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Statement Re: the Decision by the U.S. Supreme Court in Aetna Health Inc. v. Davila and Cigna Healthcare of Texas Inc. v. Calad
June 21, 2004 — The Supreme Court decision in Aetna Health Inc. v. Davila and Cigna Healthcare of Texas Inc. v. Calad highlights a troubling loophole that Congress needs to close.
This ruling confirms that the federal Employee Retirement Income Security Act closes the doors to state courts for people who are injured when an HMO refuses to provide a correct course of care prescribed by a doctor. Their only recourse is to sue in federal court, which can only compel the HMO to pay the cost of the care denied or, if it’s not too late, provide the care. Practically speaking, people irreparably harmed by delays in treatment have nowhere to turn.
Congress needs to act now to close this dangerous loophole by enacting legislation that would amend ERISA to give injured patients in these cases the right to bring suit against their HMO in state court under state liability laws. It’s the least these people deserve.
