By Sara Rosenbaum

Enacted to secure the nation’s private pension system, the Employee Retirement Income Security Act (ERISA) has become a pillar of U.S. health policy because of the legal framework it establishes for employer-sponsored group health benefit plans. Even as it creates crucial protections for workers and their families, ERISA simultaneously diminishes the power of states to regulate employee health benefits. Furthermore, the law curtails the legal rights of patients who experience death or injury as a result of the negligence or misconduct of health benefit plan administrators. The Affordable Care Act preserves the ERISA framework, expanding the federal standards applicable to employee health benefit plans while preserving the law’s shielding effects against state regulation and health plan liability. A major unanswered question under the Act remains how the ERISA shield will affect the rights of patients whose employers purchase coverage through state Exchanges.