Health Care


This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.

The Maryland state legislature overrode a veto yesterday and passed a law that effectively forces Wal-Mart to spend more on health insurance. It mandates Maryland employers with more than 10,000 employees to spend at least 8 percent of their payrolls on health care. The state's other big three employers already spend that much so the law is really aimed at the huge retailer, Wal-Mart. Various stories about the Maryland law say that similar efforts will be made in other states. And to check on what's happening, we've called on Laura Tobler, who is health policy analyst at the National Conference of State Legislatures in Denver.

Welcome to the program once again.

Ms. LAURA TOBLER (Health Policy Analyst, National Conference of State Legislatures): Thank you. Glad to be here.

SIEGEL: How common are state bills that mandate health coverage or more spending on health coverage by employers, employers generally or by Wal-Mart specifically?

Ms. TOBLER: Well, this particular initiative is really aimed at addressing the growing number of uninsured in the states. And, indeed, Maryland is the only state that has passed a bill addressing large employers, 10,000 employees or more. However, Hawaii has an employer mandate that covers a variety of employers in their state and that's been in place since the early '70s. The reason that no other states have followed in Hawaii's footsteps is because right after Hawaii implemented their law the federal government passed a law called ERISA, the Employee Retirement Income Security Act in 1974 and it precluded states from regulating employer benefits, including health insurance. And there were states that have made attempts in the past--Massachusetts, Oregon and Washington among them--that have made attempts to implement employer mandates, and for reasons different in each state, gave up those attempts.

SIEGEL: Well, are people then watching the Maryland law assuming it's going to be challenged, watching to see whether it's going to be thrown out as a violation of ERISA?

Ms. TOBLER: I am certain that everyone is watching the Maryland law and waiting to see what's going to happen there. Will it be challenged? California passed a law in 2003 that would have mandated employers to provide a certain amount of insurance--health insurance for their employees and there was quite a bit of analysis of that law and the conclusions were not clear as to whether or not it would have passed an ERISA muster. We really haven't seen an ERISA challenge to these types of laws. However, you're correct in assuming that states across the nation are going to be watching Maryland and, in fact, there have been a few states that have filed bills that are very similar to the Maryland bill.

SIEGEL: Now I've read a list of those bills with brief descriptions of them and there seems often to be a linkage between employees of big companies and the state's Medicaid program. The message seems to be to companies, `If your employers need state funds to get medical care, then you are presumed to be not spending enough money on their insurance.'

Ms. TOBLER: That's right. In recent years the policy-makers have been paying close attention to who are the beneficiaries in publicly-funded health insurance. And they're seeing that, of course, a percentage of these beneficiaries are employed and that those employers either offer insurance that's unaffordable for low-income individuals or they don't offer insurance to a percentage of their employees, part-time employees or they don't offer insurance for the first six to 12 months of employment. So states are looking at ways to share the burden of paying for health insurance for those individuals, which is why Maryland named their bill the Fair Share Health Care Fund, indicating that they wanted employers to pay their fair share.

SIEGEL: That's Laura Tobler, who is health policy analyst at the National Conference of State Legislatures in Denver. Thank you very much for talking with us.

Ms. TOBLER: Thank you.

Copyright © 2006 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.



Please keep your community civil. All comments must follow the Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

NPR thanks our sponsors

Become an NPR sponsor

Support comes from