High Court Hears Case With Big Stakes For HMOs
The viability of health maintenance organizations could be at stake in a case heard last week by the United States Supreme Court.
The issue involves state “any willing provider” statutes, which require HMOs and other managed care organizations (MCOs) to offer contracts to all physicians and other health care providers who are willing to meet terms and conditions for participation in the health plan.
The Sixth Circuit Court of Appeals recently upheld Kentuckys any willing provider 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 Sixth Circuits opinion is allowed to stand, the implications for health plans are severe.
“The holding of the Sixth Circuit Court of Appeals threatens the financial ability of the nations 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, the American Association of Health Plans, the Health Insurance Association of America and the Blue Cross/Blue Shield Association.
“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 in defending AWP statutes. The statute, according to a brief filed by the American Medical Association, regulates the relationship between physicians, as well as other health care professionals, and health insurers.
It is, AMA says, one of a myriad of laws that regulate health care.
“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,” AMA says.