733     PISSN: 10731105     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1748-720x.2004.tb00167.x     Document Type: Review

References (27)

1. See Hamdi v. Rumsfeld, 124 S.Ct. 2633 (2004) (emphasizing due process rights of citizens detained in the war on terror declaring that "a state of war is not a blank check for the President when it comes to the rights of the Nation's citizens"); Rasul v. Bush, 124 S.Ct. 2686, 2692-99 (2004) (holding that United States courts have jurisdiction to consider the legality of detention of foreign nationals captured abroad and held at Guantanamo Bay).
2. See Blakely v. Washington, 124 S.Ct. 2531 (2004). Blakely held that the U.S. Constitution requires a jury determination of certain types of sentencing enhancements, a decision that had caused several lower federal courts to conclude that aspects of the U.S. Sentencing Guidelines are unconstitutional, a development with potentially cataclysmic impact on federal law enforcement. The Supreme Court recently agreed to hear two of these lower court decisions this fall. See United States v. Booker, 2004 WL 1713654 (Aug. 2, 2004) (grant of certiorari); United States v. Fanfan, 2004 WL 1713655 (Aug. 2, 2004) (same).
3. 124 S.Ct. 2488 (2004). The decision discussed here addressed two consolidated cases, respectively styled Aetna Health, Inc. v. Davila and Cigna HealthCare of Texas, Inc. v. Calad. The legal questions that the two cases presented to the Court were identical.
4. See generally M. Gregg Bloche, "One Step Ahead of the Law: Market Pressures and the Evolution of Managed Care," in M. Gregg Bloche, ed., The Privatization of Health Care Reform (New York: Oxford University Press, 2003), at 28-31 (explaining how health plans responded to physician and consumer pressures by "backing away from aggressive preauthorization review").
5. See B. Strunk & J. Reschovsky, "Kinder and Gentler: Physicians and Managed Care, 1997-2001," HSC Tracking Report from Community Tracking Study, No. 5, Nov. 2002.
6. See Texas Civ. Prac. & Rem. Code Ann. Sec. 88001-88.003 (2004 Supp.).
7. See 29 U.S.C. §§1001-1461 (2004).
8. See 29 U.S.C. §1144(a) (2004).
9. See 536 U.S. 355 (2002).
10. 538 U.S. 329 (2002).
11. See 530 U.S. 211 (2000).
12. See id. at 236.
13. See Cal. Div. of Labor Standards Enforcement v. Dillingham Constr., N.A., Inc., 519 U.S. 316, 335 (1997) (Scalia, J., concurring).
14. 124 S.Ct. at 2486 (quoting Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58, 65-66 [1987]).
15. 29 U.S.C. §1132(a)(1)(B).
16. See Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 54-56 (1987); see also Ingersoll-Rand Co. v. McClendon, 498 U.S. 133, 143-45 (1990).
17. See id.
18. See R. Epstein and A. Sykes, "The Assault on Managed Care: Vicarious Liability, ERISA Preemption, and Class Actions," Journal of Legal Studies 30 (2001): 625, 641-42 (explaining that "it is not difficult to fashion an argument that this current ERISA remedy is inadequate").
19. See 124 S.Ct. at 2501.
20. See B. Strunk and J. Reschovshy, "Kinder and Gentler," supra note 5.
21. See 124 S.Ct. at 2503.
22. See, e.g., Kaiser Daily Health Policy Report, June 22, 2004 (noting reintroduction of patients' rights legislation in the House of Representatives in response to Aetna).
23. On the institutional dynamics contributing to the failure of the Clinton health plan, see J.P. Ruger, Aristotelian Justice and Health Policy: Capability and Incompletely Theorized Agreements (Cambridge, MA: Doctoral Dissertation, Harvard University, 1998).
24. See 124 S.Ct. at 2504.
25. See J. Langbein, "What ERISA Means By 'Equitable': The Supreme Court's Trail of Error in Russell, Mertens, and Great-West," Columbia Law Review 103 (2003): 1317-66.
26. See 124 S.Ct. 1236 (2004).
27. See J. Gabel et al., "Health Benefits in 2003: Premiums Reach Thirteen-Year High as Employers Adopt New Forms of Cost-Sharing," Health Affairs 22, no. 5 (2003):117-126.