Supreme Court rules in favor of insurer in all-claims database case
A Supreme Court ruling Tuesday in the case Gobeille v. Liberty Mutual Insurance Co. dealt a blow to all-payer claims databases when it handed a victory to health insurers that argued states don't have the authority to require self-funded plans to submit claims information.
The Court--short one justice due to the death of Antonin Scalia--ruled 6-2 in favor of Liberty Mutual, which had argued that based on the federal Employee Retirement Income Security Act (ERISA), self-funded insurance plans should be exempt from a Vermont law compelling it to supply the state with healthcare cost and quality information for its statewide database.
"The fact that reporting is a principal and essential feature of ERISA demonstrates that Congress intended to preempt state reporting laws like Vermont's," Justice Anthony Kennedy wrote in the majority opinion.
But in the dissenting opinion, Ruth Bader Ginsburg argues that Vermont's law and ERISA serve different purposes, and thus ERISA shouldn't supersede it. ERISA's domain is the design and administration of employee benefit plans, while the Vermont law in question "aims to improve the quality and utilization, and reduce the cost of healthcare in Vermont by providing consumers, government officials and researchers with comprehensive data about the healthcare delivery system," she writes.
The case is expected to have major implications for health information exchanges, as well as the other states that have started all-payer claims databases in an attempt to improve cost and quality transparency by collecting data from commercial insurers to detect price discrepancies among doctors and hospitals.
But critics of such databases say they could lead to providers raising prices when they see competitors out-earning them. In a Supreme Court hearing in December, justices Stephen Breyer and Elena Kagan also were skeptical about costs and the administrative burden of allowing each state to determine its own regulations for claims databases.
To learn more:
- here's the ruling
Supreme Court hears all-payer claims database case
All-payer database lawsuit before Supreme Court could hurt HIEs
Supreme Court takes Vermont all-claims database case
The importance of claims databases to control costs
Payer claims transparency: Essential or counterproductive?