David Souter on Health Care
Supreme Court Justice (nominated by Pres. Bush Sr. 1990)
Allow states to restrict cigarette ads beyond federal rules
The Supreme Court handed the tobacco industry a major victory over state efforts to restrict tobacco advertising, striking down Massachusetts regulations that would have banned such advertising near playgrounds and schools. Massachusetts had argued that
the rules were necessary to prevent tobacco makers from inducing children to try a highly addictive and hazardous substance. But the court, dividing 5 to 4, agreed with the industry that the state could not adopt restrictions on top of those imposed by
federal law. In addition, the court said, the rules infringed on freedom of speech.
The court’s decision effectively prevents state and local governments from unilaterally adding regulations on cigarette advertising, as many have attempted to do in
recent years. Justice O’Connor wrote-with Rehnquist, Scalia, Kennedy, and Thomas concurring-that federal law “places limits on policy choices available to the States.” The cases are Lorillard v. Reilly, 00-596, and Altadis USA v. Reilly, 00-597.
Source: Charles Lane, Washington Post, p. A1
, Jun 29, 2001
States have authority to protect patient rights.
Justice Souter wrote the Court's decision on Rush Prudential HMO v. Moran on Jun 20, 2002:
Petitioner Rush Prudential HMO, Inc. provides medical services for employee welfare benefits plans covered by the Employee Retirement Income Security Act (ERISA), denied respondent Moran's request to have surgery on the ground that the procedure was not medically necessary. Moran made a written demand for an independent medical review of her claim, as guaranteed by Illinois' HMO Act. Rush refused her demand
HELD: Delivered by Souter, joined by Stevens, O'Connor, Ginsburg, BreyerIn 5-4 decision, justices uphold Illinois state law that requires health maintenance organizations to provide for independent review in disputed cases where physician-prescribed treatment is being denied by HMO. Although Congress has yet to enact a patients' bill of rights that would include the right to independent review, 42 states and the District of Columbia currently have medical review laws. Congress has long recognized that HMOs are risk-bearing organizations subject to state regulation.
Finally, allowing States to regulate the insurance aspects of HMOs will not interfere with the desire of Congress for uniform national standards under ERISA.
DISSENT: Dissent by Thomas, joined by Rehnquist, Scalia, KennedyThis Court has repeatedly recognized that ERISA's civil enforcement provision provides the exclusive vehicle for actions asserting a claim for benefits under health plans governed by ERISA, and therefore that state laws that create additional remedies are pre-empted. Such exclusivity of remedies is necessary to further Congress' interest in establishing a uniform federal law of employee benefits so that employers are encouraged to provide benefits to their employees. Independent review provisions could create a disincentive to the formation of employee health benefit plans. This is a judgment that must be made by Congress. I respectfully dissent.
Source: Supreme Court case 02-MORAN argued on Jan 16, 2002
Federal government decides insurance issues, not states.
Justice Souter joined the dissent on Empire HealthChoice Assurance v. McVeigh on Jun 15, 2006:
A 5-4 Court decided that federal jurisdiction does not extend to controversies over insurance contracts under the Federal Employees Health Benefits Act. Thus, state courts are the proper venue for contract disputes arising between federal employees and insurance companies, which may result in inconsistent outcomes across states.
Empire Healthchoice Assurance sued the estate of a deceased federal employee who received $157,000 in insurance benefits as the result of an injury. The wife of this federal employee had won $3.2 million in a separate lawsuit; Empire Healthchoice claimed reimbursement because the beneficiary was compensated for the same injury by a third party.
Ginsburg, joined by Roberts, Stevens, Scalia, and ThomasThe Court ruled that under the Federal Employees Health Benefits Act, state courts, not federal courts, are the proper forum for a contracts lawsuit by a plan administrator seeking reimbursement for medical costs. Empire, the Court ruled, had not demonstrated a "significant conflict between an identifiable federal policy or interest and the operation of state law."
DISSENT: Breyer, joined by Kennedy, Souter, and AlitoThe dissenting opinion asserted that the dispute should have been deliberated at the federal level because, in part, "there is little about this case that is not federal."
ORIGINAL HOLDING: SotomayorJudge Sotomayor, then on the Second Circuit prior to her Supreme Court nomination, found no federal jurisdiction because Empire failed to show that New York state law "significantly conflicts" with federal interests. The Supreme Court affirmed Sotomayor's decision.
Source: Supreme Court case 06-MCVEIGH argued on Apr 25, 2006