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Volumn 37, Issue SUPPL. 2, 2009, Pages 51-70

Health insurance exchanges: Legal issues

Author keywords

[No Author keywords available]

Indexed keywords

COMMERCIAL PHENOMENA; CONFERENCE PAPER; HEALTH CARE POLICY; HUMAN; INSURANCE; LEGAL ASPECT; NATIONAL HEALTH INSURANCE; UNITED STATES;

EID: 69549096025     PISSN: 10731105     EISSN: 1748720X     Source Type: Journal    
DOI: 10.1111/j.1748-720X.2009.00420.x     Document Type: Conference Paper
Times cited : (8)

References (154)
  • 1
    • 69549098604 scopus 로고    scopus 로고
    • The literature on exchanges is vast, but a useful sampling of recent papers would include. Academy Health Stateside. last visited June 15, 2009)
    • The literature on exchanges is vast, but a useful sampling of recent papers would include A. Lischko, Health Insurance Connectors & Exchanges: A Primer for State Officials, Academy Health Stateside, September 2007, http://www.statecoverage.org/files/ Health%20Insurance%20Connectors%20and%20Exchanges- A%20Primer%20for%20State%20Officials.pdf last visited June 15, 2009)
    • (2007) Health Insurance Connectors & Exchanges: A Primer for State Officials
    • Lischko, A.1
  • 2
    • 84869714426 scopus 로고    scopus 로고
    • State health reform: How pooling arrangements can increase small-business coverage
    • July 23 < > (last visited June 15, 2009)
    • E. F. Haislmaier, "State Health Reform: How Pooling Arrangements can Increase Small-Business Coverage," Heritage Foundation WebMemo 1563, July 23, 2007 < http://www.heritage.org/Research/HealthCare/wm1563.cfm > (last visited June 15, 2009)
    • (2007) Heritage Foundation WebMemo , vol.1563
    • Haislmaier, E.F.1
  • 3
    • 84869708384 scopus 로고    scopus 로고
    • Health insurance 'connectors' should be designed to supplement public coverage, not replace it
    • January 29, 2007 < > (last visited June 15, 2009)
    • J. Solomon, "Health Insurance 'Connectors' Should Be Designed to Supplement Public Coverage, Not Replace It," Center on Budget and Policy Priorities, January 29, 2007 < http://www.cbpp.org/1-29-07health.htm > (last visited June 15, 2009)
    • Center on Budget and Policy Priorities
    • Solomon, J.1
  • 4
    • 0037842072 scopus 로고    scopus 로고
    • Group purchasing arrangements: Issues for states
    • April 2003
    • M. Kofman, "Group Purchasing Arrangements: Issues for States," State Coverage Initiatives Issue Brief 4, no. 3 (April 2003)
    • State Coverage Initiatives Issue Brief , vol.4 , Issue.3
    • Kofman, M.1
  • 5
    • 69549152381 scopus 로고
    • The role of insurance purchasing cooperatives in health care reform
    • 1-6. One older article also worth reading
    • -1-6. One older article also worth reading is M. A. Hall, "The Role of Insurance Purchasing Cooperatives in Health Care Reform," Kansas Journal of Law & Public Policy 3 (1993-1994)
    • (1993) Kansas Journal of Law & Public Policy , vol.3
    • Hall, M.A.1
  • 7
    • 84895593967 scopus 로고    scopus 로고
    • California Health Care Foundation Issue Brief
    • Insurance Markets: What Health Insurance Pools Can and Can't Do, California Health Care Foundation Issue Brief, 2005 < http://www.chcf.org/ documents/insurance/WhatHealthInsurancePoolsCanAndCantDo.pdf > (last visited June 15, 2009)
    • (2005) Insurance Markets: What Health Insurance Pools Can and Can't Do
  • 8
    • 85061075181 scopus 로고    scopus 로고
    • Health insurance purchasing cooperatives
    • < > (last visited June 15, 2009)
    • E. K. Wicks, "Health Insurance Purchasing Cooperatives," Commonwealth Fund Issue Brief, November 2002 < http://www.commonwealthfund. org/usr-doc/wicks-coops.pdf?section=4039 > (last visited June 15, 2009)
    • Commonwealth Fund Issue Brief, November 2002
    • Wicks, E.K.1
  • 9
    • 0035220007 scopus 로고    scopus 로고
    • Consumer-choice purchasing pools: Past tense, future erfect?
    • R. E. Curtis et al., "Consumer-Choice Purchasing Pools: Past Tense, Future Perfect?" Health Affairs 20, no. 1 (2001): 164-168
    • (2001) Health Affairs , vol.20 , pp. 164-168
    • Curtis, R.E.1
  • 10
    • 0035219972 scopus 로고    scopus 로고
    • Have small-group purchasing alliances increased coverage?
    • S. H. Long and M. S. Marquis, "Have Small-Group Purchasing Alliances Increased Coverage?" Health Affairs 20, no. 1 (2001): 154-163
    • (2001) Health Affairs , vol.20 , Issue.1 , pp. 154-163
    • Long, S.H.1    Marquis, M.S.2
  • 11
    • 0034576294 scopus 로고    scopus 로고
    • Purchasing cooperatives for small employers: Performance and prospects
    • E. K. Wicks and M. A. Hall, "Purchasing Cooperatives for Small Employers: Performance and Prospects," Milbank Quarterly 78 (2000): 511.
    • (2000) Milbank Quarterly , vol.78 , pp. 511
    • Wicks, E.K.1    Hall, M.A.2
  • 12
    • 69549093851 scopus 로고    scopus 로고
    • Senator McCain's plan did not include insurance exchange proposals.
    • Senator McCain's plan did not include insurance exchange proposals.
  • 13
    • 69549132875 scopus 로고    scopus 로고
    • S. 2795, 110th Cong. 2008.
    • S. 2795, 110th Cong. 2008.
  • 14
    • 69549151467 scopus 로고    scopus 로고
    • These arrangements, authorized by section 125 of the Internal Revenue Code, allow employees to pay for various benefits with their own income on a pre-tax basis.
    • These arrangements, authorized by section 125 of the Internal Revenue Code, allow employees to pay for various benefits with their own income on a pre-tax basis.
  • 16
    • 69549154296 scopus 로고    scopus 로고
    • Barak Obama's Plan for a Healthy America is no longer available online.
    • Barak Obama's Plan for a Healthy America is no longer available online.
  • 17
    • 69549154302 scopus 로고    scopus 로고
    • Id.
    • Id.
  • 18
    • 69549151475 scopus 로고    scopus 로고
    • Id.
    • Id.
  • 19
    • 69549100215 scopus 로고    scopus 로고
    • S. 334, 110th Cong. 2008.
    • S. 334, 110th Cong. 2008.
  • 20
    • 84872536924 scopus 로고    scopus 로고
    • Some commentators attempt to draw a clear distinction between the purchasing cooperatives and health alliances that were widely discussed in the 1970s, ′80s, and ′90s and were at the heart of the Clinton Health Security Act, and the contemporary health insurance exchange. See at 2
    • Some commentators attempt to draw a clear distinction between the purchasing cooperatives and health alliances that were widely discussed in the 1970s, ′80s, and ′90s and were at the heart of the Clinton Health Security Act, and the contemporary health insurance exchange. See Lischko, supra note 1, at 2
    • Supra Note , vol.1
    • Lischko1
  • 21
    • 69549099449 scopus 로고    scopus 로고
    • Because the terms purchasing cooperative, health alliance, and health insurance exchange cover or have covered a broad assortment of models among which there is considerable variety and overlap, I do not believe it is possible to draw a clear line between the modern insurance exchange and its antecedents.
    • Moffit, supra note 6. Because the terms purchasing cooperative, health alliance, and health insurance exchange cover or have covered a broad assortment of models among which there is considerable variety and overlap, I do not believe it is possible to draw a clear line between the modern insurance exchange and its antecedents.
    • Supra Note , vol.6
    • Moffit1
  • 22
    • 69549148838 scopus 로고    scopus 로고
    • at 12 for an analysis of exchanges written for the Blue Cross/Blue Shield Association that strongly supports this conclusion.) Insofar as there are differences, they are the following: (1) that health insurance exchanges, as some commentators define them, do not act as purchasing agents or egulators but rather simply connect insurance purchasers with insurers, and (2) that some commentators in the past have included as purchasing cooperatives entities that purchase services directly from providers, while contemporary health insurance exchanges generally contract only with insurers. Believing that the terms are in fact largely interchangeable, I will use the term insurance exchange throughout this paper instead of the terms purchasing cooperative (or pool) or health alliance.
    • (See Bender and Fritchen, supra note 2, at 12, for an analysis of exchanges written for the Blue Cross/Blue Shield Association that strongly supports this conclusion.) Insofar as there are differences, they are the following: (1) that health insurance exchanges, as some commentators define them, do not act as purchasing agents or regulators but rather simply connect insurance purchasers with insurers, and (2) that some commentators in the past have included as purchasing cooperatives entities that purchase services directly from providers, while contemporary health insurance exchanges generally contract only with insurers. Believing that the terms are in fact largely interchangeable, I will use the term insurance exchange throughout this paper instead of the terms purchasing cooperative (or pool) or health alliance.
    • Supra Note , vol.2
    • Bender1    Fritchen2
  • 23
    • 69549100212 scopus 로고    scopus 로고
    • These include, by one list, California, Connecticut, Georgia, Kansas, Maryland, Michigan, Minnesota, Missouri, Montana, New Jersey, Oregon, Texas, Virginia, Washington, and Wisconsin. See. Health Economics Consulting Group. last visited June 15, 2009).
    • These include, by one list, California, Connecticut, Georgia, Kansas, Maryland, Michigan, Minnesota, Missouri, Montana, New Jersey, Oregon, Texas, Virginia, Washington, and Wisconsin. See J. E. Schneider et al. Legal and Economic Analysis of Health Insurance Exchange Mechanisms Health Economics Consulting Group, 2007http://www.hecg.llc.com/health-care-regulation.htm last visited June 15, 2009).
    • (2007) Legal and Economic Analysis of Health Insurance Exchange Mechanisms
    • Schneider, J.E.1
  • 24
    • 69549153901 scopus 로고    scopus 로고
    • Massachusetts health reform: A social compact and a bold experiment
    • See C. L. Hager Massachusetts Health Reform: A Social Compact and a Bold Experiment University of Kansas Law Review 20 (2007 1313 1329
    • (2007) University of Kansas Law Review , vol.20 , pp. 1313-1329
    • Hager, C.L.1
  • 25
    • 69549132873 scopus 로고    scopus 로고
    • Universal health care in massachusetts: Setting the standard for national reform
    • M. A. Chirba-Martin, "Universal Health Care in Massachusetts: Setting the Standard for National Reform," Fordham Urban Law Journal 35 (2000): 409-449.
    • (2000) Fordham Urban Law Journal , vol.35 , pp. 409-449
    • Chirba-Martin, M.A.1
  • 26
    • 69549100199 scopus 로고    scopus 로고
    • The new Massachusetts health law: Preemption and rxperimentation
    • See Hager, supra note 13 E. A. Zelinsky The New Massachusetts Health Law: Preemption and Experimentation William and Mary Law Review 49 (2007 229 287, at 235.
    • (2007) William and Mary Law Review , vol.49 , pp. 229-287
    • Zelinsky, E.A.1
  • 28
    • 69549153904 scopus 로고    scopus 로고
    • See Hager, supra note 13, at 1316.
    • Supra Note , vol.13 , pp. 1316
    • Hager1
  • 29
    • 0034576294 scopus 로고    scopus 로고
    • Purchasing cooperatives for small employers: Performance and prospects
    • See. and
    • See E. K. Wicks and M. A. Hall Purchasing Cooperatives for Small Employers: Performance and Prospects Milbank Quarterly 78 (2000 511.
    • (2000) Milbank Quarterly , vol.78 , pp. 511
    • Wicks, E.K.1    Hall, M.A.2
  • 31
    • 0029575365 scopus 로고
    • Policy issues in health alliances: Of efficiency, monopsony, and equity
    • See
    • See H. T. Greely Policy Issues in Health Alliances: Of Efficiency, Monopsony, and Equity Health Matrix 5 (1995 37 81.
    • (1995) Health Matrix , vol.5 , pp. 37-81
    • Greely, H.T.1
  • 32
    • 69549099448 scopus 로고
    • United States v. South-Eastern Underwriters Association, 322 U.S. 533
    • United States v. South-Eastern Underwriters Association, 322 U.S. 533 (1944).
    • (1944)
  • 33
    • 84869702354 scopus 로고    scopus 로고
    • 15 U.S.C. § 1011 (2007).
    • -15 U.S.C. § 1011 (2007).
  • 34
    • 69549153903 scopus 로고    scopus 로고
    • Printz v. United States, 521 U.S. 898 (1997)
    • Printz v. United States, 521 U.S. 898 (1997)
  • 35
    • 69549144396 scopus 로고    scopus 로고
    • New York v. United States, 505 U.S. 144 (1992)
    • New York v. United States, 505 U.S. 144 (1992)
  • 36
    • 0041306456 scopus 로고
    • Constitutional impediments to national health reform: Tenth amendment and spending clause hurdles
    • C. Hoke, "Constitutional Impediments to National Health Reform: Tenth Amendment and Spending Clause Hurdles," Hastings Constitutional Law Quarterly 21 (1994): 489-575.
    • (1994) Hastings Constitutional Law Quarterly , vol.21 , pp. 489-575
    • Hoke, C.1
  • 37
    • 84869730370 scopus 로고    scopus 로고
    • This is the approach Congress took with the portability provisions of the Health Insurance Portability and Accountability Act, 42 U.S.C. §§ 300gg-22(a)(2) and 300gg-44(b)(3. and with eliminating state limits on high deductible policies coupled with health savings accounts
    • This is the approach Congress took with the portability provisions of the Health Insurance Portability and Accountability Act, 42 U.S.C. §§ 300gg-22(a)(2) and 300gg-44(b)(3 2007 and with eliminating state limits on high deductible policies coupled with health savings accounts
    • (2007)
  • 38
    • 33645295808 scopus 로고    scopus 로고
    • The role of state regulation in consumer-driven health care
    • See T. S. Jost and M. A. Hall, "The Role of State Regulation in Consumer-Driven Health Care," American Journal of Law & Medicine 31 (2005): 395-418.
    • (2005) American Journal of Law & Medicine , vol.31 , pp. 395-418
    • Jost, T.S.1    Hall, M.A.2
  • 39
    • 69549141305 scopus 로고    scopus 로고
    • See South Dakota v. Dole, 483 U.S. 203, 206 (1987)
    • See South Dakota v. Dole, 483 U.S. 203, 206 (1987)
  • 40
    • 69549152380 scopus 로고    scopus 로고
    • Another issue that might arise involves the provisions of the Constitution that require uniform taxation among the states. See U.S. Const. Art. 1, Sec. 2, cl. 3
    • New York v. United States, 505 U.S. 144 (1992). Another issue that might arise involves the provisions of the Constitution that require uniform taxation among the states. See U.S. Const. Art. 1, Sec. 2, cl. 3
  • 41
    • 81255208366 scopus 로고    scopus 로고
    • U.S. Const. Art. 1, Sec. 8, cl. 1. If the federal government were to require individuals to purchase insurance through purchasing exchanges, the premiums might be characterized as taxes, and if premiums varied from state to state or region to region, as would be likely, the question of whether these "taxes" were direct and uniform would need to be reached. This is a difficult question, but would probably ultimately not prove an insurmountable barrier to the establishment of exchanges by federal law. It is discussed comprehensively by Greely will not be addressed further here
    • U.S. Const. Art. 1, Sec. 8, cl. 1. If the federal government were to require individuals to purchase insurance through purchasing exchanges, the premiums might be characterized as taxes, and if premiums varied from state to state or region to region, as would be likely, the question of whether these "taxes" were direct and uniform would need to be reached. This is a difficult question, but would probably ultimately not prove an insurmountable barrier to the establishment of exchanges by federal law. It is discussed comprehensively by Greely, supra note 17, and will not be addressed further here.
    • Supra Note , vol.17
  • 43
    • 69549100969 scopus 로고    scopus 로고
    • If exchanges are private entities, on the other hand, their exclusionary or regulatory practices will not raise constitutional issues, as private entities are not bound by the constitutional provisions discussed here.
    • If exchanges are private entities, on the other hand, their exclusionary or regulatory practices will not raise constitutional issues, as private entities are not bound by the constitutional provisions discussed here.
  • 44
    • 69549149892 scopus 로고    scopus 로고
    • U.S. Const. Art. 1, Sec. 10, cl. 1. The Due Process and Takings Clauses are found in the 5th Amendment, and the States' Due Process and Equal Protection Clauses are found the 14th Amendment.
    • U.S. Const. Art. 1, Sec. 10, cl. 1. The Due Process and Takings Clauses are found in the 5th Amendment, and the States' Due Process and Equal Protection Clauses are found the 14th Amendment.
  • 45
    • 69549151474 scopus 로고    scopus 로고
    • See, e.g., Exxon Corp. v. Eagerton, 462 U.S. 176 (1983)
    • See, e.g., Exxon Corp. v. Eagerton, 462 U.S. 176 (1983)
  • 46
    • 69549146046 scopus 로고    scopus 로고
    • Some states, however, have interpreted their state constitutions more restrictively to strike down economic regulation. Some states, however, have interpreted their state constitutions more restrictively to strike down economic regulation.
    • Williamson v. Lee Optical Co., 348 U.S. 483 (1955). Some states, however, have interpreted their state constitutions more restrictively to strike down economic regulation
  • 48
    • 69549100959 scopus 로고    scopus 로고
    • Energy Reserves Group Inc. v. Kansas Power & Light Co., 459 U.S. 400, 410 - 412 (1983)
    • Energy Reserves Group Inc. v. Kansas Power & Light Co., 459 U.S. 400, 410 - 412 (1983)
  • 49
    • 69549147254 scopus 로고    scopus 로고
    • Liberty Mut. Ins. Co. v. Texas Dept. of Ins., 187 S.W.3d 808 (Tx. App. 2006).
    • Liberty Mut. Ins. Co. v. Texas Dept. of Ins., 187 S.W.3d 808 (Tx. App. 2006).
  • 50
    • 69549155893 scopus 로고    scopus 로고
    • Connelly v. Pension Benefit Guar. Corp. 475 U.S. 211 (1986) F.3d 11th Cir.
    • Vesta Fire Ins. Corp. v. State of Fla., 141 F.3d 1427 (11th Cir. 1998).
    • (1998) Vesta Fire Ins. Corp. V. State of Fla. , vol.141 , pp. 1427
  • 51
    • 69549154295 scopus 로고
    • See O'Gorman & Young, Inc. v. Hartford Fire Ins. Co., 282 U.S. 251 (1931)
    • See O'Gorman & Young, Inc. v. Hartford Fire Ins. Co., 282 U.S. 251 (1931)
    • (1931)
  • 52
    • 69549153894 scopus 로고    scopus 로고
    • Gerling Global Reinsurance Corp. of America v. Low, 296 F.3d 832 (9th Cir. 2002); Stephens v. State Farm Mut. Auto. Ins. Co., 894 S.W.2d 624 (Ky 1995) (discussing the application of the takings clause to insurance regulation cases).
    • Gerling Global Reinsurance Corp. of America v. Low, 296 F.3d 832 (9th Cir. 2002); Stephens v. State Farm Mut. Auto. Ins. Co., 894 S.W.2d 624 (Ky 1995) (discussing the application of the takings clause to insurance regulation cases).
  • 53
    • 69549142897 scopus 로고
    • Health Ins. Ass'n of America v. Harnett, 44 N.Y.2d 302, 376 N.E.2d 1280, 1284-1285, 405 N.Y.S.2d 634, 639 (1978).
    • Health Ins. Ass'n of America v. Harnett, 44 N.Y.2d 302, 376 N.E.2d 1280, 1284-1285, 405 N.Y.S.2d 634, 639 (1978).
    • (1978)
  • 54
    • 69549100214 scopus 로고    scopus 로고
    • New Hampshire-Vermont Health Service v. Whaland, 119 N.H. 886, 410 A.2d 642 (1979).
    • New Hampshire-Vermont Health Service v. Whaland, 119 N.H. 886, 410 A.2d 642 (1979).
  • 55
    • 69549094700 scopus 로고    scopus 로고
    • Golden Rule Ins. Co. v. Stephens, 912 F.Supp. 261 (E.D.Ky. 1995) Golden Rule Ins. Co. v. Stephens, 912 F.Supp. 261 (E.D.Ky. 1995).
    • Golden Rule Ins. Co. v. Stephens, 912 F.Supp. 261 (E.D.Ky. 1995) Golden Rule Ins. Co. v. Stephens, 912 F.Supp. 261 (E.D.Ky. 1995).
  • 56
    • 69549129939 scopus 로고
    • S.W.2d 104 (Tex.App. limiting the number of temporary life insurance agents available to an insurer)
    • See, e.g., Massachusetts Indem. and Life Ins. Co. v. Texas State Bd. of Ins., 685 S.W.2d 104 (Tex.App. 1985 limiting the number of temporary life insurance agents available to an insurer)
    • (1985) Massachusetts Indem. and Life Ins. Co. V. Texas State Bd. of Ins. , vol.685
  • 57
    • 69549146047 scopus 로고    scopus 로고
    • Matter of Plan for Orderly Withdrawal from New Jersey of Twin City Fire Ins. Co., 591 A.2d 1005 (N.J. Super. A.D.1991) (prohibiting an insurer from continuing to do business in some insurance lines if it dropped others). Although insurance regulations generally survive due process challenges, they are usually challenged in state court and some states have their own particular lines of doctrinal development. In Florida, for example, statutes that prohibit discounted sales of insurance have been held unconstitutional.
    • Matter of Plan for Orderly Withdrawal from New Jersey of Twin City Fire Ins. Co., 591 A.2d 1005 (N.J. Super. A.D.1991) (prohibiting an insurer from continuing to do business in some insurance lines if it dropped others). Although insurance regulations generally survive due process challenges, they are usually challenged in state court and some states have their own particular lines of doctrinal development. In Florida, for example, statutes that prohibit discounted sales of insurance have been held unconstitutional.
  • 58
    • 69549152373 scopus 로고    scopus 로고
    • Chicago Title Ins. Co. v. Butler, 770 So.2d 1210 (Fla. 2000)
    • Chicago Title Ins. Co. v. Butler, 770 So.2d 1210 (Fla. 2000)
  • 59
    • 69549146514 scopus 로고    scopus 로고
    • Department of Insurance v. Dade County Consumer Advocate's Office, 492 So.2d 1032 (Fla.1986).
    • Department of Insurance v. Dade County Consumer Advocate's Office, 492 So.2d 1032 (Fla.1986).
  • 60
    • 69549152372 scopus 로고    scopus 로고
    • Goodin v. State of Oklahoma, ex rel. Oklahoma Welfare Commission, Dept. of Institutions, Social and Rehabilitative Services, 436 F.Supp. 583 (D.C.Okl. 1977
    • Goodin v. State of Oklahoma, ex rel. Oklahoma Welfare Commission, Dept. of Institutions, Social and Rehabilitative Services, 436 F.Supp. 583 (D.C.Okl. 1977
  • 61
    • 69549142102 scopus 로고    scopus 로고
    • Attoma v. State Department of Social Welfare, 270 N.Y.S.2d 167 (1966)
    • Attoma v. State Department of Social Welfare, 270 N.Y.S.2d 167 (1966)
  • 62
    • 69549141304 scopus 로고    scopus 로고
    • Merry Heart Nursing and Con. Home v. Dougherty, 330 A.2d 370 (1974)
    • Merry Heart Nursing and Con. Home v. Dougherty, 330 A.2d 370 (1974).
  • 63
    • 69549151468 scopus 로고    scopus 로고
    • United Seniors Ass'n, Inc. v. Shalala, 2 F.Supp.2d 39 (D.C. 1998).
    • United Seniors Ass'n, Inc. v. Shalala, 2 F.Supp.2d 39 (D.C. 1998).
  • 64
    • 69549146509 scopus 로고
    • Constitutional limits on state insurance regulation
    • R. E. Brown Constitutional Limits on State Insurance Regulation Tort & Insurance Law Journal 29 (1994 651 683.
    • (1994) Tort & Insurance Law Journal , vol.29 , pp. 651-683
    • Brown, R.E.1
  • 65
    • 69549142101 scopus 로고    scopus 로고
    • Colonial Life Ins. Co. v. Curiale, 617 N.Y.S.2d 377 (1994)
    • Colonial Life Ins. Co. v. Curiale, 617 N.Y.S.2d 377 (1994).
  • 66
    • 69549146048 scopus 로고    scopus 로고
    • U.S. 591. analyzing the implications of the takings clause for utility rate-setting).
    • F.P.C. v. Hope Natural Gas, 320 U.S. 591 (1944 analyzing the implications of the takings clause for utility rate-setting).
  • 67
    • 84869708369 scopus 로고    scopus 로고
    • 5 U.S.C. §§ 552, 552a, 552b, 553, 554 & 702 (2007)
    • -5 U.S.C. §§ 552, 552a, 552b, 553, 554 & 702 (2007).
  • 68
    • 84869604446 scopus 로고    scopus 로고
    • http://www.nfoic.org/state-foi-laws last visited June 15, 2009) and the Freedom of Information Center of the Missouri School of Journalism last visited June 15, 2009)
    • These can be found at the Open Government Guidehttp://www.rcfp.org/ogg/ index.php last visited June 15, 2009) and the Freedom of Information Center of the Missouri School of Journalismhttp://www.nfoic.org/state-foi-laws last visited June 15, 2009).
    • These Can Be Found at the Open Government Guide
  • 69
    • 84869708370 scopus 로고    scopus 로고
    • Presumably much of the information received by insurance exchanges would be exempt from public disclosure under state law equivalents to the federal freedom of information act exemptions for "commercial and financial information obtained from a person and privileged and confidential," 5 U.S.C. § 552(b)(4. and "personnel and medical files and similar files the disclosure of which would constitute a clearly unwarranted invasion of personal privacy." 5 U.S.C. § 552(b)(6) (2008).
    • Presumably much of the information received by insurance exchanges would be exempt from public disclosure under state law equivalents to the federal freedom of information act exemptions for "commercial and financial information obtained from a person and privileged and confidential," 5 U.S.C. § 552(b)(4 2008 and "personnel and medical files and similar files the disclosure of which would constitute a clearly unwarranted invasion of personal privacy." 5 U.S.C. § 552(b)(6) (2008).
    • (2008)
  • 71
    • 84869723434 scopus 로고    scopus 로고
    • 29 U.S.C. § 1144 (2007).
    • -29 U.S.C. § 1144 (2007).
  • 72
    • 69549141297 scopus 로고    scopus 로고
    • Shaw v. Delta Airlines, 463 U.S. 85, 97 (1983)
    • Shaw v. Delta Airlines, 463 U.S. 85, 97 (1983).
  • 73
    • 84869730348 scopus 로고    scopus 로고
    • 29 U.S.C. § 1132. See Aetna Health Inc., v. Davila, 542 U.S. 200, 201 (2004).
    • -29 U.S.C. § 1132. See Aetna Health Inc., v. Davila, 542 U.S. 200, 201 (2004).
  • 74
    • 69549132866 scopus 로고    scopus 로고
    • The MEWA provisions of ERISA, however, allocate responsibility between the federal and state government to regulate private purchasing pools. See section III below.
    • The MEWA provisions of ERISA, however, allocate responsibility between the federal and state government to regulate private purchasing pools. See section III below.
  • 75
    • 84869708371 scopus 로고    scopus 로고
    • 29 U.S.C. § 1144(b)(2)(A) (2007)
    • -29 U.S.C. § 1144(b)(2)(A) (2007).
  • 76
    • 69549150667 scopus 로고    scopus 로고
    • One commentator has observed that if a state requires every resident to be covered by a health insurance policy, meeting specific minimum coverage requirements, it effectively requires employers to provide that level of coverage, which could raise ERISA concerns. See Zelinsky at 276
    • One commentator has observed that if a state requires every resident to be covered by a health insurance policy, meeting specific minimum coverage requirements, it effectively requires employers to provide that level of coverage, which could raise ERISA concerns. See Zelinsky, supra note 14, at 276.
    • Supra Note , vol.14
  • 77
    • 84869723432 scopus 로고    scopus 로고
    • 29 U.S.C. § 1144(a) (2007)
    • -29 U.S.C. § 1144(a) (2007).
  • 78
    • 69549146050 scopus 로고    scopus 로고
    • Cf. Retail Industry Leaders Ass' v. Fielder, 475 F.3d 180 (4th Cir. 2007)
    • Cf. Retail Industry Leaders Ass' v. Fielder, 475 F.3d 180 (4th Cir. 2007)
  • 79
    • 69549100213 scopus 로고    scopus 로고
    • Retail Industry Leaders Ass'n v. Suffolk County, 497 F.Supp.2d 403 (E.D.N.Y. 2007)
    • Retail Industry Leaders Ass'n v. Suffolk County, 497 F.Supp.2d 403 (E.D.N.Y. 2007)
  • 80
    • 69549152379 scopus 로고    scopus 로고
    • (finding ERISA preemption of Maryland and New York pay or play laws) and Golden Gate Restaurant Ass'n v. City and County of San Francisco, 546 F.3d 639, 2008 WL 4401387 (9th Cir. 2008)
    • (finding ERISA preemption of Maryland and New York pay or play laws) and Golden Gate Restaurant Ass'n v. City and County of San Francisco, 546 F.3d 639, 2008 WL 4401387 (9th Cir. 2008)
  • 81
    • 69549155894 scopus 로고    scopus 로고
    • This issue is discussed in another Legal solutions in health reform
    • (finding no preemption) paper authored by Peter Jacobson,J.D., M.P.H. See also A. B. Monahan, Pay or Play Laws, ERISA Preemption, and Potential Lessons from Massachusetts
    • (finding no preemption). This issue is discussed in another Legal Solutions in Health Reform paper authored by Peter Jacobson,J.D., M.P.H. See also A. B. Monahan, Pay or Play Laws, ERISA Preemption, and Potential Lessons from Massachusetts, University of Kansas Law Review 55 (2007): 1203-12320
    • (2007) University of Kansas Law Review , vol.55 , pp. 1203-1232
  • 82
    • 84869730340 scopus 로고    scopus 로고
    • ERISA Implications for State Health Care Access Initiatives: Impact of Maryland Fair Share Act: Court Decision,Academy Health State Coverage Initiatives last visitedDecember 16, 2008
    • P. A. Butler, ERISA Implications for State Health Care Access nitiatives: Impact of Maryland Fair Share Act: Court Decision,Academ Health State Coverage Initiatives, 2006http://www.statecoverage.net/SCINASHP.pdf> (last visited December 16, 2008).
    • (2006)
    • Butler, P.A.1
  • 83
    • 69549146056 scopus 로고    scopus 로고
    • Mackey v. Lanier Collection Agency, 486 U.S. 825 (1988)
    • Mackey v. Lanier Collection Agency, 486 U.S. 825 (1988).
  • 84
    • 69549147250 scopus 로고    scopus 로고
    • For the analysis in this section and in the section on HIPAA that follows, I am greatly indebted to Amy Monahan, Mark Hall, and Pat Butler. A monograph on "Section 125 Plans for Individual Insurance and HIPAA's Group Insurance Provisions," by Amy Monahan and Mark Hall was made available to me as I was drafting this paper and is now last visited June 15, 2009) California Healthcare Foundation, October 2008, last visited June 15, 2009).
    • For the analysis in this section and in the section on HIPAA that follows, I am greatly indebted to Amy Monahan, Mark Hall, and Pat Butler. A monograph on "Section 125 Plans for Individual Insurance and HIPAA's Group Insurance Provisions," by Amy Monahan and Mark Hall was made available to me as I was drafting this paper and is now available at http://www.phs.wfubmc. edu/public/pub-insurance/HIPAA-125-Policy-Brief-final.pdf last visited June 15, 2009). See also P. Butler, Employer Cafeteria Plans: States' Legal and Policy Issues, California Healthcare Foundation, October 2008http://www.chcf.org/ topics/download.cfm?pg=insurance&fn=EmployerCafeteriaPlans%2Epdf&pid= 511167&itemid=133770 last visited June 15, 2009).
    • Employer Cafeteria Plans: States' Legal and Policy Issues
    • Butler, P.1
  • 85
    • 84869708366 scopus 로고    scopus 로고
    • I.R.C. § 125 (1996)
    • I.R.C. § 125 (1996).
  • 86
    • 84869723422 scopus 로고    scopus 로고
    • 29 U.S.C. § 1002(1) (2007)
    • -29 U.S.C. § 1002(1) (2007).
  • 87
    • 69549132874 scopus 로고    scopus 로고
    • See New England Mut. Life Ins. Co. v. Baig, 166 F.3d 1 (1st Cir. 1999
    • See New England Mut. Life Ins. Co. v. Baig, 166 F.3d 1 (1st Cir. 1999
  • 88
    • 69549150669 scopus 로고    scopus 로고
    • O'Brien v. Mutual of Omaha Ins. Co., 99 F.Supp.2d 744 (E.D. La.)
    • O'Brien v. Mutual of Omaha Ins. Co., 99 F.Supp.2d 744 (E.D. La. 1999). Where employers are more involved in the insurance relationships or individual insurance policies seem to be part of a larger employee plan, however, the arrangements will be held subject to ERISA. Burrill v. Leco Corporation, 1998 WL 340781444 (W.D. Mich. 1998).
  • 89
    • 84869723424 scopus 로고    scopus 로고
    • 29 C.F.R. § 2510.3-1(j) (2007)
    • -29 C.F.R. § 2510.3-1(j) (2007).
  • 90
    • 69549094699 scopus 로고    scopus 로고
    • See, e.g., Butero v. Royal Maccabees Life Ins. Co. 174 F.3d 1207 (11th Cir. Hrabe v. Paul Revere Life Ins. Co., 951 F.Supp. 997, 1001 (M.D.Ala. 1996). There is also a line of ERISA cases that have held that a scheme under which an employer pays for individual insurance premiums on a payroll deduction basis is a group policy if the employee receives a discount that is otherwise not available for purchasing through the employer. See Tannenbaum v. Unum Life, 2006 U.S.Dist. LEXIS 6623 (E.D. Pa. Mar. 18, 2005)
    • See, e.g., Butero v. Royal Maccabees Life Ins. Co. 174 F.3d 1207 (11th Cir. 1999 Hrabe v. Paul Revere Life Ins. Co., 951 F.Supp. 997, 1001 (M.D.Ala. 1996). There is also a line of ERISA cases that have held that a scheme under which an employer pays for individual insurance premiums on a payroll deduction basis is a group policy if the employee receives a discount that is otherwise not available for purchasing through the employer. See Tannenbaum v. Unum Life, 2006 U.S.Dist. LEXIS 6623 (E.D. Pa. Mar. 18, 2005)
    • (1999)
  • 91
    • 69549140487 scopus 로고    scopus 로고
    • See Schwartz v. Provident Life and Accident, 280 F.Supp. 2d 937 (D.Ariz. Murdoch v. Unum Provident Co., 265 F.Supp. 2d 539 (W.D. Pa. 2002); Merrick v. Northwestern Mutual Life, F.Supp.2d, 2001 WL 34152095 (N.D.Iowa 2001) Byard v. Qualmed Plans for Health, Inc. 966 F.Supp. 354 (E.D. Pa. 1997); Levett v. American Heritage Life Ins. Co., 971 F.Supp. 1399 (M.D. Ala. 1997).
    • See Schwartz v. Provident Life and Accident, 280 F.Supp. 2d 937 (D.Ariz. 2003 Murdoch v. Unum Provident Co., 265 F.Supp. 2d 539 (W.D. Pa. 2002); Merrick v. Northwestern Mutual Life, F.Supp.2d, 2001 WL 34152095 (N.D.Iowa 2001)
    • (2003)
  • 92
    • 84869723419 scopus 로고    scopus 로고
    • Although there is no authority addressing this question, it would seem that participation by an employee in a state-mandated § 125 arrangement would still be "voluntary" under the terms of the safe harbor because it would not be required by the employer, which is the concern of the regulation.
    • Although there is no authority addressing this question, it would seem that participation by an employee in a state-mandated § 125 arrangement would still be "voluntary" under the terms of the safe harbor because it would not be required by the employer, which is the concern of the regulation.
  • 94
    • 84869730336 scopus 로고    scopus 로고
    • U.S. Dept. of Labor, Advisory Opinion 96-12A. In the particular situation at issue in the opinion, the § 125 arrangement was used to pay premiums for an ERISA plan, and thus became part of the ERISA plan.
    • U.S. Dept. of Labor, Advisory Opinion 96-12A, July 17, 1996. In the particular situation at issue in the opinion, the § 125 arrangement was used to pay premiums for an ERISA plan, and thus became part of the ERISA plan.
    • (1996)
  • 95
    • 84869723418 scopus 로고    scopus 로고
    • 26 U.S.C. §§ 9801. 29 U.S.C. § 1182 (2007); 42 U.S.C. § 300gg-1 (2007); I.R.C. § 9802.
    • -26 U.S.C. §§ 9801 (2007 29 U.S.C. § 1182 (2007); 42 U.S.C. § 300gg-1 (2007); I.R.C. § 9802.
    • (2007)
  • 96
    • 69549153896 scopus 로고    scopus 로고
    • Id.
    • Id.
  • 97
    • 84869723413 scopus 로고    scopus 로고
    • 29 U.S.C. § 1002(1). See 42 USC § 300gg-1 and 42 USC § 300g-91.
    • -29 U.S.C. § 1002(1). See 42 USC § 300gg-1 and 42 USC § 300g-91.
  • 98
    • 84869728431 scopus 로고    scopus 로고
    • 29 C.F.R. § 2590.702 (2008)
    • -29 C.F.R. § 2590.702 (2008).
  • 99
    • 84872536924 scopus 로고    scopus 로고
    • at 3-4 Section 125 also has its own non-discrimination provisions that apply to discrimination in favor of highly compensated employees and key employees. These provisions are not discussed here (see for thorough analysis of these provisions.) If they are violated, however, favored employees may not be able to take advantage of the tax advantages offered by § 125.
    • Section 125 also has its own non-discrimination provisions that apply to discrimination in favor of highly compensated employees and key employees. These provisions are not discussed here (see Butler, supra note 52, at 3-4 for thorough analysis of these provisions.) If they are violated, however, favored employees may not be able to take advantage of the tax advantages offered by § 125.
    • Supra Note , vol.52
    • Butler1
  • 100
    • 84869708354 scopus 로고    scopus 로고
    • I.R.C. § 5000(b)(1).
    • I.R.C. § 5000(b)(1).
  • 101
    • 84869708355 scopus 로고    scopus 로고
    • Dept. of the Treasury, Proposed Rule, 72 Fed. Reg. 43938. to be codified at 26 C.F.R. § 125-1(m). It would seem to make no sense for the Treasury Department to specify that individual policies could be purchased through a § 125 arrangement if all health insurance purchases made through a § 125 arrangement automatically became part of a group health plan due to the fact that § 125 contributions are considered employer contributions for tax purposes.
    • Dept. of the Treasury, Proposed Rule, 72 Fed. Reg. 43938 (Aug. 6, 2007) to be codified at 26 C.F.R. § 125-1(m). It would seem to make no sense for the Treasury Department to specify that individual policies could be purchased through a § 125 arrangement if all health insurance purchases made through a § 125 arrangement automatically became part of a group health plan due to the fact that § 125 contributions are considered employer contributions for tax purposes.
    • (2007)
  • 102
    • 84869698592 scopus 로고    scopus 로고
    • I.R.C. § 125(d) and (f).
    • I.R.C. § 125(d) and (f).
  • 104
    • 69549140486 scopus 로고    scopus 로고
    • at 3. The one case that has interpreted the tax code definition (for the purposes of a different law that uses the same definition) held that the fact that individual policies paid for on a payroll deduction basis were issued to employees rather than through a group policy conclusively determined that the policies were individual rather than group policies. Brooks v. Blue Cross & Blue Shield of Florida, 116 F.3d 1364 (11th Cir. 1997) (interpreting the definition for the Medicare as secondary payer statute.) This would not, of course, be persuasive authority for interpreting the definition for HIPAA purposes. The tax definition of group plan is also used for COBRA continuation coverage requirements. Regulations implementing COBRA regulation seem to extend the reach of that definition.
    • Monahan, supra note 51 at 3. The one case that has interpreted the tax code definition (for the purposes of a different law that uses the same definition) held that the fact that individual policies paid for on a payroll deduction basis were issued to employees rather than through a group policy conclusively determined that the policies were individual rather than group policies. Brooks v. Blue Cross & Blue Shield of Florida, 116 F.3d 1364 (11th Cir. 1997) (interpreting the definition for the Medicare as secondary payer statute.) This would not, of course, be persuasive authority for interpreting the definition for HIPAA purposes. The tax definition of group plan is also used for COBRA continuation coverage requirements. Regulations implementing COBRA regulation seem to extend the reach of that definition. 26 C.F.R. § 54.4980B-2 provides that insurance provided through individual policies by an employer could constitute group coverage "even if the employer or employee organization does not contribute to it if coverage under the plan would not be available at the same cost to an individual but for the individual's employment-related connection to the employer or employee organization." This definition is not directly relevant to HIPAA coverage, but might be used by a court to interpret ERISA.
    • Supra Note , vol.51
    • Monahan1
  • 106
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    • What have we learned from research on small insurance reforms?
    • On coverage mandates, see. and. A. C. Monheit and J. Rizzo, Mandated Health Insurance Benefits: A Critical Review of the Literature, New Jersey Dept. of Human Services and Rutgers Center for State Health Policy, January 2007 last visited June 15, 2009). On rating reforms A. C. Monheit and J. C. Cantor, eds. New York: Rutledge
    • On coverage mandates, see F. A. Sloan and C. J. Conover Effects of State Reforms on Health Insurance Coverage of Adults Inquiry 39 (1998 118 A. C. Monheit and J. Rizzo, Mandated Health Insurance Benefits: A Critical Review of the Literature, New Jersey Dept. of Human Services and Rutgers Center for State Health Policy, January 2007http://www.cshp.rutgers.edu/Downloads/7130.pdf last visited June 15, 2009). On rating reforms
    • (1998) Effects of State Reforms on Health Insurance Coverage of Adults Inquiry , vol.39 , pp. 118
    • Sloan, F.A.1    Conover, C.J.2    Simon, K.I.3
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    • What have we learned from research on individual market eforms?
    • A. C. Monheit and J. C. Cantor, eds. New York: Rutledge
    • D. Chollet, "What Have We Learned from Research on Individual Market Reforms?" in A. C. Monheit and J. C. Cantor, eds., State Health Insurance Market Reform (New York: Rutledge, 2004).
    • (2004) State Health Insurance Market Reform
    • Chollet, D.1
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  • 110
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    • It should be noted that the line between private and public purchasing exchanges might not always be bright. The state may become so entwined with private actors that their actions can become state action for purposes of constitutional constraints
    • It should be noted that the line between private and public purchasing exchanges might not always be bright. The state may become so entwined with private actors that their actions can become state action for purposes of constitutional constraints
    • (2001)
  • 111
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    • See Brentwood Academy v. Tennessee Secondary School Athletic Ass'n, 531 U.S. 288 (2001 stating actions of private entities will be viewed as state actions when the two are irreparably entwined).
    • See Brentwood Academy v. Tennessee Secondary School Athletic Ass'n, 531 U.S. 288 (2001 stating actions of private entities will be viewed as state actions when the two are irreparably entwined).
  • 112
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    • NAIC Model Laws, Regulations and Guidelines, 82-1.
    • NAIC Model Laws, Regulations and Guidelines, 82-1.
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    • According to the NAIC, 22 states have adopted the Model Act or related legislation or regulations. See also. OLR Research Report. last visited June 15, 2009).
    • According to the NAIC, 22 states have adopted the Model Act or related legislation or regulations. See also J. L. Kaminski Health Insurance Purchasing Cooperatives OLR Research Report, 2006http://www.cga.ct.gov/2006/rpt/2006-R- 0005.htm last visited June 15, 2009).
    • (2006) Health Insurance Purchasing Cooperatives
    • Kaminski, J.L.1
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    • Association health plans: What's all the fuss about?
    • See
    • See M. Kofman et al. Association Health Plans: What's All the Fuss About? Health Affairs 25, no. 6 (2006 1591 1602.
    • (2006) Health Affairs , vol.25 , Issue.6 , pp. 1591-1602
    • Kofman, M.1
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    • The geography of health insurance regulation
    • at 178-179.
    • M. A. Hall The Geography of Health Insurance Regulation Health Affairs 19, no. 2 (2000 173 184, at 178-179.
    • (2000) Health Affairs , vol.19 , Issue.2 , pp. 173-184
    • Hall, M.A.1
  • 116
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    • 15 U.S.C. §§ 1 & 2 (2007)
    • -15 U.S.C. §§ 1 & 2 (2007).
  • 117
    • 69549144393 scopus 로고    scopus 로고
    • California Retail Liquor Dealers Ass'n v. Midcal Aluminum, Inc., 445 U.S. 97 (1980); Parker v. Brown, 317 U.S. 341 (1943)
    • California Retail Liquor Dealers Ass'n v. Midcal Aluminum, Inc., 445 U.S. 97 (1980); Parker v. Brown, 317 U.S. 341 (1943)
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    • Health care reform and competing visions of medical care: Antitrust and state provider cooperation legislation
    • J. Blumstein, "Health Care Reform and Competing Visions of Medical Care: Antitrust and State Provider Cooperation Legislation," Cornell Law Review 79 (1994): 1459-1506
    • (1994) Cornell Law Review , vol.79 , pp. 1459-1506
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    • Health insurance purchasing alliances: Monopsony threat or rocompetitive Rx for health sector ills?
    • F. Miller, "Health Insurance Purchasing Alliances: Monopsony Threat or Procompetitive Rx for Health Sector Ills?" Cornell Law Review 79 (1994): 1546-1572.
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    • Miller, F.1
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    • C. Havighurst Antitrust Issues in the Joint Purchasing of Health Care Utah Law Review 1995 (1995 409 450.
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    • Havighurst, C.1
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    • Quality of care and market failure defenses in antitrust health care litigation
    • See. In a 1994 business review letter, the Department of Justice stated that it would not challenge a purchasing group representing sixteen large private firms and the California Public Employees Retirement System that proposed to negotiate a price for two standard benefit plans with Health Maintenance Organizations (HMOs) for its members, with an understanding that the members would not negotiate independently with the HMOs (although they could contract outside the group with other HMOs), because the Justice Department concluded that the arrangement had the potential to create efficiencies and bring about lower health care costs. Bay Area Business Group on Health, Letter Number 94-4, Trade Regulation Reporter (CCH), ¶ 44,094 (February 18, 1994).
    • See T. Greaney Quality of Care and Market Failure Defenses in Antitrust Health Care Litigation Connecticut Law Review 21 (1989 605 665. In a 1994 business review letter, the Department of Justice stated that it would not challenge a purchasing group representing sixteen large private firms and the California Public Employees Retirement System that proposed to negotiate a price for two standard benefit plans with Health Maintenance Organizations (HMOs) for its members, with an understanding that the members would not negotiate independently with the HMOs (although they could contract outside the group with other HMOs), because the Justice Department concluded that the arrangement had the potential to create efficiencies and bring about lower health care costs. Bay Area Business Group on Health, Letter Number 94-4, Trade Regulation Reporter (CCH), ¶ 44,094 (February 18, 1994).
    • (1989) Connecticut Law Review , vol.21 , pp. 605-665
    • Greaney, T.1
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    • Chicago Board of Trade v. United States, 246 U.S. 231 at 417
    • Chicago Board of Trade v. United States, 246 U.S. 231 (1918 see Havighurst, supra note 82, at 417.
    • (1918) Supra Note , vol.82
    • Havighurst1
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    • 84869708351 scopus 로고    scopus 로고
    • See U.S. Dept. of Justice, Statements of Antitrust in Health Care Policy Issued By the Dept. of Justice and Federal Trade Commission. at 68, last visited June 15, 2009).
    • See U.S. Dept. of Justice, Statements of Antitrust in Health Care Policy Issued By the Dept. of Justice and Federal Trade Commission, August 1996, at 68http://www.usdoj.gov/atr/public/guidelines/0000.pdf last visited June 15, 2009).
    • (1996)
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    • 29 U.S.C. § 1002(40) (2008)
    • -29 U.S.C. § 1002(40) (2008).
  • 126
    • 84869698587 scopus 로고    scopus 로고
    • 29 U.S.C. § 1002(1) (2008)
    • -29 U.S.C. § 1002(1) (2008).
  • 127
    • 84869730324 scopus 로고    scopus 로고
    • 29 U.S.C. § 1002(5) (2008)
    • -29 U.S.C. § 1002(5) (2008).
  • 128
    • 84869730321 scopus 로고    scopus 로고
    • It could perhaps be argued that insurance exchanges are not formed for the purpose of "offering or providing" benefits, but rather merely to facilitate access to insurers who independently offer benefits. This seems to be an implausible argument.
    • It could perhaps be argued that insurance exchanges are not formed for the purpose of "offering or providing" benefits, but rather merely to facilitate access to insurers who independently offer benefits. This seems to be an implausible argument.
  • 129
    • 84869723407 scopus 로고    scopus 로고
    • U.S. Dept. of Labor, MEWAs: Multiple Employer Welfare Arrangements under the Employee Retirement Income Security Act (ERISA): A Guide to Federal and State Regulation, 2004 last visited June 15, 2009); S. Stadtmauer, "Self-Insured MEWAs: Are the Risks Worth the Reward?" Quinnipiac Health Law Journal 7(2003-4): 284-287.
    • U.S. Dept. of Labor, MEWAs: Multiple Employer Welfare Arrangements under the Employee Retirement Income Security Act (ERISA): A Guide to Federal and State Regulation, 2004http://www.dol.gov/ebsa/pdf/mwguide.pdf last visited June 15, 2009); S. Stadtmauer, "Self-Insured MEWAs: Are the Risks Worth the Reward?" Quinnipiac Health Law Journal 7(2003-4): 284-287.
  • 130
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    • Moideen v. Gillespie, 55 F.3d 1478 (9th Cir. 1995)
    • Moideen v. Gillespie, 55 F.3d 1478 (9th Cir. 1995).
  • 131
    • 0347212487 scopus 로고    scopus 로고
    • See U.S. Dept. of Labor
    • See U.S. Dept. of Labor, supra note 91.
    • Supra Note , vol.91
  • 132
    • 69549152375 scopus 로고    scopus 로고
    • See Donovan v. Dillingham, 688 F.2d 1367 (11th Cir. 1982)
    • See Donovan v. Dillingham, 688 F.2d 1367 (11th Cir. 1982)
  • 133
    • 84869708345 scopus 로고    scopus 로고
    • Chao v. Crouse, 346 F.Supp.2d 975 (S.D.Ind. 2004.). They may also be subject to other ERISA obligations imposed on administrators as opposed to obligations imposed on plans. See, e.g., 29 C.F.R. § 29 C.F.R. § 2560.503-1(f) - (j) (2007).
    • Chao v. Crouse, 346 F.Supp.2d 975 (S.D.Ind. 2004.). They may also be subject to other ERISA obligations imposed on administrators as opposed to obligations imposed on plans. See, e.g., 29 C.F.R. § 29 C.F.R. § 2560.503-1(f) - (j) (2007).
  • 134
    • 84869730322 scopus 로고    scopus 로고
    • U.S. Dept. of Labor, Employee Benefits Security Administration, "FAQS on the Form M-1," last visited June 15, 2009).
    • U.S. Dept. of Labor, Employee Benefits Security Administration, "FAQS on the Form M-1," available at http://www.dol.gov/ebsa/faqs/faq- FormM1.html last visited June 15, 2009).
  • 135
    • 84869698586 scopus 로고    scopus 로고
    • 29 U.S.C. § 1144(b)(2)(B) (2008)
    • -29 U.S.C. § 1144(b)(2)(B) (2008).
  • 136
    • 84869708346 scopus 로고    scopus 로고
    • 29 U.S.C. § 1144(b)(6)(A) (2008)
    • -29 U.S.C. § 1144(b)(6)(A) (2008).
  • 137
    • 69549132872 scopus 로고    scopus 로고
    • Id.
    • Id.
  • 138
    • 84869723408 scopus 로고    scopus 로고
    • Under 29 U.S.C. § 1144, a MEWA is considered to be "fully insured," "only if the terms of the arrangement provide for benefits ... guaranteed under a contract, or policy of insurance, issued by an insurance company, insurance service, or insurance organization, qualified to conduct business in a State." 29 U.S.C. § 1144(b)(6)(D)
    • Under 29 U.S.C. § 1144, a MEWA is considered to be "fully insured," "only if the terms of the arrangement provide for benefits... guaranteed under a contract, or policy of insurance, issued by an insurance company, insurance service, or insurance organization, qualified to conduct business in a State." 29 U.S.C. § 1144(b)(6)(D) (2008).
    • (2008)
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    • MDPhysicians & Associates, Inc. v. State Bd. of Ins, 957 F.2d 178 (5th Cir.
    • MDPhysicians & Associates, Inc. v. State Bd. of Ins, 957 F.2d 178 (5th Cir. 1992).
    • (1992)
  • 140
    • 69549152999 scopus 로고
    • Niethammer v. Prudential Ins. Co. of America. WL 1629886 (E.D.Mo. 2007); May Hollingshead v. Matsen, 40 Cal.Rptr.2d 603 (CalApp.
    • Niethammer v. Prudential Ins. Co. of America, 2007 WL 1629886 (E.D.Mo. 2007); May Hollingshead v. Matsen, 40 Cal.Rptr.2d 603 (CalApp. 1995).
    • (1995)
  • 141
    • 69549154299 scopus 로고    scopus 로고
    • Independent Distributors Co-op. USA v. Advanced Ins. Brokerage of America, Inc. 264 F.Supp.2d 796 (S.D. Ind.
    • Independent Distributors Co-op. USA v. Advanced Ins. Brokerage of America, Inc. 264 F.Supp.2d 796 (S.D. Ind. 2003).
    • (2003)
  • 142
    • 69549099443 scopus 로고
    • Donovan v. Dillingham, 688 F.2d 1367 (11th Cir. Chao v. Crouse, 346 F.Supp.2d 975 (S.D.Ind. 2004).
    • Donovan v. Dillingham, 688 F.2d 1367 (11th Cir. 1982 Chao v. Crouse, 346 F.Supp.2d 975 (S.D.Ind. 2004).
    • (1982)
  • 143
    • 33845334390 scopus 로고    scopus 로고
    • http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=21070
    • M. Kofman et al., "Insurance Markets, Group Purchasing Arrangements: Implications of MEWAs," California Healthcare Foundaton, Issue Brief, July 2003 tp://www.chcf.org/topics/healthinsurance/index.cfm?itemID=21070 last visited June 15, 2009).
    • (2004) MEWAs: The Threat of Plan Insolvency and Other Challenges
    • Kofman, M.1
  • 146
    • 84869708340 scopus 로고    scopus 로고
    • 45 C.F.R. § 164.500(b) (2007).
    • -45 C.F.R. § 164.500(b) (2007).
  • 147
    • 84869730316 scopus 로고    scopus 로고
    • 45 C.F.R. §§ 160.103. Although the term "health care clearinghouses" would seem to apply to insurance exchanges, in fact it refers to specific kinds of entities that standardize health data.
    • -45 C.F.R. §§ 160.103. (2007). Although the term "health care clearinghouses" would seem to apply to insurance exchanges, in fact it refers to specific kinds of entities that standardize health data.
    • (2007)
  • 148
    • 84869723404 scopus 로고    scopus 로고
    • Unless it could be argued that an exchange is described by the part of the health plan definition that refers to "any other individual or group plan, or combination of individual or group plans that provides or pays for the cost of medical care." 45 C.F.R. §§ 160.103
    • Unless it could be argued that an exchange is described by the part of the health plan definition that refers to "any other individual or group plan, or combination of individual or group plans that provides or pays for the cost of medical care." 45 C.F.R. §§ 160.103 (2007).
    • (2007)
  • 149
    • 84869723403 scopus 로고    scopus 로고
    • 45 C.F.R. § 164.501 (2007)
    • -45 C.F.R. § 164.501 (2007).
  • 150
    • 84869723401 scopus 로고    scopus 로고
    • 45 C.F.R. §§ 164.502(d), 164.514(a) & (b) (2007)
    • -45 C.F.R. §§ 164.502(d), 164.514(a) & (b) (2007).
  • 151
    • 84869698585 scopus 로고    scopus 로고
    • 45 C.F.R. §§ 160.103, 164.502(e), 164.504(e) (2007)
    • -45 C.F.R. §§ 160.103, 164.502(e), 164.504(e) (2007).
  • 152
    • 84869723399 scopus 로고    scopus 로고
    • 45 C.F.R. § 160.504(a) & (f) (2007)
    • -45 C.F.R. § 160.504(a) & (f) (2007).
  • 153
    • 84869730313 scopus 로고    scopus 로고
    • 45 C.F.R. § 164.502(e)(1)(i) (2007)
    • -45 C.F.R. § 164.502(e)(1)(i) (2007).
  • 154
    • 84869708339 scopus 로고    scopus 로고
    • 42 U.S.C. § 1320d(5) (2008)
    • -42 U.S.C. § 1320d(5) (2008).


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.