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Supreme Court to hear ERISA health case arguments

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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.

The federal government has not been collecting the kind of detailed, current self-insured plan data that state health care system regulators need to do their jobs, and past federal court decisions have respected “states’ historic police powers” in matters involving “generally applicable state laws, unrelated to the objectives of ERISA,” Gobeille argued in his petition seeking Supreme Court review of the case.

Liberty Mutual and its allies have opposed the Vermont data call, arguing that, although collecting health system data may generally be a good thing, the federal government already collects large amounts of data from ERISA plans, and that letting each state impose its own unique will subject the plans to the kinds of annoyances and expenses that ERISA was supposed to eliminate.

Liberty Mutual has also argued that the case originated with the Vermont insurance commissioner as the original defendant in the case, and that Vermont has not gone through the procedures necessary to give Gobeille standing to serve as the petitioner in the Supreme Court case.

The Obama administration argued that the case is not ripe for Supreme Court review, but that, in the existing ERISA preemption framework, states should be able to collect experience data from self-insured health plans.

The Blues have expressed mixed feelings in the past about the spread of self-insured plans, but, in their petition for this case, they say, “The compliance burdens created by Vermont’s law and other states’ similar laws are immense, especially for multi-state ERISA plans.”

See also: Supreme Court eyes benefits preemption cases

The Blues said that, under a 1990 Supreme Court ruling, a state law “relates to” an employee benefit plan protected by the ERISA if the law contains a “reference to such a plan.”

The Vermont experience database law contains an obvious “reference to” ERISA-protected plans, because the implementing regulations refer directly to “any administrator of an insured, self-insured, or publicly funded health care benefit plan,” the Blues said.

The Supreme Court later said the “reference to” comes in only when a state law applies exclusively to ERISA plans, the Blues said.

The Supreme Court should help ERISA plans avoid a new wave of state demands by ruling that any state law with a reference to “ERISA plans or their essential actors” triggers ERISA preemption, the Blues said.

See also: Feds: ERISA plans must share their decision support tools