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June 19, 1996

Law and Medicine

Author Affiliations

Georgetown University Law Center/Johns Hopkins Program on Law and Public Health Washington, DC

JAMA. 1996;275(23):1817-1819. doi:10.1001/jama.1996.03530470045027

The failure of the federal government to reform national health care has not stopped significant reform at the state level and within the private sector. Health care plans, particularly those that manage care, have thrived under state and private reform initiatives. Health care plans are sometimes criticized for withholding needed care as a method of cost savings by excluding or limiting coverage for chronic conditions such as human immunodeficiency virus (HIV) disease or mental illness, denying reimbursement for experimental procedures such as bone marrow transplants, or establishing maximum durations for inpatient hospital care such as for women giving birth. Legislative and judicial activity, as well as ethical discussion, has occurred in each of these controversial areas over the past year. State legislatures and courts, however, were often precluded from regulating risk retention (self-insured) health plans under the preemption provisions of the Employee Retirement and Income Security Act (ERISA); risk retention