When Congress passed the Employee Retirement Security Act (ERISA) of 1974, it intended to help the American worker through pension reform, and though it made no mention of health, it would ultimately transform health insurance within the realm of self-insured health plans, the prevalence of which is ever-increasing. What is problematic about ERISA"s design is it denies legal recourse to those who have been denied coverage for prescribed health care by their self-insured health plans, which not only leaves patients behind, but makes it all the more challenging to hold health insurers accountable. This book project raises the following core questions:
- Given ERISA’s shortcomings to workers seeking health coverage, why has its design endured across multiple periods of proposed and enacted health reform beginning in the 1990s?;
- What other tools might employers and private employment-based plans have had if ERISA had not carved out this regulatory vacuum?;
- How does ERISA’s design disproportionately disadvantage patients from marginalized groups?; and
- How has lobbying amid the growth of managed health care entrenched these shortcomings and costs to American workers, especially those from marginalized populations?
Drawing on historical analysis and original data collection, elite interviews, as well as original survey evidence, this project probes the path dependence and implications of this policy across multiple periods of proposed and enacted health care reform, and offers insights into potential policy reforms for these labor and health politics problems.
