Forum Session Announcement - Show Me the Data! What’s at Stake in the SCOTUS Case on Claims from Self-Insured Health Plans?

Typically, the data comes from medical, pharmacy, and dental claims, and eligibility and provider files.2 States and other stakeholders use the comprehensive information from APCDs to support a range of activities aimed at improving health and health care, including analyzing service use, costs, and quality, and developing and implementing health care payment and delivery system reforms. [...] Vermont argues that ERISA does not preempt the law because: (i) it does not infringe on the core functions of ERISA, which relate to plan benefits and administration and fiduciary responsibility for managing health plans in the interest of beneficiaries, and (ii) Congress did not intend for ERISA to preempt laws that fall under states’ traditional powers to protect public health and regulate healt. [...] Supporters also assert the APCD law creates a minimal burden, both because self-insured plans already have the necessary data to comply with the law and because the state’s reporting requirements follow industry-wide technical standards mandated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).7 Liberty Mutual counters that the requirements under Vermont’s law conflict. [...] The large amount of data supports a big-picture view of the state’s health care system, and it facilitates comparative and population-based studies that are best undertaken with a full data set.12 For example, in Vermont, researchers used the state’s APCD to evaluate Blueprint for Health, an all-payer, medical home program that includes support from a community health team. [...] In addition, Medicaid spending increased for dental, social, and community-based services.13 The Supreme Court case implies tension between the benefits of state data collection on the one hand and the uniform regulation of self-insured plans on the other hand.