Members of PCG Health’s Health Innovation Policy Information Technology (HIPIT) center of excellence have been keeping an eye on Gobeille vs Liberty Mutual Insurance Company given its direct impact on All-Payer Claims Databases (APCD), which many PCG state clients rely on to gather data necessary to analyze data on health care services and impact rising health care costs. At issue in the case was whether Vermont (and, by extension, other states) can compel self-insured employers governed by the Federal Employee Retirement Income Security Act of 1973 (ERISA) to submit their health care claims data. Given the large portion of insured individuals enrolled in self-insured plans, the loss of this data would leave huge gaps in APCDs.
After being dismissed by the US District Court for the District of Vermont – a decision that was overturned by the Second Circuit Court of Appeals – the Supreme Court accepted the case last summer. Last week, the Court held that ERISA does preempt the Vermont requirement that self-insured employers submit claims data to the state’s Advanced Premium Tax Credits (APTC).
This summary outlines the case, the decision and potential alternatives for ensuring the comprehensiveness of APCDs.
Published by Lisa Kaplan Howe
Lisa Kaplan Howe (J.D.) is a Senior Advisor who has spent her career working in health law and policy. At PCG, she focuses on statutory and regulatory analysis and strategic advising, particularly related to health care policy. Lisa has provided subject matter expertise to support state health care reform efforts, including policy development and regulatory support for health insurance Marketplaces and state insurance plan management efforts, Medicaid expansion and Medicaid Waivers (including DSRIP Waivers) and State Innovation Waivers. Lisa led PCG’s work with the New Hampshire Insurance Department relative the state’s Section 1115 Medicaid Waiver to provide coverage to newly-eligible adults through the Marketplace and continues to support the states’ Marketplace plan management work. In those roles, Lisa has served as the chief advisor and policy expert related to Medicaid and private insurance law to the New Hampshire Insurance Department, helping to identify, analyze and lead strategic consideration of federal opportunities and requirements. Lisa is also part of the team helping to design Colorado’s Delivery System Reform Incentive Payment (DSRIP) program. Ms. Kaplan Howe also provides broad policy and regulatory support to PCG’s other health care clients across the country, analyzing policy and regulatory developments, providing strategic advice relative to regulatory questions, and drafting policy briefs and position papers. Lisa is a managing editor of PCG’s monthly health practice area newsletter, Health Policy News.
Prior to joining PCG, Lisa served as Policy Director at New Hampshire Voices for Health, where she led legislative and regulatory analysis, strategic planning, and implementation of the organization’s policy agenda. Her work included drafting bills, amendments, testimony, and communications and testifying at hearings. Lisa also held the positions of Private Market Policy Manager and Consumer Health Policy Coordinator at Health Care for All of Massachusetts. While there, she managed private insurance market policy work and was a member of the organization’s internal health reform team. Lisa also practiced law in the Ropes & Gray health care department, advising health care provider and insurer clients.
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