For many years, health care prices paid by US insurers and employers have been protected as trade secrets. Those prices and the lack of transparency are widely blamed for the high costs of health care in the US. To address this problem most states, including all ERC states, are creating all-payer claims databases (APCDs) as critical tools to support health system reform efforts. Ideally APCDs include detailed claims data from every coverage plan in a state allowing comprehensive health care delivery planning, public health interventions, “hotspotting” health care problems, program evaluation, and fair payment rate setting among many benefits. An APCD can also be used by consumers and payers for price shopping, which may help control health care costs.
However earlier this month, in Gobeille v. Liberty Mutual, the US Supreme Court ruled that under federal law self-insured plans, covering 63% of Americans, do not have to submit their data to Vermont’s APCD. Seventeen states and the District of Columbia filed briefs supporting Vermont’s position including New York, Connecticut, Maine, Maryland, Massachusetts and Rhode Island. Large health systems and large insurers who tend to get better prices have the most to gain by the Court’s ruling. Potential solutions include Congressional action, although that is unlikely, or regulations from the federal Department of Labor.