Before the 1974 Employee Retirement Income Security Act, otherwise known as ERISA, was enacted, patients had recourse in the medical malpractice arena. ERISA doesn’t sound as if it should have anything to do with medical care, but it does. This law is best known for governing pension plans, but it also covers most health plans offered as an employee benefit. ERISA was meant to protect us from corporate abuse, but includes a special provision that health organizations have used to protect themselves from lawsuits. The employee-benefit plans are exempt from state law. Which means that under state law, lawsuits can seek damages such as lost income, suffering and medical expenses, but under federal law a lawsuit can only be filed for the cost of the medical benefit denied. As an example, if you or a loved one dies of leukemia because the HMO wouldn't authorize an early blood test, you can recover no more than the cost of the test. Before managed care obvious negligence could result in a medical malpractice suit that could compensate at least a portion of what went wrong during a procedure. Post ERISA, most Americans don’t realize this exemption in federal law that makes it much more difficult to win a malpractice suit against an HMO. So if there is no financial penalty when the doctors HMOs hire are negligent, where is the check a balance to keep the profit-driven healthcare from withholding adequate medical care? Another case of Law of Unintended Consequences.