The U.S. Supreme Court has issued a ruling that could stall health care reform efforts in the Green Mountains.
Vermont in 2005 passed legislation that requires private insurers to hand over all data related to patients’ health care claims.
Al Gobeille, chairman of the Green Mountain Care Board, says the data will give policy makers the insights they need to tailor their reforms as they seek to reshape the health care industry.
In a 6-2 decision issued on Tuesday morning, however, justices ruled in favor of the insurance company, Liberty Mutual Insurance Co, that had challenged the law. Gobeille says it’s important that Vermont now find other ways to gain legal access to the data.
“I think that there’s enough people in the United States that want this to happen, that we need to work with the [United States] Secretary of Labor to find a different path,” Gobeille says.
Gobeille says claims data offers health care providers, and the regulators that oversee them, a window into the effectiveness of various reform projects. Unless the state can track the fate of patients as they move through the system, Gobeille says, it’s impossible to determine with any precision the impact of reform initiatives on costs and outcomes.
The federal government has for the most part deferred to the states when it comes to the regulation of insurance industries. There’s one big exception however, and it involves companies that are self-insured.
A federal law known as ERISA governs those self-insurance plans, and that federal law preempts state statute. Liberty Mutual argued that since the claims in question involve a self-insurance plan, it’s exempt from state regulations calling for the release of the data.
The company won a lower-court ruling, and the state appealed the decision to U.S. Supreme Court, where justices rules in favor of Liberty Mutual.
Gobeille says the ruling affects only claims data related to self-funded plans, such as ones at large companies like IBM for instance or National Life. But those self-funded plans represent the largest chunk of the private insurance market, and Gobeille says that “because they’re the largest part of commercial insurance, it would make sort of the data not whole.”
Self-funded plans for the most part have willingly supplied Vermont with claims data up until now. Liberty Mutual demurred, but the data it withheld represented only 137 people.
Gobeille says the state now has to make sure that other companies will continue to voluntarily supply the data, the Supreme Court ruling notwithstanding.
“So if nothing changes it’s as if this [ruling] didn’t happen, because the [decision] did not say they can’t willingly submit,” Gobeille says.
If companies do continue to submit data, Gobeille says the state should continue to pursue its costly health care claims database. If they do not, Gobeille says the state may need to reconsider its course.
Gobeille says the justices in their ruling left open the possibility of states working with the U.S. Secretary of Labor to find alternate ways of accessing the claims data.
The ruling deals a blow to similar data-collection laws in 17 other states.
