ERISA - Bill of Health

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The Infertility Shift

May 12, 2023May 5, 2023 The Petrie-Flom Center Staff Leave a comment

By Valarie K. Blake and Elizabeth Y. McCuskey

In vitro fertilization (IVF), like most medical care in the U.S., costs far more than most people can afford out-of-pocket: over $12,500 per cycle, with multiple cycles typically required. But, unlike most other expensive medical care, IVF rarely has insurance coverage to defray the cost.

In 2020, only 27% of employers with 500+ employees and 42% of employers with 20,000+ employees covered IVF in their employer plans. Companies like Starbucks and Amazon know this and use it to draw in employees at low (or essentially neutral) wages.

Recent reports reveal women working second shifts for these corporations solely to qualify for employer health benefits that cover infertility treatments. Starbucks, for example, covers IVF for employees who work 240 hours over three months, or roughly 20 hours per week. Frequently, in these low-wage positions, workers earn just enough to pay for their health insurance premiums and sometimes the associated cost-sharing requirements.

How did we get to a place where women must work an “infertility shift” beyond their full-time jobs to access medical care?

Three Reactions to Braidwood v. Becerra

April 3, 2023April 3, 2023 The Petrie-Flom Center Staff Leave a comment

Last week, a federal judge in Texas dealt a blow to the Affordable Care Act’s preventative care requirements that private insurers cover services such as behavioral counseling, HPV vaccination, and pre-exposure prophylaxis for HIV/AIDS (PrEP). In Braidwood Management Inc. v. Becerra, Judge Reed O’Connor enjoined the enforcement of the preventative care coverage mandate.

Led by Braidwood Management Inc., the plaintiffs claimed that the preventive services requirements were unconstitutional, violating the Appointments Clause and the Nondelegation Doctrine. Further, they argued that requiring coverage of PrEP violates the Religious Freedom Restoration Act.

In siding with the plaintiffs, Judge O’Connor has jeopardized access to critical health care services, potentially affecting over 150 million insured Americans. The Biden administration was quick to challenge the ruling; on Friday, attorneys for the Department of Health and Human Services filed a notice of appeal.

To make sense of these developments, leading experts in health law policy analyze Judge O’Connor’s ruling below.
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Health Reform via State Waiver

May 24, 2021May 21, 2021 The Petrie-Flom Center Staff Leave a comment

By Erin Fuse Brown and Chelsea Campbell

The path to systemic health reform in the U.S. may run through the states. To get there, the Biden/Harris administration should use its existing waiver authority under federal health care statutes to facilitate progressive state health reform efforts, including a state-based public option or single-payer plan.

One of the benefits of the United States’ federalist system, in which the power to enact policy and govern is divided between the national government and the states, is that we can test policies at the state level, and if we can establish a proof of concept there, it smooths the way for federal reform.

Hand arranging wood block pyramid with health icons on each block.

ERISA Preemption Reform: Unlocking States’ Capacity for Incremental Reform

May 10, 2021May 10, 2021 The Petrie-Flom Center Staff Leave a comment

By Elizabeth McCuskey

For the past 46 years, the Employee Retirement Income Security Act (ERISA) has preempted state regulation that “relates to” employer-sponsored health benefits.

Much has changed in health care and society over that time; but ERISA’s preemption abides — widely maligned, yet unaltered. An ERISA preemption waiver thus presents a long-overdue update to health care regulation with a lot to recommend it to the Biden Administration’s health care agenda: it enables states to “strengthen and build on the Affordable Care Act,” it offers a modest incremental step that could pave the way for bigger structural change, it prompts no federal spending, and it has bipartisan political support.

The preemption provision in 1974 was supposed to entice multistate employers to offer benefits by creating some federal uniformity in benefit regulation. For health benefits, however, that uniformity has been largely deregulatory.

ERISA preemption currently prevents states from fully enforcing a wide variety of health reforms, ranging from claims data collection to state-level employer mandates. And it casts a pall of private litigation challenges over even the ones that should be enforceable, like surprise billing regulation, prescription drug pricing measures, and state and local public option plans.

A Legislative Override Could Save the ACA (and Fix Other Misapplications of Health Laws)

May 6, 2021May 20, 2021 The Petrie-Flom Center Staff Leave a comment

By John Aloysius Cogan, Jr.

The Congressional Democrats and the Biden administration need not wait for the Supreme Court to determine the fate of the Affordable Care Act (ACA) in California v. Texas; they can take charge of the case today by enacting and signing into law overriding legislation.

Since the threat to the ACA is based on the interpretation of a federal statute — the ACA’s “inseverability clause” — Congress is within its rights to take charge of the case. Why? Because courts are not the final word on the meaning of a statute, Congress is.

Symposium Introduction: Recommendations for a Biden/Harris Health Policy Agenda

May 3, 2021May 19, 2022 The Petrie-Flom Center Staff Leave a comment

By Erin C. Fuse Brown

This digital symposium explores recommendations for the Biden/Harris administration’s health policy agenda. We asked leading health law scholars to describe one health policy action the administration should pursue, beyond the pandemic response. Their recommendations make up this symposium. The responses range from concrete policy changes to broad reform ideas and can be grouped into three categories, those that (1) Reverse and Restore; (2) Reinforce; (3) Reform.

New TWIHL with Erin Fuse Brown and Elizabeth McCuskey

November 26, 2019November 25, 2019 Nicolas P. Terry Leave a comment

Erin Fuse Brown and Elizabeth McCuskey have a fantastic new article coming out in the University of Pennsylvania Law Review entitled “Federalism, ERISA, and State Single-Payer Health Care” that is the subject of our conversation.

Erin Fuse Brown is a Professor of Law at Georgia State University’s College of law. She teaches Administrative Law; Health Law: Financing & Delivery; and the Health Care Transactional & Regulatory Practicum. She is a faculty member of the Center for Law, Health & Society. In 2019 Professor Fuse Brown was awarded a grant from the Laura and John Arnold Foundation to study out-of-network air ambulance bills. She served as co-investigator on a grant from the National Human Genome Research Institute from 2014-2017 to study legal protections for participants in genomic research and in 2017 won the Patricia T. Morgan Award for Outstanding Scholarship among her faculty. Elizabeth McCuskey is a Professor Law at UMass School of Law, There she teaches Civil Procedure, Health Law, Food & Drug Law, and Health Care Antitrust courses. Her research focuses on regulatory reforms for health equity and courts’ roles in securing those reforms. She is broadly published and her work on ERISA preemption and state health reform was featured on Health Affairs Blog and she has covered FDA preemption for SCOTUSBlog. She was a 2016 ASLME Health Law Scholar.

The Week in Health Law Podcast from Nicolas Terry is a commuting-length discussion about some of the more thorny issues in health law and policy. Subscribe at Apple Podcasts or Google Play, listen at Stitcher Radio, Spotify, Tunein or Podbean.

Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find me on Twitter @nicolasterry or @WeekInHealthLaw.

Tag: ERISA