A self-funded insurer does not have to share health data with a state’s all-payer database, according to a March 1 U.S. Supreme Court decision that could affect information-sharing reforms nationwide.
In a 6-2 opinion , the majority justices ruled that the Employee Retirement Income Security Act ( ERISA ) protects plaintiff Liberty Mutual from having to provide claims and member data to the Vermont Green Mountain Care Board . ERISA, which includes its own reporting, disclosure, and record-keeping provisions, has an express clause that invalidates Vermont’s reporting statute as applied to ERISA plans, Associated Justice Anthony Kennedy wrote in the opinion.
“The state statute imposes duties that are inconsistent with the central design of ERISA, which is to provide a single uniform national scheme for the administration of ERISA plans without interference from laws of the several states even when those laws, to a large extent, impose parallel requirements,” Justice Kennedy wrote.
Associate Justice Ruth Bader-Ginsburg and Associate Justice Sonia Sotomayor dissented with the majority, insisting that Vermont’s database does not infringe on ERISA’s control to regulate self-funded plans. Seventeen other states have enacted similar database systems, which aim to “serve compelling interests,” Justice Ginsburg wrote, such as identifying effective reforms, driving down health care costs, evaluating utility of treatment options, and detecting discrimination in care provision.
“I would hold that Vermont’s effort to track health care services provided to its residents and the cost of those services does not impermissibly intrude on ERISA’s dominion over employee benefit plans,” Justice Ginsburg wrote in her dissent.
The case of Gobeille v. Liberty Mutual Insurance Company stems from a Vermont law that requires all health providers in the state to provide detailed data about their services for the development of an all-payer database. Liberty Mutual argued the law imposed a burden on the self-funded plan because it enforces sharing requirements on top of reporting and disclosure obligations already necessary for the federal Department of Labor. Vermont Green Mountain Care Board Chair Al Gobeille argued the insurer’s purported burdens are trivial because the insurer’s claims administrator already prepares the data required to the state for its non-ERISA operations in Vermont. The 2nd U.S. Circuit Court of Appeals sided with Liberty Mutual.
Liberty Mutual was “pleased,” with the Supreme Court ruling, spokesman John Cusolito said in an interview. He declined to comment further. Mr. Gobeille had not returned a request for comment at press time.
Medical associations expressed disappointment at the ruling.
“It is unfortunate that Vermont’s efforts to increase transparency of health insurance information has been thwarted. The U.S. Supreme Court determined today that a highly complex and confusing federal law can be used to keep the insurance payment process cloaked in mystery,” Dr. Steven J. Stack, president of the American Medical Association said in a statement. “The ruling stands in the way of reform efforts in Vermont and at least 18 other states aimed at providing important information to patients, health professionals and policymakers about health care options, outcomes and costs.”
The American Hospital Association concurred. “Self-insured plans cover a large, growing, and distinctive portion of the population,” AHA spokeswoman Marie Watteau said in a statement. “It is essential that they be included in all-payer databases if those databases are to realize their potential, and if America’s hospitals are to realize their goal of improving community health and controlling costs while providing the high-quality care for which they are known.”
Other medical associations previously weighed in on the case. In a friend-of-the-court brief to the U.S. Supreme Court, the AMA and the Vermont Medical Society said the Gobeille case presents a prime opportunity for the Supreme Court to reexamine ERISA and alleviate confusion between traditional state regulation of health care and exclusive federal regulation of employee benefit plans.
Seventeen states and the District of Columbia issued a joint brief in support of Vermont. A handful of insurers, including the Blue Cross and Blue Shield Association penned briefs in support of Liberty Mutual.
On Twitter @legal_med
