Tuesday, January 19, 2016
Vermont's All-Payer Claims Database: What Hangs in the Balance.
I have been following Vermont's all-payer claims database litigation, Gobeille v. Liberty Mutual Insurance Co. -- argued at the U.S. Supreme Court on December 2, 2015. Perhaps you have as well. There is absolutely nothing like a good ERISA preemption dispute to to remind me of the force of Bill Sage's observation that is a case like this that reminds you why you must explain "to every class of Health Law students... that ERISA [is] the most important law affecting private health insurance in the United States."
Strictly as an ERISA preemption case, Gobeille is interesting for how it may force the Court to parse yet again and yet further whether the collection of health care data by a state interferes with a core ERISA function belonging to the U.S. Secretary of Labor or whether state by state variable all-payer claims database reporting requirements are arguably unduly burdensome on the reporting entities and firms. If you've read this far, I know you are fascinated by preemption, but even more importantly, such a decision would test whether or not the gradual movement of the states to mandating reporting of all-payer claims data has legs.
It is early days, but there is some evidence that the all-payer claims data has begun to influence health care cost to consumers and health care consumer decision making in New Hampshire (under its Comprehensive Healthcare Information System established by state law in 2007). The claim of price transparency triumphant, of course, is also balanced by arguments about adverse affects of health care price transparency because limited research may also indicate that it causes rates to narrow and average costs to rise.
All of this is based on fairly little experimentation with health care cost transparency in the U.S. of the sort that may be developed from all payer claim databases. So just what is it that we would rather not know, rather not test empirically, about the competitive effects of the disclosure of this kind of information?