HMO ruling by supreme court can affect us dramatically...

[whistle]

...for me it means that even though I'm paying for my own insurance, I can't get the medications my doctor orders. The insurance company vetoes all brand names and it's Aetna HMO.

Supreme Court victory for health insurers
By Ellen Kelleher in New York
Published: June 21 2004 18:52 | Last Updated: June 21 2004 18:52


The Supreme Court has awarded a sweeping victory to US health insurers, voting to overturn a lower court ruling that would have permitted patients to sue insurance companies at the state level for providing inadequate healthcare.


The justices ruled unanimously that the Employee Retirement Income Security Act (Erisa), the federal law that regulates employer-sponsored health plans, requires patients to sue their insurers over malpractice in federal courts - not at the state level.

The decision strikes down two appeals court rulings filed in Texas against Aetna and Cigna, two of the biggest US insurers. Aetna and Cigna run health maintenance organisations in Texas, a state with a law allowing patients to sue health insurers over medical care.

"When a federal statute completely pre-empts a state law cause of action, the state claim can be removed. Erisa is such a statute," Justice Clarence Thomas wrote in Monday's opinion.

In the first case, a man participating in Aetna's managed care programme sued the company for requiring that he use a cheaper version of a prescribed painkiller. The cheaper drug almost killed him, he charged. In the second case, a woman sued Cigna because the insurer only paid for one day in hospital after a hysterectomy. She later suffered complications.

The decision had been expected, based on the tenor of oral arguments that took place a few months ago, according to Wall Street analysts.

Matthew Borsch, an analyst with Goldman Sachs, wrote, "The issue appears settled for now . . . Today's decision could reignite debate in Congress over legislation that would set national paremeters on how managed care companies can be held liable for medical malpractice."

A federal appellate court had previously ruled that Aetna and Cigna improperly denied these patients medical treatment. Last year, Aetna and Cigna brought their case to the Supreme Court.

Insurers welcomed the ruling. Karen Ignagni, president of America's Health Insurance Plans, an industry lobbying group, said it would put "the brakes on trial lawyers' attempts to turn every benefit decision into a lawsuit".

The ruling is likely to prompt more debate on Capitol Hill over whether companies that offer managed care health plans are liable for malpractice. Congress had tried to pass legislation that would create a "patient's bill of rights", but has failed to enact such a law.

[Dookus]

1. In this case

the problem is with the legislation in question, not the court. There's nothing obviously unconstitutional about the law in question. It's horrific, it's awful, it's abysmal. It needs to be changed.

But the responsibility for this lies with the legislative branch, not the judicial branch.

[Hoping4Change]

2. Might not this get repugs & independents riled up?

[cosmicdot]

3. this wasn't even 5 to 4 ... "The justices ruled unanimously"

:shrug:

would we even need this type of litigation if we had an Universal Healthcare Program which excludes corporate involvement in our private lives?