Supreme Court ruling a setback for patients' rights

Patients and physicians wonder if managed care will be magnanimous in victory.

Editorial. July 19, 2004.

What a difference two years can make. In June 2002, physicians and patients were applauding a U.S. Supreme Court ruling upholding an Illinois law that created an independent review system for cases in which a treating physician and a patient's health plan disagree on what is medically necessary for the patient.

With similar laws on the books in 41 states and the District of Columbia, the 5-4 ruling was a significant legal victory over managed care companies.

In those heady days it would have been hard to imagine that 24 months later the court would deal patients' rights advocates such a blow. Patients and physicians are now forced to fall back on that victory for recourse following this major setback dealt to them by that very same Supreme Court.

Last month the high court struck down a landmark Texas law, the Texas Health Care Liability Act, that allowed patients to sue their health plans in state court for damages incurred when plans refused to pay for doctor-recommended treatments.

In a unanimous decision, the court ruled in June that the federal Employee Retirement Income Securities Act of 1974 preempted the Texas law and others like it in 10 states. The ruling is bad news for some 140 million people who receive their health insurance through employer-sponsored health plans covered by ERISA. Patient advocate groups, including the AMA, were quick to register their disappointment.