Chirba-Martin M A, Brennan T A
Health Aff (Millwood). 1994;13(2):142-56. doi: 10.1377/hlthaff.13.2.142.
Despite prominent roles for employers and state regulation in the Clinton administration's Health Security Act, relatively little attention has been accorded to the impact of federal preemption of state legislation through the Employee Retirement Income Security Act (ERISA). As interpreted by the U.S. Supreme Court, ERISA permits state regulation of insured employee health plans but otherwise preempts analogous regulation relating to self-insured benefit plans. This has prompted lower courts to find that hospital rate-setting legislation, regulation of preferred provider organizations (PPOs), and medical malpractice suits for utilization review decisions are preempted by ERISA. Several issues with major implications for health reform remain unresolved, such as the availability of ERISA preemption to self-insured health alliances and health maintenance organizations (HMOs).
尽管雇主和国家监管在克林顿政府的《健康安全法案》中发挥了重要作用，但通过《雇员退休收入保障法》（ERISA）联邦对州立法的优先适用所产生的影响却相对很少受到关注。根据美国最高法院的解释，ERISA允许州对参保雇员健康计划进行监管，但在其他方面优先适用与自保福利计划相关的类似监管。这促使下级法院认定，医院费率制定立法、对优选提供者组织（PPO）的监管以及针对利用审查决定的医疗事故诉讼均被ERISA优先适用。一些对医疗改革具有重大影响的问题仍未得到解决，例如ERISA优先适用对自保健康联盟和健康维护组织（HMO）的适用性。
