Day: July 2, 2026

Florence Corcoran, an employee of South Central Bell Telephone Company, was eight months into a high-risk pregnancy when her obstetrician recommended she spend the final month on bed rest in the hospital, for close monitoring. Despite the recommendation, her health insurer determined that it would only cover partial-day at-home nursing care.

While a nurse was off duty, her fetus went into distress and died.

Corcoran sued her insurer, UnitedHealthcare. Because of a little-known law called the Employee Retirement and Income Security Act of 1974, or ERISA, she was unable to recover any money from her insurer due to their wrongful denial. She would see no legal justice following this avoidable tragedy.

Facing health insurance hurdles is an all-too-common American experience. But while courtroom dramas would have many Americans believe that patients can sue to recover money damages when they face wrongful denials, for most people who have employer-sponsored insurance, that is far from the truth. Corcoran’s case was decided in 1992 – and the situation is only worse today.

I’m a political scientist studying health insurance barriers and the politics of efforts to reform America’s health care system. In my book, “Coverage Denied: How Insurers Drive Inequality in the United States,” I traced how health insurance obstacles can upend patients’ health and economic lives.

ERISA magnifies those barriers by limiting patients’ legal ability to hold health insurers accountable – instead giving them a free pass to keep denying coverage without facing real consequences.

Healthcare rationing by inconvenience

Health insurance hurdles, such as prior authorization and claim denials, are widespread in U.S. healthcare, and the problem is growing.

Americans who have health insurance say prior authorization is the healthcare system’s biggest burden, causing administrative headaches while care is kept out of reach. Claim denials hit hard too.

Between 2016 and 2023, claim denials increased from 9% to 12%. In a nationwide survey I conducted in 2024, I found that 36% of Americans experience at least one coverage denial – though usually, it’s several.

The denial rate is even higher among people on employer-sponsored insurance, the type of insurance to which ERISA applies.

Denials can be appealed, but doing so demands a level of health insurance literacy and bureaucratic know-how that most people lack. My research shows that less affluent people are less likely to appeal denials in the first place, and sicker patients and those from historically marginalized groups are less likely to prevail even if they do appeal.

Such hurdles effectively create a dynamic that I call “rationing by inconvenience,” with red tape impeding meaningful access to care. This drives both health and economic inequities.

When healthcare is kept out of reach, less affluent and Black and Hispanic patients are more likely to postpone care they need, often to the detriment of their health. And they may delay non-medical spending, too, due to unexpected healthcare costs.

ERISA’s unintended effects

The sweeping impact of coverage barriers makes it especially important for patients to be able to take effective legal action against insurers. But ERISA strictly limits legal leverage for most people who get health insurance through their employer.

ERISA was crafted in response to widespread public concern about the mismanagement of private pensions, such as with the infamous sudden closure of Studebaker’s factory in South Bend, Indiana in 1963, which left thousands of autoworkers without their pension benefits. By establishing minimum federal standards and regulations for private benefit plans, the law aimed to protect workers’ pensions from fraud and mismanagement.

But shortly before Congress voted on the legislation, it added text related to “employee welfare benefit plans,” which include health benefits. It seems that lawmakers failed to appreciate that pensions and health benefits might demand different approaches to enforcement.

Unlike with other insurance plans, patients with ERISA-governed plans can’t sue an insurer for money damages – to reflect pain and suffering or lost income – when an insurer wrongly denies their care. They can only sue to get the specific treatment covered.

The law mainly affects one type of employer health insurance, called self-insured plans, in which the employer pays employees’ medical claims itself rather than buying coverage through an insurer. When ERISA was enacted in 1974, no more than 6% of workers who got health insurance through an employer were covered by a self-funded plan.

Today, 67% of people insured through an employer – roughly 100 million Americans – are in these plans, making the law’s defects especially salient.

Driving health inequity

ERISA’s constraints on patient protections have far-reaching effects. For one thing, lawyers prefer not to take on cases that don’t involve money, making it hard for patients to sue even for the limited benefits to which they would be entitled.

What’s more, even if patients are able to sue an insurer, the harms they experienced from wrongful coverage denials still wouldn’t be fully addressed – or in some cases, addressed at all.

For a worker suing an employer over a wrongly withheld pension, which ERISA was originally enacted to address, receiving that retained money would restore their loss. But that’s not the case for a worker who sues an insurer that denies coverage for their health condition.

Imagine a patient denied coverage for cancer treatment, for example. Even if a court reverses the decision, the patient’s condition may have worsened to the point where the treatment is no longer clinically indicated or as effective.

Florence Corcoran experienced this in the extreme: When she lost her fetus at eight months, the only relief to which she was entitled under ERISA was the inpatient monitoring that she no longer required after her pregnancy’s tragic conclusion.

ERISA’s poor design thus creates a destructive feedback loop that limits Americans’ access to healthcare and promotes health and economic disparities. By disincentivizing lawsuits, ERISA makes it virtually costless for insurers to deny coverage for patients’ prescribed healthcare.

A block on health reform

In many cases, individual states can pass their own laws to get around congressional gridlock relating to health policy. But ERISA explicitly overrides state laws that relate to self-insured health plans – including consumer protection laws that could potentially protect patients. In doing so, ERISA blocks states from enacting comprehensive health insurance reforms, including those promoting health insurance equity.

Lawmakers have raised this issue over the years, but Congress has not made serious attempts to reform these provisions since the late 1990s’ unsuccessful efforts toward a patients’ bill of rights. Later healthcare measures, including the Affordable Care Act, have focused on increasing the number of people who have health insurance and largely steered clear of efforts to reduce barriers for the tens of millions enrolled in these plans.

In my view, that is especially unfortunate because at the state level, there is bipartisan appetite to address ongoing health insurance barriers, such as by reforming prior authorization.

For example, California’s prior authorization reform bill, SB 1120, passed in 2024 unanimously. The problem is that ERISA prevents laws like SB 1120 from addressing health insurance barriers within the majority of employer-sponsored insurance plans.

Congress could move toward overhauling this outdated law – for example, by allowing states to seek waivers from ERISA’s constraints. Without such action, insurers will continue to face relatively little legal risk when they wrongly deny coverage, and patients will continue to bear most of the consequences.

Miranda Yaver does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

​Politics + Society – The Conversation

In Watson v. RNC, decided June 29, 2026, liberal and conservative Supreme Court justices joined a noteworthy cross-ideological majority to uphold state grace periods for mail-in ballots. The decision, which went against President Donald Trump’s policy preferences, preserved the status quo, allowing states to accept and count mail-in ballots postmarked by Election Day but received after.

The case revolved around the meaning of “election day,” which federal law states is the Tuesday after the first Monday in November. The statute does not say anything about casting or counting ballots on or by Election Day.

The Constitution says the time, manner and place of elections will be managed by states. Thus, Mississippi’s Legislature passed a law in 2020 to count mail-in ballots if they are postmarked by and received within five days of Election Day. Thirteen other states and Washington also allow this grace period, which ranges from one day in Texas to 20 days in Washington. The Republican National Committee, the Mississippi Republican Party, the Libertarian Party of Mississippi and several individuals challenged the Mississippi law, saying it violates federal law because it allows the state to count votes received after Election Day.

Advocates argue that these grace periods are important, in part because irregularities in the postal service can make it difficult for people who use mail-in voting to get their ballots to an election official by Election Day. These challenges are more acute for people with disabilities and people living in remote areas or abroad.

As a legal scholar with expertise in veterans affairs, I’ve paid close attention to how the Watson v. RNC case could impact active-duty military and veterans, given the latter’s higher rates of disability and rurality.

Background on the decision

This Supreme Court ruling stems from a pandemic-era law to make mail-in voting easier. Before 2020, Mississippi required mail ballots to be received by 5 p.m. on the day prior to the election.

The pandemic changed voting behavior, with mail-in voting rates higher than they were pre-pandemic. Since Donald Trump lost the 2020 presidential election, after these laws were passed, the president’s critique of mail-in voting has often hinged on false election fraud claims. This helped make mail-in voting a partisan issue.

In the oral arguments, conservative Supreme Court justices asked about the possibility of grace periods making an election’s outcome uncertain for weeks or months. They also expressed concern that a person could potentially cast a ballot and then recall it after Election Day, which goes against the federal law’s purpose.

Liberal justices were concerned that reading the statute as requiring votes to be received on or by Election Day could undermine states’ efforts to expand voting access through early voting.

Interestingly, the decision did not turn on the issue of early voting; rather, the history and impact of active-duty military voting was central.

The conservative justices split on how to interpret the statute – how to interpret historical voting practices and previous court decisions. Justice Amy Coney Barrett and Chief Justice John Roberts joined the liberals. Barrett penned the opinion, saying that “election day” means the day by which someone chooses a candidate, not the day the ballots are received.

Importantly, the majority was concerned about preserving the Uniformed and Overseas Citizens Absentee Voting Act. This 1986 law, passed under Ronald Reagan, is the culmination of numerous efforts to ensure that active-duty military would be able to vote in federal elections.

The Uniformed and Overseas Citizens Absentee Voting Act clarifies that states can establish their own procedures for counting ballots. The majority in Watson v. RNC explained that this provision of the 1986 law would make no sense if states could not count ballots received after Election Day.

As a practical matter, if states were not allowed to count ballots received after Election Day, many active-duty military and their dependents would be disenfranchised. That’s because the main reason active-duty military votes are not counted is late-arriving mail.

Mail-in voting and the military

Mail-in voting was first implemented to extend voting rights to active-duty soldiers during the Civil War. Soldiers submitted ballots to be counted and recorded by commanding officers, and their votes played an important role in the reelection of Abraham Lincoln.

The conservative justices split on how to interpret this history, since Civil War soldiers’ votes had to be received by Election Day. But Barrett’s opinion says that this practice tells us little about whether federal law required it.

Today, active-duty military and their families frequently go to great lengths to ensure they cast a ballot. In federal elections, they are voting for their commander in chief and members of Congress who control their budget. Many see it as a civic duty much like their military service. This sense of duty to vote remains even after active-duty military transition to veteran status.

For military stationed outside their home states or outside the country, mail-in voting is a necessity. Since 1942, Congress has passed laws to ensure that overseas military and their dependents are able to vote in federal elections. Current law protecting overseas voters requires that citizens abroad, including military, be sent their absentee ballots at least 45 days prior to the election.

The Justice Department’s Civil Rights Division has filed more than 30 lawsuits since 2000 against states and territories – including Vermont, Alabama and Guam – to ensure states properly mail and count absentee ballots of active-duty military and other Americans overseas.

In 2014, for example, a case against West Virginia ended in a judicial order that the state would count any ballots “executed” by Election Day but received up to 13 days later. Watson v. RNC reinforces these decisions designed to protect the voting rights of overseas military personnel.

Veterans’ voting rights

Veterans vote in higher proportion than the civilian population. Despite long-standing bipartisan support for veterans benefits, such as healthcare, their voting access has been controversial.

At the turn of the 20th century, Democrats tried to restrict voting rights for veterans because of their tendency to elect Republicans.

Historically, poor and disabled veterans have faced the biggest hurdles. For example, in the 1860s, Ohio state legislators passed a law so veterans in an Ohio residential facility would not count as Ohio citizens and, thus, would not be able to vote for congressional candidates.

Veterans often come from and return to rural areas, and many have disabilities, meaning they greatly benefit from mail-in voting policies because it is more difficult for them to show up in person to a polling location. Policies that make it harder for them to vote illustrate the negative impacts on Americans who also live in rural areas or are disabled, transient or otherwise unable to get to polling booths.

For these reasons, bipartisan veterans groups are actively engaged in protecting voting rights, and many have already spoken out in favor of the majority’s decision, which will help active-duty military and veterans be confident that their votes will be counted.

Jamie Rowen receives funding from National Science Foundation.

​Politics + Society – The Conversation