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November 09, 2015 at 12:22 PM
The U.S. Supreme Court will hear oral arguments Dec. 2 on a case that could affect states’ ability to call for experience data from self-insured employer-sponsored health plans.
The court has agreed to review Gobeille vs. Liberty Mutual (Case Number 14-181), a case triggered by efforts in Vermont to collect health claim data both from health insurers in the state and from self-insured plans with 200 or more covered lives.
Major consumer groups, health care provider groups and health data groups, including AARP, Families USA, the American Medical Association and the National Association of Health Data Organizations, are supporting the plaintiff in the case, Alfred Gobeille, the chair of the Vermont Green Mountain Care Board.
Major business groups and insurance groups, including America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association, are supporting Liberty Mutual.
Federal law normally lets states regulate the business of insurance, but the Employee Retirement Income Security Act of 1974 (ERISA) preempts the ability of states to regulate the benefit plans of multistate employers, to keep states from increasing those employers’ costs by forcing them to comply with many different, potentially conflicting sets of requirements.
See also: Feds: Self-Funded Plans Not Much Different From Other Plans
In practice, the Supreme Court has ruled in the past that states can continue to regulate insurance companies, even when insurers are providing insurance for large employers, but that self-insured benefit plans are exempt from state insurance regulator oversight, even when the plans use insurance companies as plan administrators.
Liberty Mutual has been the fiduciary and official administrator for self-insured employee health plans. In Vermont, the company has been using Blue Cross Blue Shield of Massachusetts to process claims. Managers of Vermont’s all-payer claims database asked Massachusetts Blue to send it claims data in 2011. Liberty Mutual told Massachusetts Blue not to send the data, saying ERISA preempted Vermont’s ability to make self-insured plans send in data.
A federal district court judge sided with Vermont. A three-judge panel at the 2nd U.S. Circuit Court of Appeals ruled 2-1 in favor of Liberty Mutual.
Gobeille and the parties that have sent the Supreme Court briefs supporting him say states have an obvious need to get current health plan experience data from self-insured employers, because a state needs to understand how its entire health care system works.
