Tuesday's Supreme Court ruling in the Gobeille v. Liberty Mutual Insurance Co. case goes beyond the rules surrounding states' authority to require self-funded plans to submit claims information, as it has major implications for the future of healthcare transparency, according to an article from ProPublica.
In its 6-2 ruling in favor of Liberty Mutual, the Supreme Court said that self-funded insurance plans should be exempt from a Vermont law compelling it to supply the state with healthcare cost and quality information for its statewide database under the federal Employee Retirement Income Security Act. ProPublica argues that this is a step back for healthcare transparency, since it essentially hampers efforts to track the quality and cost of care.
The American Medical Association, which had supported Vermont's case, made a similar argument.
"It is unfortunate that Vermont's efforts to increase transparency of health insurance information has been thwarted. The U.S. Supreme Court determined today that a highly complex and confusing federal law can be used to keep the insurance payment process cloaked in mystery," Steven J. Stack, president of the AMA, said in a statement emailed to FierceHealthPayer. "The ruling stands in the way of reform efforts in Vermont and at least 18 other states aimed at providing important information to patients, health professionals and policymakers about health care options, outcomes and costs."
Because of the ruling, ProPublica says that Americans will rely heavily on data that is released by Medicare in order to study difference in healthcare, but without data from self-funded plans as well, all-payer claims databases will be incomplete and not as valuable as they could be. Hospitals only have information on the patients they treat--not across the entire spectrum--and complete data from all payers would help providers and policymakers understand the variations in the healthcare system, the article says.
One solution to this data-blocking issue could be for the federal government require self-insured plans to disclose their data, the article suggests. Or, it says, self-funded plans could voluntarily provide their data to state-run databases.
To learn more:
- check out the ProPublica article