Earlier this year, the U.S. Supreme Court’s decision in Gobeille v. Liberty Mutual dealt a blow to the 18 existing state-run all-payer claims databases (APCDs) by holding that ERISA prevents states from compelling self-funded insurers to report to their data systems. In response to the Court’s decision, a number of state APCDs and/or payers have temporarily halted data submission from all plans as both groups determine how data reporting will now be done.
While this work is ongoing, APCD states are looking to the words of the Supreme Court to determine if there is an opportunity to have continued access to payment data from self-funded plans. In the Gobeille opinion, the Court indicated that existing law might allow the United States Department of Labor (DoL) to collect and share payment data from plans subject to ERISA. In recent weeks, NASHP has convened a post-Gobeille Work Group of state officials and legal experts who have been considering potential options for continued data collection and have had preliminary conversations with DoL. NASHP will provide updates on the activities of the Work Group as recommendations are developed.
The Gobeille decision also has potential ramifications beyond the status of ongoing data collection in states with APCDs. The case has opened up the possibility of ERISA-exemptions expanding to new areas of law and has stifled states that were considering developing data systems and collecting payment information from health insurance plans. Updates below from Michigan and Florida, that are working through these issues:
- Parties in the Michigan Medicaid Tax case file new briefs in response to the Gobeille In March, the Supreme Court told the Sixth Circuit to reconsider whether a Michigan health insurance tax on all payers, including the self-funded, was preempted by ERISA in light of Gobeille. A decision against the state by either the Sixth Circuit or the Supreme Court could result in the end of state assessments on self-funded plans. In late April, Michigan and the group challenging the tax, the Self-Insurance Institute of America (SIIA), filed new briefs arguing how the Sixth Circuit should apply Gobeille. In the new briefs, Michigan argues that the Supreme Court saves the tax by distinguishing between the extensive reporting needed to comply with APCD requirements and the more minimal record keeping related to the Michigan law. In contrast, SIIA argues that the Court in Gobeille was concerned about the burdens that result from record keeping and reporting requirements, which they argue are an integral part of complying with the Michigan tax. SIIA also argues that Michigan retains the option of taxing health care providers, as is done in a number of states. The date of oral arguments on the new issue has yet to be published.
- Florida Governor signs new price transparency and data reporting law that state policymakers believe sidesteps the decision in Gobeille. The new law requires the state’s health care agency to contract with a private vendor to provide an easy-to-use, web-based database that allows consumers to research the cost of healthcare services. To support the database’s development, the law requires insurers participating in the Medicaid managed care or state group health insurance plan programs to submit claims data for all Florida policyholders. The state believes that by including data submission as a requirement of contracting, as opposed to mandating submission by law as in Gobeille, the program escapes ERISA preemption. We will keep you posted if challenges arise.
NASHP will continue to follow ongoing work on this issue. We encourage you to check back for further updates.
Gobeille v. Liberty Mutual Landing Page