Kentucky Ass'n of Health Plans, Inc. v. Miller, 538 U.S. 329 (U.S. 2003)
Kentucky Association of Health Plans v. Miller is a cornerstone ERISA preemption decision that reshaped how courts assess whether a state law regulating health insurance survives ERISA's sweeping preemption clause.
Do Kentucky's any‑willing‑provider statutes "regulate insurance" within the meaning of ERISA's saving clause, and thus avoid ERISA preemption for insured plans?
A state law "regulates insurance" within ERISA's saving clause if (1) it is specifically directed toward entities engaged in insurance, and (2) it substantially affects the risk pooling arrangement between the insurer and the insured. Even if saved from preemption under this test, the ERISA deemer clause prevents states from applying such laws to self‑funded ERISA plans by deeming them insurers.
Yes. Kentucky's any‑willing‑provider laws are specifically directed at insurers and HMOs and substantially affect the risk‑pooling arrangement between insurers and insureds. They therefore "regulate insurance" and are saved from ERISA preemption as applied to insured plans. The deemer clause continues to shield self‑funded ERISA plans from state regulation.
Miller provides the modern, controlling test for ERISA's saving clause and clarifies the boundary between federal preemption and state insurance regulation. It empowers states to regulate key features of insured health coverage—such as network access, utilization review, and external appeals—while preserving ERISA's core protection for self‑funded plans via the deemer clause. For law students, Miller is essential for exam and practice analysis: it replaces the older McCarran‑Ferguson‑influenced approach with a concise two‑part inquiry, shaping arguments and outcomes in cases testing state regulation of insurers that impacts plan design and risk allocation.