SCOTUS ruling a blow to all-payer claims databases

In a 6-2 vote announced this week, the U.S. Supreme Court ruled that state officials can’t force certain health insurers to turn over data revealing how much they pay for medical claims (Source: “High court limits state power to gather health care data,” Associated Press via Washington Post, March 1, 2016).

The justices ruled that efforts by Vermont and at least 17 other states to gather and analyze the data in all-payer claims databases conflict with federal law covering reporting requirements for employer health plans. The case involves Liberty Mutual Insurance Co., which operates a self-insured health plan for its workers and refused to turn its data over to Vermont.

Writing for the court, Justice Anthony Kennedy said the potential for a patchwork of different state regulations could impose major financial and administrative burdens on healthcare providers and could subject them to wide-ranging liability. He said Vermont’s reporting law is inconsistent with the federal goal of “a uniform national scheme” for collecting the data.

Justice Ruth Bader Ginsburg dissented, saying Vermont’s efforts to track healthcare services did not intrude on federal law. She said federal law was focused on making sure that benefit plans offered the right coverage, while Vermont was gathering data aimed at improving healthcare quality and reducing costs. She was joined in dissent by Justice Sonia Sotomayor.

More than a dozen other states had shown interest in compiling similar databases to monitor health care prices and allow consumers to compare plans (to learn more, see HPIO’s recently released publication “Healthcare Data Transparency Basics 2016”). About 93 million people are covered under self-insured health care plans, in which the employer pays out claims with its own funds rather than going through an insurance company.

In what could potentially be a way forward for all-payer claims databases, Kennedy pointed out that the U.S. Secretary of Labor, not the states, is authorized to collect data on benefit plans for statistical and research purposes.