Vermont's Healthcare Data Law Faces ERISA Challenge
Vermont's healthcare database law faces a legal challenge from Liberty Mutual, which argues that the state's requirements conflict with the Employee Retirement Income Security Act (ERISA). The case, if decided in Liberty Mutual's favor, could impact states' abilities to monitor healthcare markets and develop policy.
Vermont's law mandates reporting of claims, enrollment, cost, price, quality, utilization, and resources data from health insurers, providers, and agencies. This data is crucial for evidence-based policy decisions, given the rising cost of healthcare in the U.S. Liberty Mutual, however, contends that ERISA preempts Vermont's law as applied to its self-insured employee health plan administered by Blue Cross Blue Shield.
ERISA's preemption clause voids state laws relating to employer-sponsored health plans. The dispute centers on whether recordkeeping and reporting are core ERISA functions. The U.S. Supreme Court case Gobeille v. Liberty Mutual Insurance Company has questioned the viability of these databases. Possible solutions if ERISA preemption is found include congressional amendment, federal data sharing, or encouraging data standardization.
The American Academy of Pediatrics (AAP) and several healthcare groups and trade organizations have filed the lawsuit against Vermont's law. The Supreme Court's decision in Gobeille v. Liberty Mutual will significantly impact states' ability to monitor healthcare markets and develop policy. Given that a majority of workers receive coverage from self-insured employer plans, their data is critical for comprehensive healthcare databases.
