GOBEILLE V. LIBERTY MUTUAL INSURANCE CO.
This case, so far, is the one to watch for those in healthcare. It has potential ramifications for self-funded insurers and states eyeing healthcare reform.
The case will decide whether the third-party administrator for self-funded insurer Liberty Mutual Insurance Co. should have to turn over certain data—such as claims, member eligibility and other issues—to the state of Vermont. The state argues it needs the data to improve the cost and effectiveness of healthcare. Liberty Mutual, however, says that the federal Employer Retirement Income Security Act, known as ERISA, protects it and its administrator from having to share the information.
If the Supreme Court sides with the insurer, that could hinder healthcare reform efforts in the states, said Dana Berkowitz, a partner at Stris & Maher, which is representing the state of Vermont in the case.
“It would basically stifle the states’ abilities to be laboratories of innovation in the healthcare field,” Berkowitz said.
Nicholas Bagley, a law professor at the University of Michigan, called the case “a big deal.”
“If those pretty modest informational demands are impermissible under ERISA, that suggests a fairly limited scope of state power to undertake future reforms to the healthcare systems in their states,” he said.
The American Hospital Association and the American Medical Association have filed briefs in the case supporting the state of Vermont.
Liberty Mutual, however, has argued in court documents that states will still have enough data to consider healthcare reforms even without information from self-funded insurers. It has also argued that ERISA was meant to protect such plans from “the burdens of complying with conflicting state laws.”
Steve Wojcik, vice president of public policy with the National Business Group on Health, said employers will be closely watching the case.
“This will be hopefully a good case that strengthens ERISA pre-emption of state requirements put on selffunded employer plans,” Wojcik said. But if Vermont is successful, he said, “It could encourage other states to do a similar type of thing, to place administrative burdens on employer plans, asking them for data or reporting of other information.”
Oral arguments have not yet been scheduled, but Berkowitz said they will likely happen in December or January.