AAE Urges Supreme Court to Protect Patients & Dental Providers from Insurance Abuse  

In June, the AAE pledged its support for an amicus brief (friend of the court) led by the dental community, urging the U.S. Supreme Court to review a lower court decision that wrongfully limits states’ rights to regulate healthcare and insurance policies if they impact federal law, the Employee Retirement Income Security Act (ERISA). The AAE is supporting the state of Oklahoma’s argument in Rutledge v. Pharmaceutical Care Management Association, that state laws, including dental insurance laws, should not be preempted by ERISA. The ERISA preemption creates a dangerous loophole that allows insurance carriers to bypass state laws that protect patients and dentists from abuse. 

ERISA insurance plans, also referred to as “self-funded” plans, involve employers paying into the plan and taking on the risk of covering their employees’ dental insurance claims. Enacted in 1974, ERISA is a federal law that sets minimum standards to protect employees in these health and retirement plans. It includes a “preemption” clause that prevents state and local laws from interfering with the uniform administration of ERISA plans. Over the years, insurance companies have used the ERISA preemption as a loophole to not comply with state laws designed to protect patient rights and healthcare providers, including endodontists, from abuse. 

Because ERISA is a federal law, only federal courts can determine if ERISA preemption applies in specific insurance disputes under state law. This has led to a chain of recent federal court battles due to uncertainty over whether state laws interfere with the administration of ERISA plans. In 2021, the Supreme Court ruled in Rutledge v. Pharmaceutical Care Management Association that some state laws regulating healthcare prices can be exempt from ERISA preemption, a significant victory for the dental and medical communities. 

Most recently, the legal debate over ERISA continued with the Mulready (State of Oklahoma) v. Pharmaceutical Care Management Association case, a dispute over Oklahoma’s regulation of pharmacy benefit managers (PBMs) to increase price transparency and lower prescription drug costs. Unfortunately, the Tenth Circuit Court of Appeals ruled in 2023 that ERISA preempts segments of the Oklahoma law, ruling against the interests of patients, lawmakers, and the medical community. 

Given this misguided interpretation, the AAE, along with the dental community are requesting the Supreme Court to review this case. The amicus brief supports the state of Oklahoma, as the case could set a legal precedent on whether state insurance reforms can impact ERISA plans. There has been considerable debate in lower courts over whether ERISA preemption overrides states’ rights to govern healthcare policies. 

The AAE is hopeful that this amicus brief will persuade the Supreme Court to clarify ERISA preemption in a way that reaffirms states’ rights to enact pro-patient laws that dental plans need to comply with. This decision could bring legal clarity to state governments and empower them to enact more insurance reforms that protect patients and dental providers from insurance abuse. 

Learn More About Amicus Briefs

Of Latin origin, meaning “friend of the court,” an amicus brief is a written argument that provides input, aid, historical context, and outside information to the court. Often, the brief offers expertise that the judge or justice may lack. A well-written amicus brief offers additional perspectives on legal matters with public policy implications. 

Amicus briefs serve several purposes, including: 

• Providing appellate courts with additional information, perspectives, and legal or policy arguments; 
• Creating direct, case-specific judicial access for any organization with a vested interest in the questions presented by an appeal;  
• Alerting the court to the broader implications of the case beyond the original two parties involved; and  
• Drawing media and public attention to important issues. 

The mere act of filing an amicus brief by a party or coalition can signal to a court that a case is of significant importance and raises broader issues beyond the litigants’ interests. Amicus curiae briefs play a crucial role in court cases by providing documentation and expertise from specific fields and industries, thereby ensuring that the court can make a fair and informed decision.