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03.01.2016 / Press Release

Supreme Court Rules 6-2 that Certain Health Plans are Exempt from State Disclosure Requirements

Ruling Seen as a Set Back for State Efforts to Use Data to Improve Quality and Cost of Health Care

Washington, D.C. – The U.S. Supreme Court today ruled 6-2 that self-funded employer health plans can withhold their company’s information from state health care databases – also known as All Payer Claims Databases (APCD) – a decision that may have major ramifications for state policy makers and the health care consumers they represent.

The case, Gobeille v. Liberty Mutual Insurance Co., stems from a challenge made by Liberty Mutual to a Vermont law that required it to provide claims data from its self-funded health plan. Liberty Mutual claimed its self-funded plans were exempt from disclosure requirements under the federal Employee Retirement Income Security Act (ERISA). Sixteen states have laws similar to Vermont’s and others are considering legislation.

States have established All-Payer Claims Databases to collect data from public and private payers and use it to improve quality, lower costs, and to provide price transparency. While the decision prevents states from requiring this data from one type of health plan – self-funded employer plans – the impact could be significant.

Families USA, along with AARP and the U.S. Public Interest Research Group, had filed a friend-of-the-court brief in this case, urging the Supreme Court to side with Vermont. Following is the statement of Joe Ditré, Senior Director of Enterprise and Innovation at Families USA, on the decision.

“The impact of this decision could severely impinge state efforts to fully understand trends in the health care markets they regulate. It’s like asking a doctor to diagnose a patient, while withholding vital symptoms – in this case, critical data.

“As Justice Ginsburg noted in her dissenting opinion, about half of Americans with health insurance get their coverage from their employer, and of those, about 61 percent are enrolled in employer self-insured plans. This decision could create a gaping hole in the data that employers, insurers, consumers, health providers, and state policymakers need to understand the effects of benefits policies, payment models, and to provide price transparency.

“Given that Congressional action may be unlikely, we urge all of the stakeholders who came together to create these databases, and who are already working together, to continue to do so in the interest of improving quality and lowering costs.”