NU Online News Service, Jan. 14, 2:17 p.m. — Washington
The viability of health maintenance organizations could be at stake in a case scheduled to be heard today by the U.S. Supreme Court.
The issue involves state “any willing provider” statutes, which require HMOs and other managed care organizations to offer contracts to all physicians and other health care providers who are willing to meet the terms and conditions for participation in the health plan.
The 6th Circuit Court of Appeals recently upheld Kentucky’s AWP statute, arguing that it regulates the business of insurance and thus is not preempted by the Employee Retirement Income Security Act.
Health plans and employers say that if the 6th Circuit’s opinion is allowed to stand, the implications for health plans are severe.
“The holding of the 6th Circuit Court of Appeals threatens the financial ability of the nation’s employers to provide comprehensive health benefits to their employees, who depend upon their employment for health care coverage for themselves and their dependents,” according to a brief filed jointly by the National Association of Manufacturers, Washington; the American Association of Health Plans, Washington; the Health Insurance Association of America, Washington; and the Blue Cross and Blue Shield Association, Chicago.
“That holding, if allowed to stand, eliminates long-standing and effective means of cost control utilized by HMOs and other MCOs,” the brief says.
But physicians are just as adamant about defending AWP statutes. The statute, according to a brief filed by the American Medical Association, Chicago, regulates the relationship between physicians, as well as other health care professionals, and health insurers.
The statute is one of many laws that regulate health care, the AMA says.
“This court has repeatedly indicated that, in the absence of a clear expression of congressional intent, federal statutes should not displace traditional state regulation of health care,” the AMA says.
AWP statutes have become the focal point of the dispute between physicians and insurers over managed care. The NAM brief says that the inability of MCOs to control the number of providers in a network deprives them of the ability to negotiate rates on the basis of volume discounts.