Search

The Employee Retirement Income Security Act of 1974 (ERISA) not only regulates employer-sponsored retirement benefits but also extends to employer-sponsored health plans, preempting state and local regulations. Proponents argue that ERISA preemption creates a uniform regulatory environment for employers, reducing administrative costs and fostering innovation. Large employers value ERISA preemption for its ability to offer consistent benefits across states, lower costs, and promote workforce mobility. If ERISA preemption were eroded, employers may face higher costs and potential challenges in providing health benefits. [Extracted from the article]

The article "Recent Arbitration-Related Decisions in the U.S. Court of Appeals for the Fifth Circuit" reviews various recent arbitration rulings in the Fifth Circuit. It covers cases involving insurance, investment accounts, commercial liability, and employment disputes, among others. The decisions range from motions to compel arbitration being granted or denied, to questions of law being certified to the Louisiana Supreme Court regarding arbitration clauses in insurance policies. [Extracted from the article]

The text explores the challenges faced by pregnant workers in the United States, focusing on discrimination and lack of accommodations in the workplace. It discusses the limitations of existing federal laws like the Pregnancy Discrimination Act (PDA) and the Americans with Disabilities Act (ADA) in protecting pregnant workers. The passage of the Pregnant Workers Fairness Act (PWFA) in 2022 is highlighted as a significant step towards addressing these issues by requiring employers to provide reasonable accommodations for pregnancy-related conditions. Additionally, the text delves into legal protections and challenges for employees with reproductive health conditions, emphasizing the importance of enhanced antiretaliation measures, privacy protections, and access to paid sick leave for all workers, especially those with common reproductive health conditions. [Extracted from the article]

This article provides an overview of trends in self-insured health coverage in the United States, focusing on the period since the passage of the Affordable Care Act (ACA) in 2010. It highlights that the percentage of private-sector establishments offering self-insured plans has been increasing since the 1990s, with larger firms more likely to self-insure. However, since the ACA, self-insurance has increased among small and medium-sized firms while decreasing among larger firms. Enrollment in self-insured plans has also increased, particularly in large firms. The article also examines trends in stop-loss coverage, which protects employers from large claims, and finds significant differences by firm size. The text concludes by acknowledging the impact of the ACA on self-insured health plans, particularly among smaller employers, but notes that the reasons for the decline in self-insurance among larger firms are not clear. [Extracted from the article]

Identifying whether an insurance company is a proper party defendant in a claim for benefits under ERISA has for many years presented a surprisingly difficult question. Left to struggle with the issue, the federal courts developed a somewhat complex body of conflicting law on the issue. [ABSTRACT FROM AUTHOR]

The article presents an annual review from the American Bar Association on federal securities regulation in 2023. It reports regulatory developments including on the securities transaction settlement cycle, electronic data gathering, analysis and retrieval system (EDGAR) filing hours, share repurchase disclosure modernization, and references to credit ratings. It outlines accounting developments and caselaw developments in the U.S. Supreme Court and Courts of Appeals.

Purpose: This study aims to examine whether and how the experience of specialized external governance mechanisms mandated by the Employee Retirement Income Security Act of 1974 – the actuary and auditor – affect pension plan funding. Design/methodology/approach: This study uses data from annual pension plan regulatory reports (Form 5500), Form 10-K filings, Form DEF 14A filings (company proxy statements) and publicly available data sources. The hand-collected data include information related to the pension plan's actuary and auditor and various pension plan data disclosed in the company's financial statement footnotes. Findings: The author finds that more experienced actuaries and auditors are associated with better funded pension plans, especially when the company has higher financial risk or lower board independence. Additional analyses indicate that companies with more experienced actuaries and pension plan auditors are more likely to make higher annual pension plan contributions and hold fewer Level 3 fair value assets. Originality/value: The dearth of pension plan governance research generally focuses on whether and how internal governance mechanisms affect pension plan funding. To the best of the author's knowledge, this is the first empirical study of the relationship between external pension plan governance mechanisms and pension plan funding. [ABSTRACT FROM AUTHOR]

The article titled "SHOW ME THE MONEY": THE SEC'S USE OF DISTRIBUTION AS A TOOL FOR INVESTOR PROTECTION" discusses the Securities and Exchange Commission's (SEC) use of distribution as a tool for investor protection. It highlights the importance of disgorgement and distribution in SEC enforcement actions and the impact of recent developments on the SEC's ability to seek disgorgement. The article also presents recommendations for the SEC to prioritize beneficial distribution to harmed investors and continue aggressively pursuing disgorgement of ill-gotten profits. The background on securities regulations and the establishment of the SEC are also discussed. [Extracted from the article]

The provided text details North Carolina's anti-ESG (environmental, social, and governance) law and the fiduciary responsibilities of the State Treasurer.

The article focuses on trends in self-insured health plans and their enrollment since the passage of the ACA, examining differences based on firm size. It discusses how ACA components influenced the attractiveness of self-insurance, especially for small and medium-sized employers, and presents key findings on changes in offerings and enrollment between 2010 and 2022, with a particular focus on establishment size.

Our Section website highlights several of the reasons to be a member of the Tax Section: "The Section of Taxation gives you insight into current developments in tax law, connects you with the brightest minds in tax and provides cutting-edge continuing education." Dick was appointed as the first Chair of the newly formed NCBA Tax Section, served as President of the NCBA (1988-89), was active in the Civil and Criminal Tax Penalties Committee of the ABA Tax Section, and later served as President of the American College of Tax Counsel (1993). Membership in the Tax Section for all categories is only $105, making the Section a great bargain for a tax lawyer. [Extracted from the article]

When a divorce occurs, a life insurance policy where an ex-spouse has been designated as a beneficiary may not be a focus of attention. States have taken steps, either through a judicial mandate or the enactment of legislation, to establish policies for dealing with beneficiary designations that have not been changed from an ex-spouse. However, when the life insurance is provided through a federal program, or is an employee benefit governed by the Employment Retirement Income Security Act of 1981 (ERISA), the Supreme Court has been clear in finding that state law is preempted, and that federal law must be applied to determine the status of the beneficiary. [ABSTRACT FROM AUTHOR]

The pension maximization strategy can be a viable one for those couples facing a pension benefit decision. We examine a methodology that will allow planners to show clients whether the strategy should be implemented. [ABSTRACT FROM AUTHOR]

The article presents the discussion on policymakers understanding the strategies for improving employee financial wellness. Topics include examining trends in account balances, individual and employer contributions, distributions, invested assets, and account-owner demographics from 2011‒2021; and accountholder investing the HSA in assets other than cash.

The article discuses the research study conducted by the Employee Benefit Research Institute (EBRI) regarding how Health Savings Accounts (HSAs) are used by employees. It is reported that age and tenure play a major role in HSA utilization, with older accountholders having higher average contributions and balances than younger accountholders. It is further reported that only 12 percent of accountholders invested their HSAs in assets other than cash.

Many people are unfamiliar with Social Security's unique risks and how to deal with them. We examine what makes the Social Security environment so different from other areas in which financial planners work. A quick summary of the main risks facing private-sector pension plans is provided as a helpful basis, and then unique Social Security risks are explored. [ABSTRACT FROM AUTHOR]

On July 27, 2020, in Allen v. Wells Fargo & Co., the U.S. Court of Appeals for the Eighth Circuit held that plaintiffs who bring an imprudence claim under the Employment Retirement Income Security Act against a fiduciary of an employee stock ownership plan (ESOP) alleging that the fiduciary failed to act on negative inside information do not meet their pleading burden. In doing so, the Eighth Circuit agreed with three other federal circuit courts that an imprudence claim predicated on an ESOP fiduciary's failure to disclose negative information is insufficient to survive a motion to dismiss. Only the Second Circuit has held that plaintiffs can survive a motion to dismiss when offering early disclosure as a possible alternative action the fiduciary could have taken. This Comment argues that the Eighth Circuit's holding is correct because it best protects ESOP plan managers and takes account of ESOP's unique structure. [ABSTRACT FROM AUTHOR]

The article examines trends in the availability of and enrollment in self-insured health plans among private-sector establishments since the passage of the Patient Protection and Affordable Care Act of 2010 (ACA) in the U.S. Data shows the percentage of private sector establishments offering at least one plan from 1996-2021 and by firm size from 2013-2021, percentage of covered workers from 1996-2021 and by firm size from 2013-2021 and percentage of enrollees by state in 2021.

In a unanimous decision, the Supreme Court restored order to the church plan community by holding that an employee benefit plan sponsored by a church affiliate does not have to be established by a church in order for that plan to qualify for the church plan exemption under the Employee Retirement Income Security Act, as long as the plan is maintained by a principal-purpose organization. However, this decision will not end the litigation brought by church plan participants. There are other elements of the church plan definition that have to be resolved. [ABSTRACT FROM AUTHOR]

The issue of coverage under the Employee Retirement Income Security Act of 1974 (ERISA) of certain bonus, incentive, stock, severance, and other similar arrangements remains a source of considerable controversy and litigation. This column reviews the factors courts use to determine whether compensatory arrangements are being provided pursuant to an ERISA-covered plan. Furthermore, there is not a great deal of certainty in how courts will determine whether an ERISA-covered plan exists. Given this uncertainty, it is recommended that during the planning stages and as part of an employer's overall risk management strategy, serious consideration should be given to the pros and cons of deciding whether a benefit plan should be covered by ERISA. [ABSTRACT FROM AUTHOR]

This discussion about the Department of Labor's conflict-of-interest rule and its impact on those who engage in commission-based sales involving retirement accounts provides a practical and insightful understanding of the topic. [ABSTRACT FROM AUTHOR]

Millions of Americans count ort employer-sponsored health insurance. Recent lawsuits and imestigations show, however, that valid claims are often clenied. The governing law, the Employee Retirement Income Security Act of 1974 (ERISA), shields plan administrators from their mistakes; if a claim is denied without a valid reason, a consumer may sue for the benefit that should have been paid, but not consequential or punitive damages. One aspect of ERISA potentially incentivizes plan administrators to process claims correctly the first time: an attorney's fee provision gives judges discretion to award fees to either side courts have developed a fivefactor test to guide their discretion. But individual healthcare claimants can rarely satisfi two of the test's five factors, thus eroding their chances of recovering fees and blunting any incentive for administrators to decide claims correctly the first time. The attorney's fee test arose in the 1 9705 in common fund and pension malfeasance claims; it is an awkward fit for today's healthcare clainis. The Supreme Court observed in 2010 that the factors bear "no obvious relation" to ERISA or existing fee-shifting jurisprudence, holding that courts need not lise them at all. Yet courts still do. This Article proposes that courts recalibrate the attorney's fee factors for individual healtlicare claims. The current factorS; impOSe duties aticl considerations found nowhere iii ERISA, and many prevailing ERISA plaintiffs cannot recover their attorney's fees under this standard. A revised live-factor test would help ensure that the fee provision functions as intended and serves ERISA'S dual goals of protecting benefits and providing ready access to the federal courts. [ABSTRACT FROM AUTHOR]

Prior to the 1980s, health insurers were prohibited-- uniformly in all jurisdictions--from seeking reimbursement or subrogation from personal injury recoveries. Today, health benefit providers collect over $1 billion dollars annually through seizures of personal injury recoveries meant for victims. These subrogation and reimbursement claims functionally transform tort victims into collection agents for their insurers. Unfortunately, states' common law and statutory plaintiff protections are largely preempted by federal legislation. This note discusses the history of this policy shift over the past four decades and how common law principles and legislative intent have been largely ignored. In addition, this note examines how health insurance reimbursement and subrogation negatively impact victims of catastrophic injuries, who are never made whole, even before losing portions of their recovery to their insurer. Finally, this note proposes a practical solution for state regulators to enforce anti-subrogation policies; states should use their authority to regulate stop-loss insurers to limit a benefit plan's ability to sidestep anti-subrogation regulations. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide financial advisors with an overview of the different ways a client's risk profile can be measured and assessed. The paper begins by providing a definitional framework to help financial advisors better understand the similarities and differences between and among concepts such as risk tolerance, risk preference, risk need, and risk profiling. Next, information based on interviews of representatives from several risk profiling firms is presented. Based on these interviews and an assessment of each firm's risk profiling methodology, risk profiling tools are classified as being (a) comprehensive, (b) subjective, or (c) asset allocators. Guidance on the use of risk profiling tools is provided, as well as a discussion about the need for more policy guidance on the topic of risk assessment. [ABSTRACT FROM AUTHOR]

Duska and Weber--experts in ethics and fiduciary standards of care, respectively-- together address the difficulty of regulating professional behavior without considering an ethical guidepost. Agnostic as to the political ramifications of the new Department of Labor rules on fiduciary duties for compensated advisors giving investment advice now including IRAs, rollover IRAs, and Roth IRAs, the authors consider a professional producer or advisor's best relationship with his or her clients. [ABSTRACT FROM AUTHOR]

Since the enactment of the Employee Retirement Income Security Act of 1974, church plans have been excluded from the requirements of that statute. However, the recent Third Circuit decision in Kaplan v. Saint Peter's Healthcare System has judicially narrowed the class of qualified retirement plans that qualify for this exclusion and this, in turn, potentially threatens the status of nonqualified deferred-compensation plans maintained by affiliated church agencies, such as hospitals and schools. The church plan litigation described in this column is still in its relatively early stages and it is too soon to determine who the winners and losers may be. Clients who are plan sponsors of church agency nonqualified deferred-compensation plans and clients who are participants in such plans, particularly those church plan clients who are located in the Third Circuit, should be advised of the implications of the Kaplan decision. Those church plan clients who are plan sponsors should begin to think about ways in which the risks associated with the Kaplan decision can be mitigated. Those church plan clients who are participants also should think about what, if any, action they may want to take in order to protect their benefits under the affected plans. [ABSTRACT FROM AUTHOR]

Since the Employee Retirement Income Security Act of 1974 ("ERISA") was enacted, courts have shifted away from analogizing to trust law and consequently have created a new precedent that raises the bar for ERISA litigation. Courts have narrowed the application of the Article III standing-to-sue requirement as it applies to ERISA breach-of-fiduciary-duty cases when a Defined-Benefit Plan is involved. This cause of action in Defined-Benefit Plans is dismissed on the grounds that private plaintiffs lack sufficient injury to establish standing. However, private plaintiffs in Defined-Contribution Plans are not experiencing this same difficulty, despite ERISA granting the same rights regardless of the type of plan. Notably, in Thole v. U.S. Bank, N.A. (decided June 1, 2020), the U.S. Supreme Court began a push towards a more expansive application of the standing doctrine in breach-of fiduciary-duty claims involving Defined-Benefit Plans, also demonstrating the controversy of standing in ERISA cases because the Court was split on this issue 5-4. This Note discusses inconsistencies that are embodied in the new precedent based on the plain language of the statute and Congress's implicit intent. It also analyzes the consequences of courts' narrowed interpretations and the effect on future ERISA litigation, while noting that the dissent in Thole was a more compelling argument and would eliminate many of these consequences. In analyzing these issues, this Note advocates for equal treatment among private plaintiffs and suggests adopting a new approach for the standing requirement. There are two proposed methods that would allow for participants and beneficiaries of Defined-Benefit Plans alleging breach of fiduciary duty to establish standing, both of which remain consistent with Congress's intent and effectively resolve the implications associated with the current precedent. [ABSTRACT FROM AUTHOR]

The doctrine of unconscionable contracts is an equity doctrine. As such, it does not ask whether an agreement is or is not an enforceable contract; legality has no bearing. Rather, the doctrine asks whether it would be it be fit and proper . . . would it be fair . . . for a court to enforce such a contract. Using the doctrine, courts examine whether the price paid for a good or service far outstrips any benefit gained. What if that price is the surrender of a basic right, the Right (Not) to Associate? The Supreme Court says that a violation of that right is "always demeaning." Would that be a price, to quote Lord Chancellor Hardwicke, "such as no man in his senses would make, or as no honest man would come into"? This Article is my latest collateral attack on Citizens United. The main ideas discussed are unconscionable contracts and the Right (Not) to Associate. A little bit of time is spent on the particulars of Delaware corporate law regarding the owner of record and the Employee Retirement Income Security Act (ERISA). Somehow, it ends up being about the unfairness of giving private corporations, and the officers that rule them, an exalted place in our political system. [ABSTRACT FROM AUTHOR]

On February 4, 2020, the United States Court of Appeals for the First Circuit, in Arruda v. Zurich American Insurance Co., held that an insurance plan administrator's denial of coverage was not an abuse of discretion because the plan participant's pre-existing medical conditions contributed to his accidental death. The First Circuit rejected the "substantial factor" test and applied a plain meaning approach. In reaching this conclusion, the court split from the Fourth, Ninth, and Eleventh Circuits' interpretations of ERISA-covered accident policies. This Comment argues that the First Circuit should have applied the substantial factor test because, unlike the plain meaning analysis, it protects the interests of employees and their beneficiaries, promotes the uniform distribution of insurance benefits, and conforms with the doctrine of reasonable expectations. [ABSTRACT FROM AUTHOR]

In June 2020, the United States Supreme Court held that Title VII protection from discrimination on the basis of sex extended to LGBTQ+ employees. The Bostock v. Clayton County, Georgia decision dealt with three separate cases where LGBTQ+ employees had been fired from their jobs based on either their sexual orientation or gender identity. While the shared issue in these cases had to do with employee termination, the textualist argument presented by the Court leads many legal scholars to believe that the holding would be applicable to other areas of employment discrimination covered by Title VII such as employer-sponsored healthcare coverage for gender-affirming medical care. Prior to this expansion of Title VII, plaintiffs were able to utilize expanded protections from Section 1557 of the Affordable Care Act, Title I of the Americans with Disabilities Act, the Equal Protection Clause of the Fourteenth Amendment, the Employee Retirement Income Security Act of 1974, and state and local protections. However, the Bostock interpretation will likely become increasingly important to LGBTQ+ advocates now that major avenues of protection against LGBTQ+ workplace discrimination have been drastically weakened by recent administrative policies. This Comment will provide an overview of Title VII's historical protection of employees from sex discrimination through employer-based medical coverage, the expansion of this protection to LGBTQ+ individuals through the Bostock decision, and a comparison of this expansion to other avenues jor fighting discrimination in medical coverage for gender affirming medical care. Ultimately, this Comment will propose that the Bostock decision has made Title VII the strongest path currently available for protection against refusal of coverage for gender-affirming medical care by employer-sponsored health insurance. [ABSTRACT FROM AUTHOR]

The focus of this Article is on the agency costs that may be created by the empty voting of investment advisers to index funds and how they can be mitigated so as to protect the value of private employee pension benefit plans. This Article focuses on BlackRock because it has taken a leadership role in the leveraging of its delegated voting authority. Therefore, the issue I address in this Article is whether the fiduciary duties of a plan manager of an "employee pension benefit plan," as authorized under the Employee Retirement Income Security Act of 1974 ("ERISA"), requires it to investigate BlackRock's shareholder activism. This indirect approach is required as the fiduciary duties of ERISA do not generally extend to mutual funds and ETFs and their investment advisors. This Article takes the position that a plan manager has a fiduciary duty, the duty of prudence, to investigate BlackRock's shareholder activism. This duty applies not only to BlackRock's mutual funds or ETFs that an ERISA plan invests in but also to those BlackRock fund selections that it makes available to its participants and beneficiaries in self-directed accounts. Given these fiduciary duties, this Article argues that if a plan manager were to investigate BlackRock's shareholder activism, especially its engagement strategy, it would likely find it to be in conflict with the manager's fiduciary duties. Such a finding would require a plan manager to seek out other reasonably available alternatives that are not associated with such shareholder activism. While the focus of this Article is on BlackRock's delegated voting authority and associated shareholder activism, it is meant to apply to any and all investment advisers who attempt to leverage their delegated voting authority for purposes of engaging in such activism. Moreover, the Department of Labor should provide guidance to plan managers on when the investment products of investment advisers with delegated voting authority need to be excluded. [ABSTRACT FROM AUTHOR]

In the health insurance context, anti-assignment provisions are contractual clauses that restrict an insured individual's ability to assign rights due under a health plan to another party, such as a medical provider. As these provisions have become increasingly prevalent in employersponsored health plan agreements, they have effectively stripped medical providers of enforcement and litigation rights previously utilized under the Employee Retirement Income Security Act of 1974 (ERISA)--the relevant federal regulation governing employee benefit plans, including health insurance plans. This Note examines these effects in light of ERISA's intended protections of employees participating in employer-sponsored benefit plans and considers whether congressional intervention is warranted to address the respective impacts as a result. This Note contends that while persuasive arguments exist both in support of a need for reform and for sufficiency of the status quo, arguments around these dueling views tend to draw on merely anecdotal evidence and theoretical economic contestations. Accordingly, this Note argues that Congress should develop empirical evidence to determine whether intervention is needed and proposes plausible long-term amendments to ERISA, should they be warranted, along with interim solutions to help address problematic impacts while such study is conducted. [ABSTRACT FROM AUTHOR]

Judicial decisions, statutes, constitutions, sentencing guidelines, and ERISA-related documents have at least one thing in common: at a molecular level, the laws are all composed of words. The scientific study of linguistics, particularly the field of semantics, analyzes what words mean and how they are connected with each other. And yet, thus far, the legal field has taken little notice of academic and technological breakthroughs in the field of linguistic semantics. This Note seeks to highlight the potential utility of linguistic semantic tools in interpreting legal texts. Specifically, applying algorithms to a free online lexical database allows anyone with a computer to measure the level of relatedness between two nouns. Like more classical and widely accepted textual tools, these algorithms shed light on the plain meaning and semantic nuances of different words. Applying them to two prominent federal circuit splits regarding federal sentencing guidelines and ERISA benefits further underscores their usefulness across the legal discipline. The legal field stands to benefit from employing semantic linguistic algorithms in the law to help resolve semantic ambiguity in legal texts and arrive at more consistent, quantifiable conclusions. [ABSTRACT FROM AUTHOR]

Congress passed the Employee Retirement Income Security Act of 1974 ("ERISA") to ensure that when private employers establish benefit plans for their employees, they keep their promise to provide those benefits. This comprehensive regulatory scheme governs benefits administration, establishes plan reporting requirements, and defines fiduciary duties for those involved in plan administration and decision-making. But ERISA is silent on a key issue affecting plan participants and sponsors today--data privacy and security. The California Consumer Privacy Act ("CCPA"), enacted in 2018 and effective beginning January 1, 2020, represents the most comprehensive data privacy law in the United States. If the CCPA applies to ERISA plans, it will force plan sponsors and administrators to strengthen their data security protocols, increasing participants' data security and consumer rights while also increasing plan administration costs. But whether the CCPA applies to ERISA plans remains an open question. ERISA may preempt the CCPA if a court were to find that the CCPA impermissibly interferes with the administration of ERISA plan benefits. If ERISA preempts the entire CCPA, plans would be exempted from compliance with generally applicable state data privacy laws that would otherwise improve plan security and therefore benefit plan participants. This Comment argues that because ERISA does not create an explicit duty for plans to reasonably safeguard data and the CCPA applies generally, courts should allow for provisions of the law that are not directly connected with employee benefits administration to escape preemption. [ABSTRACT FROM AUTHOR]

The article focuses on several Arkansas Court cases on several topics. Topics discussed include U.S. Supreme Court case Rutledge v . Pharmaceutical Care Management Ass'n on Arkansas Act 900 , passed in 2015, was not pre-empted by the federal Employee Retirement Income Security Act of 1974 (ERISA); Roman Catholic Diocese of Brooklyn v. Cuomo on temporary injunctive relief to religious organizations from strict COVID-19 restrictions and Myers v. Yamato Kogyo Co. on workers' compensation.

The article examines whether there is a need to amend the burden of proof provisions of the Employee Retirement Income Security Act of 1974 (ERISA), particularly Section 510, and the Age Discrimination in Employment Act of 1967 (ADEA) in the U.S. Also cited are the aim of ADEA and ERISA to eliminate abuses in private pension plans and discrimination in employment based on age.

It is no secret: the prices of prescription drugs in the United States are unsustainable. As a piercing example of the limits of America's incomplete and disordered health care nonsystem, the crisis has only worsened in recent years. Not only do drug prices exact a toll on America's consumers, but they also impact Americans' access to life-enhancing (and sometimes lifesaving) drugs. They constitute a real and present threat to the quality of health care in the United States in 2020 and beyond. Recognizing this harm, states are increasingly operating in this space, seeking diverse regulatory solutions to better protect their citizens--from gouging statutes, to transparency laws, to formulary rules. In 2020, states operationalize multiple roles when it comes to prescription drug prices, and states' indispensability has highlighted the need to categorize and summarize these efforts and their roles. These roles include states that serve as mere payers; those that try to activate consumer tools; those that facilitate various marketplaces; those that oversee and review the prices and purchases that take place in their states; and, ultimately, those that seek to directly penalize and punish pharmaceutical companies who price their drugs at certain levels. Many states occupy multiple, complex, and overlapping roles simultaneously. This Article undertakes that necessary review, observing that increased state regulatory action reflects a rising trend of state primacy in health policy. But it also observes a key limitation for state-centric regulation: state action is too often hamstrung by preemptive blocks that prevent various state solutions from taking effect. From ERISA, to the Dormant Commerce Clause, to the Department of Health and Human Services' waiver process, to federal patent preemption, these federal sources of law serve as a cumulative preemptive cap on necessary state action. Besides the obvious harms, these regulatory clogs can be characterized as (1) functioning too often as antidemocratic, (2) weakening the regulatory structure, (3) injecting regulatory inconsistencies, and (4) lessening the chances of a satisfactory federal solution. Applying lessons from the environmental law context, this Article challenges the wisdom and legitimacy of these federal regulatory clogs in the midst of a pharmaceutical drug-cost crisis. In addition to identifying alternative pathways, this analysis suggests a reexamination of the various legal regimes that block state efforts in this area, all while millions of Americans currently face drug prices that they simply cannot afford. [ABSTRACT FROM AUTHOR]