The lawyer for Vermont’s health coverage data collection program had a rough day today in oral arguments at the U.S. Supreme Court.
Justices often viewed as moderate or liberal, including Elena Kagan and Stephen Breyer, took the lead in questioning whether states have the right, under the Employee Retirement Income Security Act of 1974 (ERISA), to require self-insured employer health plans to report information about health coverage premiums and claims.
Alfred Gobeille, the petitioner in the case, Gobeille v. Liberty Mutual Insurance Company (Supreme Court Case Number 14-181), is the chair of the Vermont Green Mountain Care Board, a state health care regulatory agency. He is defending the agency’s right to get a complete picture of health coverage in Vermont by calling for experience data from the self-insured plans governed by ERISA as well as from carriers that provide fully insured group health plans.
Bridget Asay, the Vermont solicitor general, told the court that ERISA preemption of state benefits laws does let states collect data related to matters in fields still in the hands of state regulators, such as insurance and health care.
“The database statute does not affect ERISA plans in any way that undermines ERISA’s core objectives, does not require plans to offer benefits, affect the financing or fiduciary standards for plans, or change the way the plans administer benefits to their members,” Asay said, according a transcript of the oral arguments provided by the court.
Liberty Mutual, other insurers, and insurance and employer groups are arguing that letting the Green Mountain Care Board win would drive up health plan administration costs and conflict with the goals of ERISA.
“The very fact that there could be 50 different state regulations is the burden that the preemption provision is designed to address,” said Seth Waxman, the lawyer who represented Liberty Mutual.
Drafters of ERISA tried to cut the cost of running multi-state benefit plans by preempting state benefits laws.
ERISA, and Supreme Court interpretations of ERISA, do let states continue to oversee matters traditionally in the sphere of state regulators, such as insurance, but they don’t normally let states regulate activities viewed as being in the core field of ERISA, such as filing Form 5500 plan data reports.
The Patient Protection and Affordable Care Act of 2010 (PPACA) includes a provision stating that it does not generally affect ERISA or ERISA preemption, and it also includes provisions stating that it does not preempt existing state regulatory authority.
Officials at the Green Mountain Care Board have argued that they need to collect health coverage experience data from self-insured plans governed by ERISA, as well as from state-regulated fully insured plans, because self-insured plans cover many of the state’s residents who have private health coverage.
Waxman said Vermont is asking for many types of information, items that a self-insured plan might not have readily available, including the plan’s actuarial assumptions, its provider levels, and its medical procedure claim denials.