regulated, whether different standards should apply, and whether provider systems that do not bear risk should be regulated (NAIC, 1997).
Policymakers must consider the role of private organizations that monitor and accredit health plans. For example, should health plans be required to be accredited by these organizations? Should accreditation be permitted to satisfy various government standards? Or should accreditation remain entirely separate from government oversight activities?
Finally, policymakers need to determine the level of government most capable of establishing and enforcing standards for health plans and providers. Even aside from ERISA (which imposes substantial limits on state authority to regulate consistently across health plans because it allows states to regulate insurance but not self-insured employee plans), an important policy question is whether nationally uniform standards, if they could be developed and consistently enforced, are preferable to variations that permit response to local conditions. HIPAA offers one approach to this question, creating national standards to which states can add but not subtract and leaving primary enforcement responsibility at the state level. But other models also are possible.
Butler, P. Managed Care Plan Liability: An Analysis of Texas and Missouri Legislation. Menlo Park, Calif.: Henry J. Kaiser Family Foundation, 1997.
Butler, P. State Managed Care Oversight: Policy Implications of Recent ERISA Court Decisions. Washington, D.C.: Health Policy Studies Division Center for Best Practices, National Governors' Association, 1998.
Butler, P., and Polzer, K. Private Sector Health Coverage: Variation in Consumer Protections under ERISA and State Law. Washington, D.C.: Health Policy Forum, George Washington University, 1996.
“Consumers and Providers Lobby for State Oversight of Managed Care's Compensation Plans, Incentives.” State Health Watch, Dec. 1996, pp. 1, 4.