The US Supreme Court issued a new ruling on Tuesday, citing that the Employee Retirement Income Security Act of 1974, which is commonly called as ERISA, prevents states from requiring residents’ healthcare claims to be submitted to a huge database.
With the way patients are being treated by medical practitioners and hospitals, it is safe to say that the public is far from obtaining a clearer picture of the healthcare spending activities of the US government. As a result, citizens will continue to rely on data provided by the federal health insurance program for the elderly and the disabled, Medicare, to keenly observe the variations in the country’s healthcare system.
Vermont vs. Liberty Mutual Insurance
The ruling of the Supreme Court highly involves a case from Vermont, which called for health providers, health insurers, and government agencies to accurately report healthcare services data. Vermont is among the 18 states that created all-payer claims databases.
However, the Liberty Mutual Insurance Co. expressed its objection. According to the insurance giant, what the ERISA prevents is the imposing of a requirement on self-funded plans. In addition, companies operating throughout the US shall not abide by different state legislations and shall only be subjected to the rules of a sole government agency, the Department of Labor. In a 6-2 vote, the court agreed with Liberty Mutual Insurance.
Need for Data Disclosure
On the other hand, the Association of American Medical Colleges (AAMC) and the American Hospital Association noted that all-payer claims databases will not be substantial without the necessary data from the self-funded plans, elaborating that medical facilities only possess data of their respective patients.
Without all data from all payers, lawmakers and healthcare providers will not be able to fully understand the variations in the healthcare system of the country and make the necessary amendments.
Accordingly, 60% of the labor force is enrolled in self-insured plans, making them a vital element for the completion of the databases.
Justice Stephen Breyer, on the other hand, suggested that the federal government shall mandate self-insured plans to submit their respective data themselves.
Given this complicated situation, the much-needed transparency in the US healthcare system still has a long battle to fight.