Sanders Senate Amendment Expands Support for Single Payer States
The Center for Policy Analysis worked closely
with Congressional staff to craft the two amendments to health reform legislation that offer the greatest prospects for single
payer supporters.
Summary
Some state and local governments
that have attempted to expand health care coverage have been successfully challenged in court by
employers under the terms of the Employee Retirement Income Security Act of 1974 (ERISA).
ERISA pre-empts states from enacting legislation if it is “related to” employee benefit plans. It reserves that
right to the federal government. Section 514 of ERISA states that Title
V (Administration and Enforcement) and Title IV (Fiduciary Responsibility) of ERISA “shall supercede any and all State
laws insofar as they may… relate to any employee benefit plan.” There
is no provision for an administrative waiver of these rules.
The Kucinich
amendment to HR 3200, approved by a recorded vote of the House Education and Labor Committee, would have removed this barrier
for states that have enacted and signed into law a single payer system.
What the Amendment
Proposed
The Secretary of Labor, in
consultation with the Secretary of Health and Human Services, would be authorized and required to waive the ERISA pre-emption
(Sec. 514) for states that have enacted a state single payer system. In this case, the Secretary could decline to grant the
waiver only under extraordinary circumstances. The system would have to meet requirements, and the Secretary could revoke
the waiver if it fails to do so.
The state single payer system
is defined as a non-profit program of the state for providing health care to all residents.
A single state agency would finance and administer the provision of comprehensive benefits that meet or exceed the
standards for coverage and quality described in HR 3200, and assure free choice of health care providers. Private insurance
that duplicates this coverage would be prohibited. Health maintenance organizations
could operate on a non-profit basis if they also own their facilities and provide services directly. The system would not
result in greater costs to the federal government. At the same time, the federal
government would maintain the equivalent level of support as provided to other states, accounting for variations such as population
and demographics. States could seek planning and start-up funds.
Different Advantages
of the Sanders Amendment
A
different state single payer amendment was proposed by Senator Sanders, and is included in the new law. It does not include an ERISA amendment. It does include some more detailed provisions that cover
matters that are beyond the jurisdiction of the House Education and Labor Committee.
These include: Dedicated funding for planning and implementation grants; Specific allocations of funds from existing
federal health programs such as Medicare and Medicaid, and waivers to permit coordination with those programs; Quality assurance
and health professional training programs associated with other federal programs.
