A Supreme Court case early this month may leave healthcare transparency advocates turning to the federal government and the U.S. Department of Labor if they want to get an accurate picture about the cost of healthcare procedures.
The U.S. Supreme Court ruled 6-2 against the state of Vermont in the case, Gobeille vs Liberty Mutual, in which the state had sought to compel the Liberty Mutual insurance company to turn over information about medical claims data for the self-insured health insurance plan it offers employees through BlueCross BlueShield of Massachusetts.
The high court determined that since self-insured employer-based health plans are governed by federal labor law, states had no authority to require such plans to submit data to them, just as they had no power to regulate the insurance plans.
It was a big blow to advocates to all-payer, all-claims databases, who argue that the databases could be used to identify inefficient or expensive health systems, as well as show which insurers are getting more favorable rates for the same procedures either within the same hospital system compared to their competitors, or at competing hospitals in the same market.
But if the Supreme Court handicapped Vermont as well as Oregon and other states, it didn’t let Liberty Mutual and other employers with self-insured health plans off the hook -- it just moved the authority to the U.S. Department of Labor, which could set up its own reporting requirements for healthcare data, which could then be disseminated more uniformly to states with all-payer, all-claims databases.
“The national groups have been calling on the Department of Labor to do this,” said Jesse O’Brien, consumer advocate with the Oregon State Public Interest Research Group. “They [Labor Department] haven’t been that active on the health benefit side of things.”
O’Brien was disappointed with the decision, and didn’t put too much faith in the federal government to move quickly to assist the all-payer, all-claims databases.
In Oregon, 23 percent of Oregonians receive health insurance through these federally regulated health plans. Alissa Robbins, spokeswoman for the Oregon Health Authority, said that Oregon, unlike Vermont, had only sought the voluntary submission of data from these plans because of the previous ambiguity of the federal law.
If this group is left out, it will greatly undermine the database, leaving many of the healthiest people out of the system and skewing the claims data toward Medicare and Medicaid which pay providers much less than commercial insurance carriers. “It’s much less representative of what’s going on in Oregon’s healthcare system,” complained O’Brien.
Justice Ruth Bader Ginsburg and Justice Sonia Sotomayor dissented, agreeing with the states, the Obama administration and the Public Interest Research Group that the public benefit of the data outweighed the minimal inconvenience of the self-insured plans to report the data.
O’Brien said that the Oregon Insurance Division had begun utilizing the database in its rate reviews of the individual and small business insurance market, giving the state agency a way to check the insurers’ math.
In the future the information in the database might be useful for physicians to help their patients better weigh the cost of a planned health procedure at different hospitals and ambulatory surgery centers, he thought. All of this becomes less doable if nearly a quarter of the state is left out.
