U.S. Supreme Court weighs any-willing-provider laws

The high court's roster of medically related concerns also includes a look at Medicaid drug rebate programs.

By Tanya Albert, AMNews staff. July 29, 2002.

The U.S. Supreme Court is poised next term to take up at least two hot medical issues that will affect doctors.

When the high court starts its new session in October, it will examine whether states' efforts to ensure that qualified physicians and other health professionals don't get shut out of health plan networks are preempted by the federal Employee Retirement Income and Security Act of 1974.

Justices also will look at how far states can go in trying to use their Medicaid programs to negotiate prescription drug rebates with pharmaceutical companies for non-Medicaid-eligible residents. The court may add other health-related cases to its docket as its new term approaches.

A larger number of physicians likely will be affected by the first of the cases, which originated in Kentucky.

Nearly two dozen states have laws -- at least seven of which affect physicians -- that require health plans to contract with health professionals who meet the terms of a health plan's contract, according to the National Conference of State Legislatures.

The laws, commonly known as "any-willing-provider laws," became popular in the 1990s as a way to stop managed care organizations from excluding physicians, pharmacists or others, thereby hurting their ability to practice.

Kentucky's law is among the broadest. It covers physicians, pharmacists and other licensed health professionals. The Kentucky Medical Assn. supported the law as it moved through the Legislature.

"It helps physicians have a little bit of leverage with health plans," said Patrick T. Padgett, the KMA's staff counsel and director of socioeconomic affairs. "They can't just be excluded because a health plan wants to limit the number of doctors they have. Patients want as many choices as they can get." [...]