Employee Retirement Income Security Act of 1974 (ERISA) introduced a new conceptual frame of reference for federal pension policy. Although ERISA was known as the “pension reform law,” it has also had a major effect on medical provision in the United States. The political history of ERISA suggests that, without the threat of conflicting state laws, employers and unions that sponsor multistate health plans will oppose initiatives to create federal minimum standards for health plans or expand the liability of such plans. The tax treatment of pension plans created a significant disparity in the tax laws. ERISA’s limited regulation of welfare plans and its sweeping preemption provision produced a healthcare system in which there are different rules for plans sponsored by public- and private-sector employers and different rules for private-sector plans depending on whether a plan purchases insurance or self-insures. The major influences of ERISA on health policy are explained.
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