A number of states have enacted statutes within the past couple of years requiring group health plans to report plan data (including costs, cost sharing, claims, enrollment, utilization, and other information) to one or more state agencies for the purpose of creating a transparent and accessible database for use by both the state and residents to compare costs, patient outcomes, and available resources within the state. In many instances, including the Vermont statute addressed in Gobeille v. Liberty Mutual Insurance Co., data collection is required by insurers as well as by sponsors and third-party administrators of self-funded ERISA plans. Liberty Mutual argued that states should not be permitted to subject self-funded ERISA plans and their vendors to a potential patchwork system of state reporting requirements and that this is the precise kind of activity for which ERISA pre-emption of state laws exists. The U.S. Supreme Court agreed with Liberty Mutual that the Vermont law was pre-empted by ERISA, as applied to ERISA-governed self-funded plans. Vermont’s law can still apply, however, to fully-insured plans, as well as to self-funded plans that are not ERISA plans (e.g., governmental and church plans). We expect other states to begin modifying their data collection requirements.
The Gobeille opinion is available here.