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Vermont Insurance Claims Case Headed To Supreme Court

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Jacquelyn Martin
/
AP
The U.S. Supreme Court will hear a Vermont case involving claims data that regulators say is needed for payment reform.

The state of Vermont wants access to the claims data of companies that fund their own health insurance plans. But not all of them are willing to hand it over. And the U.S. Supreme Court has agreed to resolve a legal dispute that could have national impacts on health care reform.

Al Gobeille is head of the Green Mountain Care Board, a five-person panel that oversees almost every aspect of the medical industry in Vermont. And he and his fellow board members are on a mission to change the way health care is provided in this state.

But Gobeille says he needs data about insurance claims in order to see which reforms are working, and which ones aren’t.

“The only way for the regulator, in this case the Green Mountain Care board, to be able to judge the performance of the health care system is through data, big data,” Goebille says.

But the Liberty Mutual Insurance Company isn’t willing to hand that data over, despite a Vermont law ordering it to. And while the Second Circuit Court of Appeals ruled in Liberty Mutual’s favor last February, the U.S. Supreme Court has now agreed to resolve the dispute once and for all.

"The only way for the regulator, in this case the Green Mountain Care board, to be able to judge the performance of the health care system is through data, big data." -Al Gobeille, Green Mountain Care Board

“And what this case is all about is the Green Mountain Care Board being able to get enough information about what’s going on in terms of health care delivery in this state to make informed decisions and changing or tweaking the system going forward,” says Attorney General Bill Sorrell.

Sorrell, whose office will oversee the defense of Vermont’s law, expects oral arguments to come this December. Sorrell says his office has handled the case in-house so far, and that related costs to taxpayers, aside from the salaries of the lawyers working on it, are only about $10,000 to $15,000. Sorrell says he has not yet decided whether to seek outside counsel for the Supreme Court appeal.

The case centers on whether states like Vermont can force self-insured companies, like Liberty Mutual, to hand over their claims data. States generally have authority to regulate private insurance companies operating within their borders.

But a federal law known as ERISA gives the federal government exclusive authority over self-insurance plans. Steve Wojcik is the vice-president of public policy for the National Business Group on Health, an organization that with a membership of about 400 mostly large companies. Wojcik says self-insured companies often operate in multiple states. And he says it’s critical that the federal government, and the federal government only, have the authority to tell those companies what they can and cannot do, when it comes matters of health insurance.

"The reason why ERISA was established was so that employer plans...can have the same benefits across all states and not have to comply with various state laws." - Steve Wojcik, National Business Group on Health

“The reason why ERISA was established was so that employer plans, especially employers who operate in more than one state, can have one uniform administration of benefits, can have the same benefits across all states and not have to comply with various state laws,” Wojcik says.

Sorrell says the interests of the state – in this case, reforming a health care system where costs have spiraled out of control – outweigh the interests of the insurance companies. And Sorrell says the complying with the Vermont law won’t cause any of the bureaucratic headaches Wojcik fears.

“The insurance companies have this information. They have it for their own purposes, so they’re not having to jump through all kinds of hoops to be able to generate it, and send it to the states,” Sorrell says.

A decision in the case will come sometime before the end of next June.

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