With Republicans and Democrats agreeing to strategies that move the resources and responsibilities for healthcare reform to the states, the Employee Retirement Income Security Act of 1974 (ERISA) presents even greater barriers than surfaced in federal planning. The single most formidable obstacle to state healthcare reforms, ERISA's preemption clause supersedes all state laws that "relate to" employee benefit plans. The authors trace the history of pension legislation that led to the strong ERISA protections and explain the interpretations of the law which affect healthcare. They explain the history of the Hawaii plan's waiver; the continual refinement of the law through legislation; and the growing body of case law that interprets ERISA's application through the "relate to" requirement, the "savings" clause, and the "deemer" clause. Finally, they point out that the political solutions being acted out in Congress are leading to poor healthcare policy. Overriding or waiving ERISA would not lead to national health policy solutions and could endanger millions of workers' pension and benefit plans. Meanwhile, the only relief for states comes in slow and incremental steps through the court system.