Summary: The ADA has filed an amicus brief to the Supreme Court, challenging the Tenth Circuit’s broad interpretation of ERISA preemption, arguing it undermines state laws designed to protect patients and providers.

Key Takeaways:

  • The ADA, supported by other healthcare organizations, argues that the Tenth Circuit’s decision conflicts with the Supreme Court’s Rutledge ruling, calling for a review to ensure state laws are upheld.
  • The ADA emphasizes the importance of state regulations in protecting patients and providers from potentially abusive practices by insurers leveraging ERISA preemption.

The American Dental Association (ADA) filed an amicus (friend of the court) brief to the United States Supreme Court seeking review of a decision from the U.S. Tenth Circuit Court of Appeals concerning the overly broad application of ERISA preemption of state statutes directed to administrative aspects of self-funded health care plans.

Tenth Circuit Decision and ERISA Preemption

Last year, the Tenth Circuit decided against the state of Oklahoma and, in doing so, took what the ADA calls a very expansive view of ERISA preemption. The ADA said the decision was made despite the recent Supreme Court decision in Rutledge v. Pharmaceutical Care Management Association that makes it clear ERISA preemption is not extensive. The ADA brief supports the state of Oklahoma’s position that state laws such as the one it passed should not be preempted by ERISA.

ERISA’s Impact on State Insurance Laws

The Employee Retirement Income Security Act of 1974 (ERISA) regulates the administration of employee benefit plans, including dental care. However, some insurance carriers administering self-funded plans argue that since ERISA is a federal law, it supersedes, or ‘preempts’ state insurance laws that protect patients and providers. In the amicus brief, the ADA and other healthcare providers asked the Supreme Court to review a case to clarify a lower court’s ruling to stop insurers from taking unfair advantage of ERISA’s authority and to comply with the state laws officials pass and enforce in the US.

“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,” said Linda Edgar, DDS, president of the American Dental Association. “The ADA and numerous healthcare organizations urge the Court to take the opportunity to reemphasize its holding in Rutledge before other lower court decisions further muddy the waters.”

Coalition of Healthcare Provider Organizations

The amicus brief, which was submitted along with a coalition of healthcare provider organizations, supports the Petition for Certiorari, which seeks Supreme Court review of a decision from the Tenth Circuit Court of Appeals. The coalition believes the Tenth Circuit’s decision takes an overly expansive view of ERISA preemption and conflicts with the Supreme Court decision, Rutledge v. Pharmaceutical Care Management Association, that appropriately limits the reach of the federal ERISA statute’s preemption.

The American Dental Association, The American Optometric Association, American Association of Orthodontics, American Academy of Pediatric Dentists, The Association of Dental Support Organizations, American Association of Oral and Maxillofacial Surgeons, and other groups believe that it is in the best interest of patient protections and providers that state laws requiring third-party payors must honor the laws passed in their state if not directly associated with plan administration.

Addressing Confusion in ERISA Preemption

The brief explains how the Tenth Circuit’s overly broad interpretation of ERISA preemption reintroduces the very confusion that the Rutledge decision eliminates. It also argues that the regulation of insurance and healthcare quality are parts of the historic powers reserved for the states and not the federal government.

“Unless the Tenth Circuit’s decision is addressed, ERISA plans will continue to take the position that they are not subject to pro-patient and pro-provider state laws,” said Edgar. “This leaves consumers lacking protection and vulnerable to potentially abusive practices of insurers.”