In a case closely watched by insurers and providers nationwide, the U.S. Supreme Court last month let stand a Washington state mandate that health plans must provide alternative care.
A series of lawsuits had trapped the law in limbo since it took effect on Jan. 1, 1996 (July 13, 1998, p. 48). The 9th U.S. Circuit Court of Appeals in San Francisco upheld the constitutionality of the law in June 1998, and the Supreme Court declined to hear the case, letting the appeals court decision stand.
The plaintiffs had argued that the law was pre-empted by the federal Employee Retirement Income Security Act, or ERISA, which they said was a controlling statute in cases involving health plans.
"It's time to put this fight behind us and get on with the business of protecting consumers and their access to healthcare," said Deborah Senn, the state's insurance commissioner.
Senn's office is working on regulations to enforce the 1995 law, part of the Health Reform Improvement Act.
The law requires HMO panels to expand their options to include alternative providers-such as licensed or certified specialists in acupuncture, massage therapy, chiropractic care or other alternative treatments-along with medical doctors and registered nurses.
Many of the state's leading health insurers, such as Blue Cross of Washington and Alaska (now part of Premera Blue Cross), Group Health Cooperative of Puget Sound, Kaiser Foundation Health Plan, Blue Cross and Blue Shield of Oregon, and PacifiCare of Washington, filed suit in September 1996 to overturn the mandate.
They argued, in Washington Physicians Service Association vs. Gregoire, that ERISA pre-empts the state mandate. Defendants in the suit were state Attorney General Christine Gregoire and Senn.
The high court's decision leaves a separate case in Thurston County (Wash.) Superior Court as the health plans' only active attempt to overturn or limit the alternative-care legislation.
The county suit, filed by a similar list of plaintiffs on Jan. 8, 1996, challenges the state's interpretation of the law, as opposed to the legislation itself, said Chris Bruzzo, a spokesman for Seattle-based Regence Blue Shield, a plan formed by the merger of King County Medical Blue Shield and Pierce County Medical Bureau and a plaintiff in both suits.
Senn's interpretation "vastly exceeds the scope and intent of the law" and would make it virtually impossible to effectively manage care and keep alternative care affordable, the health plan plaintiffs said in the county suit.