Borzi Phyllis C
Department of Health Policy, School of Public Health and Health Services, George Washington University Medical Center, USA.
J Law Med Ethics. 2008 Winter;36(4):660-9, 608. doi: 10.1111/j.1748-720X.2008.00320.x.
The Employee Retirement Income Security Act of 1974 (ERISA), a federal law regulating private employer-sponsored employee benefit plans, was primarily designed for pension plans, but has had a profound impact on state health care reform efforts. ERISA's broad preemption language has been judicially interpreted to preclude states from most forms of regulation of employer health plans, including benefit design (except through regulation of insurance products) and incorporating employer expenditure requirements in state health reform financing. But since 1974, Congress has never seriously returned to reexamine several fundamental questions: Should employers be required to offer or contribute to employee health coverage? Should ERISA preempt state efforts to take such actions? Or should ERISA incorporate more comprehensive regulation of health plans in these areas? Although the politics of ERISA preemption have thus far blocked federal reform, while allowing state reform activity to be simultaneously curtailed, new health reform efforts may force Congress to address these questions.
1974年的《雇员退休收入保障法》（ERISA）是一项规范私人雇主赞助的雇员福利计划的联邦法律，主要是为养老金计划而制定的，但对州医疗改革努力产生了深远影响。ERISA广泛的优先适用条款在司法上被解释为排除了各州对雇主健康计划的大多数形式的监管，包括福利设计（通过保险产品监管除外）以及将雇主支出要求纳入州医疗改革融资。但自1974年以来，国会从未认真回过头来重新审视几个基本问题：是否应该要求雇主提供或为雇员健康保险缴费？ERISA是否应优先于各州采取此类行动的努力？或者ERISA是否应在这些领域纳入对健康计划更全面的监管？尽管ERISA优先适用的政治因素迄今为止阻碍了联邦改革，同时也限制了州改革活动，但新的医疗改革努力可能会迫使国会解决这些问题。
