Insurance Regulation

The recent growth of retail clinics across the United States presents opportunities and challenges for states working to address access, costs, and quality issues within their health delivery systems.  With more than 1,000 sites in 37 states, the emergence of retail clinics as an alternate provider has shaken up traditional health care models and can no longer be viewed as a passing trend for the following reasons: • Retail clinics are accessible. They are usually found in suburban settings within a drug store, grocery store, or mass merchandise store. They are open during evening and weekend hours, without waits or appointments. • Retail clinic services often cost less. Because clinics are mostly staffed by lower cost providers such as nurse practitioners and have lower overhead costs, prices for services can be substantially less than alternatives such as an emergency room or urgent care center.

In a case that helps to define state authority to regulate health insurance, the U.S. Supreme Court held in April 2003 that ERISA (the federal Employee Retirement Income Security Act of 1974) does not preempt Kentucky's Any Willing Provider (AWP) law. This Issue Brief outlines ERISA preemption principles, explains the Supreme Court's opinion, and discusses the ruling’s implications for state laws regulating Health Maintenance Organizations (HMOs) and other health insurers.