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©2010, Jin Zhou,

Photo of President Gerald R. Ford signing Employee Retirement Income Security Act of 1974

President Obama Signing Health Bill on 03/23/2010

President Gerald R. Ford Signing ERISA on 09/02/1974

New Webinars, Seminars & Certification Classes Announced for New Federal Health Claim Appeals Regulations on July 22, 2010 from HHS, DOL & IRS, Effective On Sept. 23, 2010 for 193 Million Americans

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(Links to DOL) ©2010, Jin Zhou,

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bullet ERISA Claims Procedure, 29 CFR 2560.503-1: Regulation FAQ Fact Sheet Claims Guide Claims Card
bullet Amendments to Summary Plan Description Regulations, 29 CFR 2520.102-3: Regulation Fact Sheet News Release SPD Rights Fact Sheet SPD from DOL
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Webinars, Seminars & Certification Classes for New Federal Health Claim Appeals Regulations - Free Webinars - New Federal Claims & Appeals Regulations, Effective Sept. 23, 2010, for 193 Million Americans Seminars - 2010 Two-day Basic ERISA Appeal Seminars - Denials and Overpayment Appeals - 2010 PPACA & ERISA Claim Specialist Certification Programs in Chicago, Illinois  Create An Appeal Department for Your Hospital or Practice (In-house, onsite ERISA Claim Specialist Certification Programs)


"Failure of Imagination" Again?



Congress Finds No Simple Solutions to Current Pension Problems (The Washington Post; one-time registration required)


NASA identifies foam flaw that killed astronauts (Reuters)


Jin Zhou Identifies "ERISA Failure" That Killed U.S. Healthcare


Health-Care 9/11 Report of 2005

Health-care WMD


by Jin Zhou, 02/05/2005

© 2005, Jin Zhou,

Unanimous US Supreme Court: Employer-Sponsored Health-Care Is Completely Governed by ERISA laws and rules; Aetna Health Inc. v. Davila, 06/21/04
Congressional Leaders: One Administration = One Voice = ERISA Self Enforcement only, or No Enforcement?
Health-care Terrorists?

"ERISA Advantage" bogus plans, "unlimited and frequent premium increases, and the potential for rampant fraud with little, if any, regulatory recourse" in 30 years of ERISA self enforcement.

Health-care WMD (Weapons of Mass Destruction)

"Medical Inflation,  WMD" for "ERISA Advantage" from ERISA Failure - "Failure of Imagination" Again for US Healthcare:

USA: $1.9 Trillion, 15.7% of GDP

GM:  $5.6 Billion, $1,500 Per Car

Economists: Federal deficit a bigger risk than terrorism (USA Today)

"The survey, taken between Feb. 28 and March 8, found U.S. businesses had three nearly equal concerns about longer-term risks: health care, the aging population and the federal deficit."

USA 2005:
  1. Personal Bankruptcy

  2. GM Chapter 11,

  3. National healthcare expenditure $$1,9 trillion

  4. One nation under debt

  5. GAO Report: Tax Expenditures Represent a Substantial Federal Commitment and Need to Be Reexamined (PDF) (U.S. Government Accountability Office) Abstract Highlights-PDF PDF 

White House Rx:

 $1,000 HSA personal responsibility + AHP with More "ERISA advantage" for "widespread plan insolvencies and fraud" and "A Prescription For Disaster".

2005 for Michael Moore? "John Q. ERISA Enforcement"???
Congressional conclusion 2008:

"Failure of Imagination" Again, with No One's Responsibility and Accountability.



Unanimous US Supreme Court Ruling

In US Health Care Crisis

by Jin Zhou, 02/11/2005

© 2005, Jin Zhou,

Managed-Care Nightmares?

Health-Care Crisis without True Solutions?


What Does an Unanimous US Supreme Court Say?


On June 21, 2004, an unanimous US Supreme Court ruled that claim processing and denials of benefits under the employer-sponsored health plans, ERISA-regulated benefit plans, for both self-insured and fully-insured (through purchase of insurance) health plans, are completely governed by federal law ERISA, that supersedes and invalidates state laws.


How Can Anyone in USA, from Congress to General Motor to the White House, from Industry Experts to Patient Advocates, Solve US Health Care Crisis without Even Thinking of ERISA?

"Failure of Imagination" As a Nation Is the Real Tragedy - Supreme Court Managed Care ERISA Watch


Unanimous US Supreme Court Ruling In US Health Care Crisis


Aetna Health Inc. v. Davila


Opinion of the Court


"Held: Respondents’ state causes of action fall within ERISA§502(a)(1)(B), and are therefore completely pre-empted by ERISA §502 and removable to federal court. Pp. 4–20."


"We hold that respondents’ causes of action, brought to remedy only the denial of benefits under ERISA-regulated benefit plans, fall within the scope of, and are completely pre-empted by, ERISA §502(a)(1)(B), and thus removable to federal district court. The judgment of the Court of Appeals is reversed, and the cases are remanded for further proceedings consistent with this opinion.7 It is so ordered."




"Failure of Imagination" Again?
(Copyright © 2004 by Jin Zhou,


"Failure of Imagination" Again Led to

U.S. Health-Care Disaster,

"Labor Market Impotence",

"Pension Anemia/Failure",

New Economy Recession &

"John Q. ERISA Enforcement"

in 2006 for

"Failure of Imagination" As a Result of Political Viagra



"ERISAflation": The combination of ERISA preemption, medical inflation, tax incentive protection and cost shifting to preserve inflated health-care coverage and to stabilize short-term premiums, and to ignore long-term health-care, labor market, pension and social security disasters.  -- Jin Zhou, 10/11/2004.

Kydland and Prescott win Nobel economics prize ((Reuters)
(Mon 11 October, 2004)

"Their 1977 article on the "time consistency problem" showed that policy makers tend to abandon longer-term aims to milk shorter-term benefits -- for example, setting out to keep prices stable, but then fomenting inflation to reduce debt."



U.S. HMO 9/11

"John Q. ERISA Enforcement"

in 2006 for

(Copyright © 2004 by Jin Zhou,



John Q.: My son is dying, no one seemed to care.


HMO Hospital: We are sorry, your insurance won't cover the care, it was determined not necessary, besides, the heart surgeon you "kidnapped" last time has been out on strike for medical malpractice tort reform.


The Employer: We have just switched to a new HSA consumer driven plan.


HMO Insurance: If we let your son live, that will increase healthcare costs, HMO premiums and more uninsured.


Supreme Court: All nine of us read ERISA last night, and found Davila guilty, it's up to Congress.


The President: I'm the only one to protect you, but ERISA is tough, I must take it back.


Congress: Patient's Bill Of Rights (+R) + Medical Malpractice Tort Reform (-R) = Ground Zero (0), Adjourned.


John Q.: HMO and Congress under new management, put my son on donor's list and no one gets hurt or ....


John Q.'s Neighbors and Co-workers: John, we are with you....



ERISA Failure Syndrome

U.S. Healthcare Crisis Trilogy

(Copyright © 2004 by Jin Zhou,


Medical Killing
Medical Inflation
Insurance Robbery
"Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance

Read Making a Killing




Bar graph showing trends in hospital charges and revenues in California from 1995-2002







American Job ExportING!

Mass layoffs up in January 2004

Weirton Steel cancels 10,000

GM: $67.5 billion in 2003

One Nation under Debt: U..S. economy threatened by aging of America


Healthcare Disaster at Fault Verdict Index:

U.S. Government 30%

U.S. Employers & Insurers 30%

Healthcare Providers 30%

Consumers 10%

(ERISA Failure + Managed-Care) Destroyed US Healthcare
(ERISA Failure + Managed-Care + HSA) Invite US Federal Budget Deficit & Social Security Disasters = 100X 9/11 Attacks


GAO: Current and Emerging Fiscal and Retirement Security Challenges, American Benefits Council/MetLife Conference, Washington, DC, on January 14, 2005


  1. Rising Health care Costs Have Many Implications (Direct)

  2. Rising Healthcare Costs Have Many Implications (Indirect)


Rx-1  $$$$$$$$$ERISA"Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
$$$$$$$$$$  Rx-2


The Root of U. S. Healthcare Crisis

Jin Zhou,


The Hearing at Senate Committee on Finance on 3-3-04, [View Video "Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
or Transcript (PDF) (]  revealed the mechanism, nature and extent of ERISA failure and nonenforcement as the reasons for "Growth in Bogus Health Insurance Plans Targeting Desperate Small Business Owners", as being concluded as "No the results are not good. It’s a tragedy." by Ann Combs, assistant secretary of DOL. The mechanism, nature and extent of ERISA failure and nonenforcement as presented at the Hearing are universally true and applicable to all health care claim denials and delays in managed care environment from all employer sponsored health plans as the root of U. S. healthcare crisis.


This is a 911 call on "healthcare 9/11 disaster"!




"Failure of Imagination" Again?
(Copyright © 2004 by Jin Zhou,




Rx-1  $$$$$$$$$ERISA"Health Insurance Challenges: Buyer Beware" 3-3-04
Hearing, Senate Committee on Finance
$$$$$$$$$$  Rx-2


ASO+HMO+PPO-SPD=$1.8 Trillion/Y US Healthcare Crisis




ERISA Failure, Noncompliance and Nonenforcement of ERISA SPD and Claims Procedure Rules, Is the Damaged or Missing Foam on U.S. Healthcare Wings!

HMO Crisis Is Really An ERISA Crisis!

HMO & PPO Managed Care Contracting to 
Disregard & Substitute
ERISA SPD & Claims Procedure
The Primary & Inevitable Cause of Medical Inflation

Costly Managed Care & Medical Malpractice Lawsuits
American Job Export!


ERISA Failure Damages Are Greater Than
9/11 and Pearl Harbor Tragedies Combined

U.S. Health-care Crisis & ERISA Criminal Enforcement


(ERISA Failure + Managed-Care) Destroyed US Healthcare
(ERISA Failure + Managed-Care + HSA) Invite US Federal Budget Deficit & Social Security Disasters = 100X 9/11 Attacks

AHP +HSA + Managed Care =

Winning Battle, But Losing War on Medical Inflation


Only practical solution is to cut the skyrocketing healthcare care costs and increase the healthcare coverage and benefits at the same time without having to go to Congress to reinvent another new "Mars Project" or "Universal Uninsured Bill of Right" - "John Q. ERISA Enforcement".


Zhou's Medical Inflation Projection Through 2008:

$1,000 Deductible (HDHP / HSA) + $1,500 Discount (HHS / Indigence)
[Deductible + UCR + PPO Disc.] 
"Discretionary Spending" + "Price Gouging"
 500% Medical Inflation in 5 years   


The United States General Accounting Office


Growing Challenges Point to Need for
Fundamental Reform


January 13, 2004



First page Back Continue Last page Overview Text

HMOs Earn $10.2 Billion in 2003, Nearly Doubling Profits, According to Weiss Ratings; Blue Cross Blue Shield Plans Report 63% Jump in Earnings (BUSINESS WIRE)--Aug. 30, 2004


GAO: The Future Sustainability of Social Insurance Programs (David M. Walker, Comptroller General of the United States)

bullet (Cont'd)Social Security and Health Spending as a Percent of GDP
bullet Current Fiscal Policy Is Unsustainable
bullet We Need a 3-Pronged Approach
bullet 21st Century Questions
bullet 21st Century Questions (Cont'd)


Rx-1  $$$$$$$$


$$$$$$$$$  Rx-2


Life and Health Insurers' Earn $26 Billion in First Nine Months of 2004, According to Weiss Ratings (Business Wire (press release), CA - Mar 15, 2005)


Weiss Ratings: HMO & Health Insurance News Releases

Release Date
2/7/2005     Higher Co-Pays for Drugs and Doctors Cited as
Most Significant Change to Health Insurance Coverage
2/7/2005     50% of HMOs Financially Strong as Profitability Continues
12/8/2004     HMO Profits Increase 33% in First Quarter 2004
8/30/2004     HMOs Earn $10.2 Billion in 2003, Nearly Doubling Profits
5/3/2004     HMO Profits Skyrocket to $6.7 Billion in First Nine Months of 2003
3/2/2004     HMO Profits Surge 73% in Second Quarter 2003
1/20/2004     HMO Profits Jump 60% in First Quarter 2003


  1. GM Credit Rating Cut Again (

    "In addition, health-care costs in the United States continue to increase at an excessive rate and are a growing burden on GM's financial results. "These continuing large increases in healthcare costs put GM, and many other U.S. businesses, at a significant disadvantage," said Wagoner."

  2. GM's Spinning Wheels (Motley Fool)

  3. Ford Posts Profit on Credit, Autos Lose (
  4. Ford makes more from selling loans than making cars (


U.S. Labor Secretary Elaine L. Chao Announces Stronger Retirement, Health Benefit Security for American Workers - 121% Increase in Monetary Results Shows “Commitment to Protect Hard-Earned Benefits” Release Date: 10/21/2004

"EBSA closed 4,399 civil investigations in FY 2004. Nearly 70% of those investigations resulted in correction of violations under the Employee Retirement Income Security Act (ERISA). Criminal investigations led to the indictment of 121 individuals. In addition, EBSA received a record 474 applications to participate in its compliance assistance program to help employers and plan officials to voluntarily correct specific violations of the law."

EBSA Achieves Record $3.1 Billion in Fiscal Year 2004 Results Press Release




Press Releases

Department of Law
120 Broadway
New York, NY 10271
Department of Law
The State Capitol
Albany, NY 12224
For More Information:
(212) 416-8060
For Immediate Release 
October 14, 2004

Leading Brokerage Firm Sued for Fraud and Antitrust Violations; Insurance Company Executives Plead Guilty; Major Insurance Firms Implicated

"Attorney General Eliot Spitzer today sued the nation's leading insurance brokerage firm, alleging that it steered unsuspecting clients to insurers with whom it had lucrative payoff agreements, and that the firm solicited rigged bids for insurance contracts."



bullet Complaint [Text Version]

Birthday Sept. 2,


Happy or Sad 30th Birthday To ERISA?

(Copyright © 2004 by Jin Zhou,

Sept. 2, 2004

On Sept. 2, 1974, exactly 30 years ago today, ERISA, The Employee Retirement Income Security Act, was signed into law by President Gerald R. Ford. The congressional intent in enacting ERISA was to protect employees in pension and welfare plans, to provide uniform federal protections in response to the failure of the Studebaker Co. in December 1963, with thousands of long-service employees cheated out off their promised pensions, and to preempt any state laws when the employees pension and welfare benefits were threatened. 30 years later, ERISA Failure in its compliance and enforcement left thousands of retirees without medical benefits, and resulted in a skyrocketing national healthcare expenditure explosion with 45 million uninsured and a possible national pension bailout.

ERISA Failure Syndrome

U.S. Healthcare Crisis Trilogy


Jin Zhou Identifies "ERISA Failure" That Killed U.S. Healthcare

"Failure of Imagination" Again?




ERISA Celebrates 30th Anniversary As Trouble Brews For the Pension Insurance Program (Spencer Benefits Reports)

Excerpt: "The seed for ERISA was planted with the failure of the Studebaker Company in December 1963, leaving thousands of long-service employees without their promised pensions."

A Hard-to-Swallow Lesson on Pensions and Promises and ERISA (The New York Times; one-time registration required)

Excerpt: "Hundreds of people here in western New York, all closing in on retirement, have learned a bitter lesson about pensions and the law that guarantees them. Two years ago, their employer, ... unexpectedly started urging them to take their pensions early, warning that they would otherwise lose their right to take their benefits in a single check. The workers signed up to receive their money right away, but the money was much less than they had earlier been told they had coming."

The Economic Downturn and Changes in Health Insurance Coverage, 2000-2003, (Kaiser Commission on Medicaid and the Uninsured)

 Other Resources Icon Executive Summary (.pdf)    Reports and Studies Icon Report (.pdf)


The number of uninsured Americans under age 65 increased by 5.1million between 2000-2003 largely driven by continuing declines in employer sponsored insurance. ....."

The Supreme Court and Employee Health Insurance (FindLaw's Writ - Sebok)

"What Americans generally don't know, however, is that this issue isn't restricted to the Congress or the Executive. To the contrary, the U.S. Supreme Court has been nationalizing one important aspect of health care in this country: the administration of medical health insurance offered by employers to their employees.


This creeping nationalization has been achieved slowly and surely by the expansion of the court's interpretation of an important federal law: the Employee Retirement Income Security Act (ERISA)."

Inquiry on Medicare Finds Improper Limits on Choices of Health Care Providers (The New York Times; one-time registration required)

Excerpt: "Federal investigators said Monday that the Bush administration had improperly allowed some private health plans to limit Medicare patients' choice of health care providers, including doctors, nursing homes and home care agencies."

Medicare Demonstration PPOs: Financial and Other Advantages for Plans, Few Advantages for Beneficiaries GAO-04-960, September 27, 2004

Abstract    Highlights-PDF    PDF 



Post Supreme Court Davila Scoop:

ERISA Pre-emption of State Laws in Healthcare



Cicio v. Vytra Healthcare (pdf)

Cicio v. Vytra Healthcare

2nd Cir. 09/24/2004



The facts of this case are set forth in detail in our earlier opinion. We need not rehearse them here.

In Aetna Health Inc., the Supreme Court declared that "any state-law cause of action that duplicates, supplements, or supplants the [Employee Retirement Income Security Act of 1974 ("ERISA")] civil enforcement remedy conflicts with the clear congressional intent to make the ERISA remedy exclusive and is therefore pre-empted." 124 S. Ct. at 2495. "Congress' intent to make the ERISA civil enforcement mechanism exclusive would be undermined if state causes of action that supplement the ERISA § 502(a) remedies were permitted, even if the elements of the state cause of action did not precisely duplicate the elements of an ERISA claim." Id. at 2499-2500......



Accordingly, we vacate our previous decision in this matter and affirm the district court's dismissal of Ms. Cicio's complaint."


Barber v. Unum Life Ins Co

3rd Cir. 09/07/2004


"Because we hold 42 Pa. C.S. § 8371 is conflict preempted by ERISA, or alternatively expressly preempted under ERISA § 514(a), we will reverse the judgment of the District Court and remand with instructions to dismiss Barber’s bad faith claim."


Overview: 3rd Circuit Boots Theory Allowing Bad-Faith ERISA Litigation (


[07/30/03, 11th Cir.]

Robbie Lee Land v. Cigna Healthcare of Florida

11th Cir.

(August 27, 2004)


Before MARCUS and WILSON, Circuit Judges, and RESTANI , Judge. *



After we issued our decision in this case on July 30, 2003, Land v. CIGNA Healthcare of Florida, 339 F.3d 1286 (11th Cir. 2003), the Supreme Court vacated and remanded for further consideration in light of its recent decision in Aetna Health Inc. v. Davila, 542 U.S. ----, 124 S. Ct. 2488 (2004). After carefully reviewing Davila, we find that Land’s state law malpractice claims against his health maintenance organization (“HMO”) were preempted by Section 502 of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001-1461."


Eleventh Circuit Court Nixes State Malpractice Lawsuit Against ERISA HMO (RIA Pension & Benefits Week)


US Health Care Gaps Kill 79,000 People a Year, Report Shows (Bloomberg - United States)

"Sept. 23 (Bloomberg) -- Disparities in the U.S. health-care system result in up to 79,000 premature deaths each year because of a lack of preventative treatments and care for chronic conditions like diabetes, according to the National Committee for Quality Assurance."

The State of Health Care Quality, 2004: Industry Trends and Analysis (PDF) (National Committee for Quality Assurance)

61 pages. Excerpt: "NCQA's annual State of Health Care Quality report ... found that nearly 66.5 million avoidable sick days and more than $1.8 billion in excess medical costs can be traced to the health care system's routine failure to provide needed care."


Uninsured Reached

45 Million in 2003
US Census Press Releases

"The number of people with health insurance increased by 1.0 million to 243.3 million between 2002 and 2003, and the number without such coverage rose by 1.4 million to 45.0 million."


Income, Poverty, and Health Insurance Coverage in the United States: 2003 (P60-226) new

Health Insurance Data (Source: U.S. Census Bureau)

(10 years on the web)

Benefits cost cited in US hiring slump
Washington Times, DC - Aug 19, 2004


HMOs Earn $10.2 Billion in 2003, Nearly Doubling Profits, According to Weiss Ratings; Blue Cross Blue Shield Plans Report 63% Jump in Earnings (BUSINESS WIRE)--Aug. 30, 2004


Companies Sue Union Retirees in Attempt to Cut Promised Health Benefits (Wall Street Journal Online)









Pension Bailout Called Possibility (Bloomberg News via Chicago Tribune)


Editorial: U.S. Congress Must Take Care of Pensioners by Addressing Issue of PBGC Shortfalls (Milwaukee Journal Sentinel via JS Online)


CRS Report: Can the Pension Benefit Guaranty Corporation Be Restored to Financial Health? (PDF) (Congressional Research Service via The ERISA Industry Committee)



U.S. Expresses Concern About UAL Pensions (Reuters via The New York Times (one-time registration required))



Pensions on a Precipice: What Could Happen If UAL Offloads Its Retirement Plan on the Feds? (BusinessWeek Online)


Greenspan Issues Warning on Retirement Benefits (The New York Times)

"JACKSON HOLE, Wy., Aug. 27 — The chairman of the Federal Reserve, Alan Greenspan, warned today that the Federal government might have to scale back promises to the elderly in programs like Social Security and Medicare."


ICI Statement on Disclosure to Plan Sponsors and Participants before the ERISA Advisory Council (Investment Company Institute (ICI))


Testimony before the ERISA Advisory Council on Fee and Related Disclosures to Participants (American Society of Pension Actuaries)





Health Plans for Retirees Face Big Cuts (Business First of Buffalo via bizjournals)



Washington Put on Pensions Alert (The Financial Times; one-time registration required)




Opinion: General Motor' s Chief Says Health Care Needs Bipartisanship (AP via Council for Affordable Health Insurance)


Sourcebook: Covering Health Issues 2004 (Alliance for Health Reform)










2005 State Legislators' Guide to Health Insurance Solutions and Glossary (PDF) (The American Legislative Exchange Council and The Council for Affordable Health Insurance)





PBGC: When Will the Cash Run Out? (

PBGC could exhaust its cash and investments by 2020, according to projections from our cash flow model, the first such model to be publicly available.

Download PDF version

Download Summary Only (PDF)


Federal Pension Agency Deficit Increases to $23.3 Billion in Fiscal Year 2004 (Reuters via MSN Money)




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