ADA files Amicus brief with Supreme Court
Federal ERISA law should not supersede states’ authority
The ADA is asking the U.S. Supreme Court to review a decision from a lower appeals court on the Employee Retirement Income Security Act of 1974 that limits states’ traditional authority to regulate health care and insurance.
Dental plans have often claimed that a federal law called ERISA allows them to avoid complying with state laws impacting dental coverage if the plans are operating as administrators for an employer self-funded plan. In its amicus brief to the Supreme Court, the ADA continues to advocate that most state laws, particularly those that protect patients and dentists from abuse by dental insurers, can be applied to all carriers, including those administering self-funded dental plans for employers.
The Tenth Circuit Court of Appeals held last year that ERISA preempts provisions of an Oklahoma law regulating pharmacy benefit managers, which manage prescription drug benefits on behalf of health plans by negotiating prices with drug manufacturers and contracting with pharmacies. However, the ADA called this decision “a very expansive view” of ERISA, citing the Supreme Court’s October 2020 decision in the Rutledge v. Pharmaceutical Care Management Association case that “makes it clear ERISA preemption is not extensive.”
In a June 12 ADA news release, the Association states that the ADA brief supports Oklahoma’s position that state laws, such as the one it passed, should not be preempted by ERISA. This law regulates the administration of employee benefits plans, including dental care. Some insurance carriers administering self-funded plans argue that the federal law supersedes state insurance laws that protect patients and providers.
But in the brief, the ADA and several other health care provider organizations state that the appeal court’s decision takes an overly expansive view of ERISA preemption and conflicts with Rutledge v. Pharmaceutical Care Management Association by reintroducing the very confusion that the Rutledge decision eliminates.
The brief was developed with the American Optometric Association, American Association of Orthodontics, American Academy of Pediatric Dentists, The Association of Dental Support Organizations and American Association of Oral and Maxillofacial Surgeons. It was also supported by the American Academy of Oral & Maxillofacial Pathology, American Association of Endodontists, Academy of General Dentistry and American Academy of Periodontology.
“The regulation of insurance and health care quality are parts of the historic powers reserved for the states and not the federal government. If states cannot enforce laws regarding how health care is provided and paid for, then no one can,” according to the release.
The brief goes on to support mitigating confusion in the area of ERISA preemption, as well as advocating for states’ traditional authority to regulate health care and insurance.
“We believe that the Supreme Court should consider this case because the appellate court’s opinion appears to introduce confusion and inconsistency in an area the Supreme Court recently attempted to clarify and make uniform in a different case. The ADA and numerous health care organizations urge the court to take the opportunity to reemphasize its holding in Rutledge before other lower court decisions further muddy the waters,” ADA President Linda Edgar, D.D.S., said in the news release.
For more information on the topic, visit ADA.org/ERISA.
