Forum Session

ERISA Health Plan Liability: Examining Models for Reform
February 18, 2000

Manager

Karl Polzer

Summary

As congressional conferees faced the daunting task of resolving differences between patient protection bills passed by the House and Senate in 1999, speakers and panelists at this session explored and debated a variety of approaches to reforming the legal remedies available to individuals in employee health plans for resolving disputes over medical coverage. After examining various models for health plan liability recognized by the courts, including liability concepts originating in tort law, contract law, and trust law, panelists examined the strengths and limitations of these approaches as applied to private-sector employee health plans. Discussants also explored policy approaches that might bridge the differences between the House and Senate bills on the liability issue, including developing a limited federal cause of action.

Speakers

J. Clark Kelso, Professor of Law and Director of the Institute for Legislative Practice, University of the Pacific McGeorge School of Law; Randall R. Bovbjerg, Principal Research Associate, Urban Institute; Patricia A. Butler, Independent Health Policy Analyst; Leslie B. Kramerich, Acting Assistant Secretary, Pension and Welfare Benefits Administration, U.S. Department of Labor; Phyllis C. Borzi, Research Professor, Center for Health Services Research and Policy, School of Public Health and Health Services, George Washington University Medical Center; G. Lawrence Atkins, President, Health Policy Analysts, Inc.; Michael S. Gordon, Law Offices of Michael S. Gordon; Mark C. Mantooth, Washington Counsel, Division of Legislative Counsel, American Medical Association; Paul Dennett, Vice President, Health Policy, Association of Private Pension and Welfare Plans; Joanne L. Hustead, Director of Legal and Public Policy, National Partnership for Women and Families.

Related Materials

See also two Forum publications: "Emerging Issues in the Use of Binding Arbitration to Resolve Disputes Between Individuals and Health Plans" (Background Paper, November 2000) and "ERISA Health Plan Denials: Exploring Models for External Review" (Issue Brief No. 720, June 19, 1998).

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