All Hank, all the time.

[ltl/fb]

Originally posted by Hank Chinaski
In 1995, the Washington legislature effected sweeping changes to the state' s regulation of health insurance, and the Alternative Provider Statute (the "Act" ) is one part of that reform. The Act itself is relatively short:


Every health plan delivered, issued for delivery, or renewed by a health carrier on and after January 1, 1996, shall:

• (1) Permit every category of health care provider to provide health services or care for conditions included in the basic health plan services to the extent that:
  
  (a) The provision of such health services or care is within the health care providers' permitted scope of practice; and
  
  (b) The providers agree to abide by standards related to:
  
  (i) Provision, utilization review, and cost containment of health services;
  
  (ii) Management and administrative procedures; and
  
  (iii) Provision of cost-effective and clinically efficacious health services.

RCW 48.43.045(1).

The terms used in the Act are mostly defined in RCW 48.43.005 ("Definitions" ). In particular, a "health carrier" or "carrier" means a disability insurer, a health care service contractor, or a health maintenance organization. RCW 48.43.005(8). And a "health plan" or "health benefit plan" means "any policy, contract, or agreement offered by a health carrier to provide, arrange, reimburse, or pay for health care service," subject to a few exceptions. RCW 48.43.005(9). "Provider" is undefined in the statute, but refers to a doctor, dentist, acupuncturist, or other health care provider.

Thus, the Act forces every carrier (HMOs, disability insurers) to allow every insured to choose from an expanded list of providers (acupuncturists, massage therapists) for medical conditions covered by the insured' s policy. The Act does not force any carrier to contract with any particular provider (e.g., John Smith, M.D.) but merely forbids a carrier from excluding an entire category of licensed providers (e.g., all chiropractors or all naturopaths) from its policy.

a collection of HMOs and HCSCs, sought a declaratory judgment that the Act is preempted by ERISA and an injunction against its further enforcement. On cross motions for summary judgment, the district court ruled for the plaintiffs, finding that the Act "relates to" an employee benefit plan under ERISA, and that it is not saved as a regulation of insurance. Washington Physicians Serv. Ass' n v. Gregoire, 967 F.Supp. 424, 427-31 (W.D. Wash. 1997). The state appealed and the case was reversed.


They held ERISA provides for the federal regulation of employee welfare benefit plans. New York State Conference of Blue Cross & Blue Shield Plans v. Travelers Ins. Co., 514 U.S. 645, 650-51 (1995). To ensure that such regulation would remain "exclusively a federal concern," Alessi v. Raybestos-Manhattan, Inc., 451 U.S. 504, 523 (1981), Congress enacted a broad preemption provision, which states that ERISA "shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan . . . ." 29 U.S.C. § 1144(a). An exception is contained in 29 U.S.C. § 1144(b)(2)(A): "[N]othing in this subchapter shall be construed to exempt or relieve any person from any law of any State which regulates insurance, banking, or securities."

Thus, an ERISA inquiry is a two-step process. a court first asks whether the Act "relates to" an employee benefit plan; and if it does, it then decides whether it is exempted from preemption by the savings clause in § 1144(b)(2)(A). The court concluded that the Act escapes ERISA preemption at the first step, but since it also thinks it would be saved as a regulation of insurance, it explains the second step as well.

Duh.

[Hank Chinaski]

Originally posted by ltl/fb
Duh.

well there are people reading this board who don't know all that- if you are going to post on ERISa (and I hope you continue to do so because you make some cogent points) then you should provide this type background info

[ltl/fb]

Originally posted by Hank Chinaski
well there are people reading this board who don't know all that- if you are going to post on ERISa (and I hope you continue to do so because you make some cogent points) then you should provide this type background info

That "background" info doesn't make sense to people without any background.

[Hank Chinaski]

Originally posted by ltl/fb
That "background" info doesn't make sense to people without any background.

physician heal thyself! Who decides how many rashers of bacon come with an order for 2? Does it increase with how low cut your blouse is?

[Greedy,Greedy,Greedy]

Originally posted by Hank Chinaski
physician heal thyself! Who decides how many rashers of bacon come with an order for 2? Does it increase with how low cut your blouse is?

You two should just get a room already.

[Mmmm, Burger (C.J.)]

So, Judge Lutting resigns to become GC at Boeing.

Query--when was the last time a court of appeals judge resigned for a private sector position? Or at least the last time a prominent one did? Starr went to be SG. Most of them resign when they get old. I do remember a couple of SF (NDCal) district judges doing so in the 90s.

[taxwonk]

Originally posted by Mmmm, Burger (C.J.)
So, Judge Lutting resigns to become GC at Boeing.

Query--when was the last time a court of appeals judge resigned for a private sector position? Or at least the last time a prominent one did? Starr went to be SG. Most of them resign when they get old. I do remember a couple of SF (NDCal) district judges doing so in the 90s.

The most telling sentence in the article was: "Noone can or should plan a career around being a Supreme Court justice." He probably felt he'd been passed over for what would be his best shot and decided to take the cash.

[Mmmm, Burger (C.J.)]

Originally posted by taxwonk
The most telling sentence in the article was: "Noone can or should plan a career around being a Supreme Court justice." He probably felt he'd been passed over for what would be his best shot and decided to take the cash.

Well, I think he's probably right. Clearly Bush wasn't going to appoint him, although it's always possible down the line with another R. It's not like his backer was Bush. His backers were a cabal of conservatives who will remain around.

Another nugget that was added to the article since I posted the link:

"Luttig said his criticism of the administration "had nothing whatsoever to do with this [Padilla] decision, which is more far-reaching than any particular case."

It's phrased a bit awkwardly, but I think the "which" refers back to his critiscism of the adminstration, which is another, perhaps even more interesting reason for resigning. If I read it correctly, and it's an accurate quote, that may be an even stronger statement than Robertson's resigntion from the FISA court after the revelation of the NSA wiretaps.

ETA: It does open up a seat for Kavanagh on the 4th circuit. My recollection is he was originally nominated to the 4th, for a "Maryland" seat (i.e., the space was a maryland-based 4th cir. judge). The maryland senators blocked it on that ground, so he was nominated to the DC Circuit instead. I suspect if he gets nominated to the 4th circuit to replace luttig, it would be pretty hard to argue that Bush is making that court more conservative.

[SlaveNoMore]

Mmmm, Burger (C.J.)
So, Judge Lutting resigns to become GC at Boeing.

Query--when was the last time a court of appeals judge resigned for a private sector position? Or at least the last time a prominent one did? Starr went to be SG. Most of them resign when they get old. I do remember a couple of SF (NDCal) district judges doing so in the 90s.

Country's loss - Boeing's gain.

[sebastian_dangerfield]

Originally posted by SlaveNoMore
Country's loss - Boeing's gain.

Jesus, man, do you masturbate to this guy's rulings? He's a smart guy, but I don't have a titanium hard on for him. And he doesn't strike me as a cat I'd like to have a drink with...

[sebastian_dangerfield]

Originally posted by Replaced_Texan
And this scares the shit out of me:

Oh, those twisted fucks have as much traction in the political sphere as the fucking Moonies. That's just the Times doing its ususal "sccare the piss out of liberals" piece.

But it is a very funny article.

[SlaveNoMore]

sebastian_dangerfield
And he doesn't strike me as a cat I'd like to have a drink with...

Please.

I save my drinking for Antonin "Vaffanculo!" Scalia and Dick "Go fuck yourself" Cheney.

Originally posted by SlaveNoMore
I save my drinking for Antonin "Vaffanculo!" Scalia and Dick "Go fuck yourself" Cheney.

And the occasional tourists from Mexico City. Ay chihuahua!

[Sexual Harassment Panda]

Some thoughts, collected over the years as I traverse the continent at the bidding of my corporate masters:

1. Le Meridien hotels - huge flat screen TV, hard beds, big clean rooms, fluffy towels, great spas, every inroom amenity I can think of. Dorint hotels - not so much.

2. Swiss women - hugely underrated. Italian women - hugely overrated. Swedish/Danish/Norwegian women - tear up the return ticket.

3. Love the trams. I don't know why, but I do.

4. California wine is great. But European wines (esp. Italian) just ooze centuries of tradition and history and lore. I swear they put them in the wines. Or maybe it was the settings.

5. They just don't build buildings like they used to. Churches, town halls, opera houses, memorials...

6. They have this World Cup thingy coming up - in Germany it's the rage. Anyone know anything about it?

[Hank Chinaski]

http://www.news24.com/News24/World/N...930302,00.html

So Ty and Iron-poor and them can finally get their kids the unbiased look at the US' evils that simply isn't available in berkeley.

• 'Great Satan Park' planned
  
  Tehran - The former US embassy in Tehran could soon see a new chapter in its troubled history, with a top Iranian commander calling for the downtown compound to be turned into a "Great Satan Park".
  
  "We would be able to nicely show off the American crimes to citizens strolling in the park," General Mir-Faisal Bagherzadeh told the official news agency IRNA.
  
  "The former American Den of Spies should become the park of Great Satan," said the general, who heads the Sacred Defence Foundation - an influential propaganda body set up to commemorate the 1980-88 Iran-Iraq war.