High Court Willing to Consider "Any Willing Provider" Laws

January 13, 2003 (PLANSPONSOR.com) - Corporate benefits officials will be closely watching a US Supreme Court review of a Kentucky law giving patients access to any health care professional willing to abide by an insurance plan's conditions.

The so-called “any willing provider” laws say patients should have access to any health care professional willing to abide by an insurance plan’s conditions.   Insurers say that a decision upholding the law (as have two lower courts) would limit their ability to control healthcare costs – but if it isn’t, doctors and patient advocates (supported by the Bush administration) claim that patient choice and care quality will suffer.  

A decision in the case will have significant implications both for employers and health insurers struggling to rein in soaring costs and patients’ right advocates pushing for greater patient choice and access to quality care, according to a Hartford Courant story.

Directly at stake in the Supreme Court’s ruling are laws in Kentucky and five other states known as “any willing provider” statutes. Laws in 19 other states, including Connecticut, are more limited, generally covering only pharmacists, the Courant said.

Second “Impressions”

The Kentucky statute is the second of those laws to be tested in the Supreme Court in the last two years. Last year, the high court upheld an  Illinois law that gives patients the right to an independent review if an insurer denies them care. The justices will hear oral arguments in the Kentucky case Tuesday.

The Bush administration is supporting Kentucky. In papers filed with the court, the Labor and Justice Departments say Kentucky’s law is designed to preclude health maintenance organizations “from artificially limiting the number of available providers and thus to broaden the range of providers whose services will be covered” by an insurer or HMO.Two lower federal courts also have sided with Kentucky.

Cost Concerns

Insurers and HMOs, who opposed the Illinois law because they said it would increase their costs, are using the same argument to challenge the Kentucky statute.

The fundamental issue in the Kentucky case is whether federal or state law should apply and where to draw the line. Do the courts defer to the 1974 federal law regulating benefits or to statutes in each state that govern insurance?

When it ruled in favor of Kentucky, the Cincinnati-based U.S. 6th Circuit Court of Appeals commented on the difficulty of deciding whether state law or the federal act should apply to health benefits. “The wording of the act combined with the obvious federalism concerns involved have made it difficult to discern clear boundaries,” the appeals court said.