List of Supreme Court cases on Pre-emption:
http://www.oyez.org/issues/Federalism/Federal%20Preemption%20of%20State%20Regulation
Some are insurance related, some not. But even the ones that are NOT insurance related, provide SC opinion on when conflicting state laws are pre-empted, non-conflicting state laws are not pre-empted, etc. Here are the insurance related ones, but I would look at them all. Is there a federal ERISA law that conflicts with MGL 175-110I? (For instance, does part of ERISA say: under no conditions, can a former spouses health insurance benefits continue past the date of divorce???)
Aetna Health, Inc. v. Davila
http://www.oyez.org/cases/2000-2009/2003/2003_02_1845
Pre-emption WAS found here:
Facts of the Case:
Juan Davila sued his HMO in state court because it had refused to provide certain procedures, and the refusal led to certain injuries. He brought the suit under a Texas law that requires HMOs "to exercise ordinary care" for their patients. The HMO asked that the case be moved to federal court, arguing that the case should be governed under the Employee Retirement Income Security Act of 1974 (ERISA) rather than the Texas law, because ERISA is a federal law the takes precedence over any state laws dealing with the same subject matter. Davila objected, arguing that the case did not fall under ERISA and should be heard in state court. The federal district court sided with the HMO, finding that ERISA prohibits individuals from filing state suits against HMOs when they refuse to pay for a particular treatment. A Fifth Circuit Court of Appeals panel reversed.
Question:
Does the Employee Retirement Income Security Act of 1974 prohibit individuals from suing their HMOs in state court when the HMOs refuse to provide a recommended treatment?
Conclusion:
Yes. In a unanimous opinion written by Justice Clarence Thomas, the Court held that Congress intended ERISA to provide a uniform system for regulating retirement schemes and benefits. If a state law conflicts with ERISA, therefore, ERISA must be used in its place. Justice Thomas wrote, "[A]ny state-law cause of action that duplicates, supplements or supplants the ERISA civil enforcement remedy conflicts with the clear congressional intent to make the ERISA remedy exclusive and is therefore preempted."
Kentucky Assoc. of Health Plans, Inc. v. Miller
http://www.oyez.org/cases/2000-2009/2002/2002_00_1471
Pre-emption not found here
Facts of the Case:
Kentucky's two "Any Willing Provider" (AWP) statutes prohibit "[a] health insurer [from] discriminating against any provider who is...willing to meet the terms and conditions for participation established by the?insurer," and require a "health benefit plan that includes chiropractic benefits [to]...permit any licensed chiropractor who agrees to abide by the terms [and] conditions?of the?plan to serve as a participating primary chiropractic provider." Certain health maintenance organizations (HMOs) filed suit asserting that Kentucky's AWP laws are preempted by the Employee Retirement Income Security Act of 1974 (ERISA), which preempts all state laws "insofar as they?relate to any employee benefit plan," but saves from preemption state "laws...which regulate insurance." The District Court concluded that although both AWP statutes "relate to" employee benefit plans each law "regulates insurance" and is therefore saved from preemption. The Court of Appeals affirmed.
Question:
Does the Employee Retirement Income Security Act of 1974 preempt any of Kentucky's "Any Willing Provider" statutes?
Conclusion:
No. In a unanimous opinion delivered by Justice Antonin Scalia, the Court held that Kentucky's AWP statutes are "laws...which regulate insurance" under ERISA. The Court reasoned that the statutes were specifically directed toward entities engaged in insurance, regardless of the fact that the statutes also had the effect of prohibiting providers from entering into limited network contracts with the HMOs. Moreover, the Court concluded that, by expanding the number of providers from whom an insured may receive health services, AWP laws alter the scope of permissible bargains between insurers and insureds thus affecting the type of risk pooling arrangements that the HMOs could offer, thereby constituting regulation of the business of insurance.
Rush Prudential HMO, Inc. v. Moran
http://www.oyez.org/cases/2000-2009/2001/2001_00_1021
Pre-emption NOT found here:
Question:
Is the Illinois Health Maintenance Organization Act, as applied to health benefits provided by a health maintenance organization under contract with an employee welfare benefit plan, preempted by the Employee Retirement Income Security Act of 1974?
Conclusion:
No. In a 5-4 opinion delivered by Justice David H. Souter, the Court held that ERISA does not preempt the Illinois HMO Act. Under its common-sense view of the matter, the Court reasoned that, because HMOs are risk-bearing organizations subject to state insurance regulation and almost universally regulated as insurers under state law, "the Illinois HMO Act is a law 'directed toward' the insurance industry and an 'insurance regulation'" and is, thus, saved from preemption under ERISA's saving clause. Justice Clarence Thomas, with whom Chief Justice William H. Rehnquist and Justices Antonin Scalia and Anthony M. Kennedy joined, dissented. Justice Thomas argued that ERISA's civil enforcement provision provides the exclusive means for actions asserting a claim for benefits under health plans governed by ERISA and therefore state laws that create additional remedies are preempted.
Metropolitan Life Insurance Co. v. Massachusetts
http://supreme.justia.com/us/471/724/case.html
No. 84-325
Argued February 26, 1985
Decided June 3, 1985*
471 U.S. 724
APPEAL FROM THE SUPREME JUDICIAL COURT OF MASSACHUSETTS
Syllabus
A Massachusetts statute (§ 47B) requires that certain minimum mental health care benefits be provided a Massachusetts resident who is insured under a general health insurance policy or an employee health care plan that covers hospital and surgical expenses. Appellant insurer in No. 84-325 contends that § 47B, as applied to insurance policies purchased by employee health care plans regulated by the federal Employee Retirement Income Security Act of 1974 (ERISA), is preempted by that Act. Section 514(a) of ERISA provides that the statute shall "supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan." But § 514(b)(2)(A) provides that, with one exception, nothing in ERISA "shall be construed to exempt or relieve any person from any law of any State which regulates insurance." The one exception is found in § 514(b)(2)(B), which states that no employee benefit plan
"shall be deemed to be an insurance company or other insurer . . . or to be engaged in the business of insurance . . . for purposes of any law of any State purporting to regulate insurance companies [or] insurance contracts."
Appellant insurer in No. 84-356 contends that § 47B, as applied to insurance policies purchased pursuant to collective bargaining agreements regulated by the National Labor Relations Act (NLRA), is preempted by that Act, because it effectively imposes a contract term on the parties that otherwise would be a mandatory subject of collective bargaining. Massachusetts brought an action in Massachusetts Superior Court to enforce § 47B against appellant insurers, and that court issued an injunction requiring the insurers to provide the coverage mandated by § 47B. The Massachusetts Supreme Judicial Court affirmed, finding no preemption under either ERISA or the NLRA.
Held:
1. Section 47B, as applied, is a law "which regulates insurance" within the meaning of § 514(b)(2)(A), and therefore is not preempted by
Page 471 U. S. 725
§ 514(a) as it applies to insurance contracts purchased for plans subject to ERISA. Section 514(b)(2)(A)'s plain language, its relationship to the other ERISA preemption provisions, and the traditional understanding of insurance regulations, all lead to the conclusion that mandated benefit laws such as § 47B are saved from preemption by the operation of § 514(b)(2)(A). Nothing in ERISA's legislative history suggests a different result. Pp. 471 U. S. 739-747.
2. Nor is § 47B, as applied to a plan negotiated pursuant to a collective bargaining agreement subject to the NLRA, preempted by the NLRA. Pp. 471 U. S. 747-758.
(a) The NLRA preemption involved here is the one that protects against state interference with policies implicated by the structure of the NLRA itself, by preempting state law and state causes of action concerning conduct that Congress intended to be unregulated. Pp. 471 U. S. 747-751.
(b) Such preemption rests on a sound understanding of the NLRA's purpose and operation that is incompatible with the view that the NLRA preempts any state attempt to impose minimum benefit terms on the parties to a collective bargaining agreement. Pp. 471 U. S. 751-753.
(c) Minimum state labor standards affect union and nonunion employees equally, and neither encourage nor discourage the collective bargaining processes that are the subject of the NLRA. Nor do they have any but the most indirect effect on the right of self-organization established in the NLRA. Unlike the NLRA, mandated benefit laws such as § 47B are not designed to encourage or discourage employees in the promotion of their interests collectively; rather, they are in part designed to give minimum protections to individual employees and to ensure that each employee covered by the NLRA receives mandated health insurance coverage. These laws are minimum standards independent of the collective bargaining process. Pp. 471 U. S. 753-756.
(d) There is no suggestion in the NLRA's legislative history that Congress intended to disturb the state laws that set minimum labor standards but were unrelated to the collective bargaining or self-organization processes. To the contrary, Congress in the NLRA developed the framework for self-organization and collective bargaining within the larger body of state law promoting public health and safety. When a state law establishes a minimal employment standard not inconsistent with the NLRA's general goals, it conflicts with none of the NLRA's purposes. Section 47B is an insurance regulation designed to implement the Commonwealth's policy on mental health care, and as such is a valid and unexceptional exercise of the Commonwealth's police power. Though § 47B potentially limits any employee's right to choose one thing by requiring that he be provided with something else, it does
Page 471 U. S. 726
not limit the right of self-organization or collective bargaining protected by the NLRA. Pp. 471 U. S. 756-758.
391 Mass. 730, 46:3 N.E.2d 548, affirmed.