State health care database laws take on ERISA: SCOTUS to decide

SCOTUS will soon decide on whether ERISA trumps state health care database laws.

For the first time in almost ten years, the Supreme Court of the United States (SCOTUS) has agreed to hear a case involving an Employee Retirement Income Security Act of 1973 (ERISA) claim. The case calls into question whether or not a state’s law requiring data from health insurance providers is preempted by ERISA.

Background on the case

States throughout the country have a vested interest in the health and wellbeing of their citizens. In an attempt to help facilitate the welfare of these citizens, many states have laws that create health care databases. These databases provide information on health care policies offered within the state. Ultimately, these databases are designed to aid in ensuring that residents of the state have access to quality health services at affordable prices.

Some insurance providers argue that providing the information requested by these states to establish these databases is burdensome and preempted by federal law. Essentially, these providers argue that ERISA has a provision that preempts qualifying providers from sending additional data to states. SCOTUS has agreed to hear a case that takes this question into consideration.

As stated in the petition for review by SCOTUS in the case Gobeille v. Liberty Mutual Insurance Company, these databases are important because they:

  • Determine the capacity and distribution of existing resources.
  • Identify health care needs and informing health care policy.
  • Evaluate the effectiveness of intervention programs on improving patient outcomes.
  • Compare costs between carious treatment settings and approaches.
  • Provide information to consumers and purchasers of health care.
  • Improve the quality and affordability of patient health care and health care coverage.

Requested data is kept confidential, and the state statute complies with the federal Health Insurance Portability and Accountability Act (HIPPA).

In this case, the state’s Department of Financial Regulation requested data from Blue Cross in 2011. Blue Cross, which provides services for Liberty Mutual, was told by Liberty Mutual not to report information from its beneficiaries. Liberty Mutual then filed a lawsuit against the state, claiming ERISA preempts the need to provide any of the requested information.

The question in this case reviews whether or not states can require health care providers and health care payers to provide claims data and related information to the state’s health care database. The state law that requires entities to provide this information applies to public and private groups like private insurance providers, government programs and other third-party administrators. Even more specifically, this case focuses on whether ERISA preempts the state’s health care database law when applied to a third-party administrator of a self-funded plan.

Lower courts have found in favor of Liberty Mutual, however, as noted by the SCOTUS blog, the only thing clear after conclusion of arguments "is that the Court will not dispose of the case with a unanimous opinion." Some justices argued in favor of the databases, others argued the burden of providers gathering data for states that would likely have different requirements was too great while still others remained quiet. As a result, it is difficult to predict the outcome of this case.

However, this case is valuable for those currently navigating ERISA claims as it provides an example of the evolving and complex nature of these cases. As a result, those who are dealing with ERISA issues are wise to seek the counsel of an experienced ERISA lawyer. This legal professional will review the details of your case and guide you through the process, working to better ensure you receive the benefits you are entitled.