NU Online News Service, April 2, 2003, 5:23 p.m. EST – Washington
The U.S. Supreme Court has handed down a unanimous ruling that upholds Kentucky’s “any willing provider” statute.
The statute prohibits health insurers from discriminating against any qualified doctor or other qualified health care provider who is willing to meet the terms and conditions for participation in the plan’s provider network.
Today, many health insurers limit participation in their networks in an effort to keep out bad doctors and hospitals and ensure that network providers get enough patients to offer significant volume discounts. But some states have enacted AWP laws to give consumers more flexibility and help doctors who feel shut out get into the provider networks.
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Many groups representing providers are applauding the new ruling, on Kentucky Association of Health Plans v. Miller, but health insurers say the ruling will increase health insurance premiums and may even hurt the quality of care.
“Ultimately, it is the American worker who will bear the brunt of this decision,” says Dr. Donald Young, president of the Health Insurance Association of America, Washington.
AWP laws lead to unnecessary government interference in private relationships between doctors and health plans, Young says.
The Kentucky Association of Health Plans, Frankfort, Ky., sued to prevent enforcement of the Kentucky AWP law, arguing that it is preempted by the Employee Retirement Income Security Act of 1974.
ERISA preempts state laws that relate to employee benefit plans, but state laws that regulate the business of insurance are saved from preemption.
The Kentucky association argued that the AWP law does not regulate the business of insurance and thus is not saved from preemption.
Both a U.S. district court and the 6th Circuit Court of Appeals ruled against the Kentucky association and upheld the AWP law.
The Supreme Court agreed, in an opinion written by Justice Antonin Scalia.
In the first part of the opinion, the court rejected the Kentucky Association’s argument that the AWP law is not “specifically directed” toward the insurance industry.