High court ruling could affect state efforts to collect insurance claims data

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: dbking via Flickr

Photo: dbking via Flickr

When the U.S. Supreme Court ruled March 1 in Gobeille v. Liberty Mutual, the justices gave journalists a chance to write about how the case affects state efforts to collect data for their all-payer claims database (APCD) programs.

In a 6-2 decision (pdf), the court ruled against the plaintiff, allowing Liberty Mutual Insurance Company to withhold its employees’ health claims data from Vermont’s APCD.

The plaintiff was Alfred Gobeille, chairman of Vermont’s Green Mountain Care Board. Under Vermont law, the board is charged with controlling the rate of growth in health care costs through “regulatory and planning tools.” One tool is Vermont’s all-payer claims database. We covered this case when it was argued before the court in December.

The high court ruled that the Employee Retirement Income Security Act of 1974 (ERISA) pre-empts state laws governing employee benefit plans. ERISA pre-emption is needed, employers contend, because following different rules governing benefit plans in 50 states would be burdensome and costly.

Covering this case for Vermont Public Radio, Peter Hirschfeld reported that the decision may not be a serious blow to Vermont’s APCD program for two reasons. First, most health insurers contribute to the APCD voluntarily and may continue to do so. Second, Liberty Mutual has a self-insured health plan for only 137 employees and their family members in Vermont, a number so low that it’s unlikely to harm Vermont’s APCD. Liberty Mutual uses Blue Cross Blue Shield of Massachusetts as a third-party administrator for its employee benefit plans and instructed BCBS not to submit its claims data to Vermont’s APCD.

But nearby in Connecticut, Arielle Levin Becker of the Connecticut Mirror reported that the decision could be a serious blow to her state’s APCD. State officials called the ruling disappointing, and said some health insurers already were not submitting claims data from self-insured plans pending the Supreme Court decision. The exception was Aetna, she reported, which had been submitting data from all of its plans in Connecticut.

In The Wall Street Journal, Jess Bravin reported that Justice Stephen Breyer suggested state officials work with the federal Department of Labor to develop requirements for reporting insurance claims data.

The decision is significant because self-insured employers cover about 60 percent of all Americans who have health insurance, and roughly 18 states (including Connecticut and Vermont) operate or are developing APCDs.

Perhaps Charles Ornstein of ProPublica summed up the issues best when he wrote, “The arguments were arcane, but the effect is clear: We’re a long way off from having a true picture of the country’s health care spending, especially differences in the way hospitals treat patients and doctors practice medicine.”

For additional information on APCDs, see this interactive map from the APCD Council and our Nov. 12 webcast, in which we explained how APCDs could help consumers and others evaluate physician quality.

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