Homestoryvs. Insurers › A Blow to Health Plan Patients

News Story

A Blow to Health Plan Patients

Opinion:

The Supreme Court seems to have made the right legal judgment this week when it ruled that patients cannot sue in state courts when their managed care plans refuse to pay for treatments ordered by doctors. The nine justices' unanimous decision, expressed in majority and concurring opinions, left no room for doubt that a federal law known as Erisa, which governs employment-based health plans, pre-empts any effort by the states to give patients the right to sue for damages.

That is bad news for patients who suffer harm because of their health plans' refusal to pay. They can still sue in federal courts, but under Erisa, the Employee Retirement Income Security Act of 1974, they can seek only reimbursement for the benefits they were denied, not compensation or punitive damages for any additional costs or harm stemming from such denials. Ten states have passed laws giving patients the right to seek those damages in state courts, but the Supreme Court's ruling invalidates them all.

The two patients involved in the pair of Texas cases that provoked this week's ruling had clear grievances. A woman who had a hysterectomy was discharged after a day in the hospital even though her doctor recommended a longer stay. She developed complications and was readmitted to the emergency room several days later. A man who was prescribed an expensive medicine for arthritis was forced to start with cheaper medicine that was more likely to cause intestinal bleeding, a complication that brought the patient near death. These patients surely deserved a day in court.

With the state courts now closed off to aggrieved managed care patients, the only real remedy may lie with Congress, which has deadlocked over proposals for a patients' bill of rights for many years now. This page has long endorsed a strong patients' rights bill that would allow managed care plans to be held accountable in state courts, as doctors already are. The issue ought to be debated in the presidential campaign.