Gobeille v. Liberty Mut. Ins. Co., No. 14–181.

CourtU.S. Supreme Court
Writing for the CourtJustice KENNEDY delivered the opinion of the Court.
Citation194 L.Ed.2d 20,136 S.Ct. 936,577 U.S. 312
Parties Alfred GOBEILLE, in his official capacity as Chair of the Vermont Green Mountain Care Board, Petitioner v. LIBERTY MUTUAL INSURANCE COMPANY.
Decision Date01 March 2016
Docket NumberNo. 14–181.

577 U.S. 312
136 S.Ct.
936
194 L.Ed.2d 20

Alfred GOBEILLE, in his official capacity as Chair of the Vermont Green Mountain Care Board, Petitioner
v.
LIBERTY MUTUAL INSURANCE COMPANY.

No. 14–181.

Supreme Court of the United States

Argued Dec. 2, 2015.
Decided March 1, 2016.


Bridget C. Asay, Solicitor General, for Petitioner.

John F. Bash for the United States, as amicus curiae, by special leave of the Court, supporting the Petitioner.

Seth P. Waxman, Washington, DC, for Respondent.

David C. Frederick, Scott H. Angstreich, Kellogg, Huber, Hansen, Todd, Evans & Figel, P.L.L.C., Washington, DC, Peter K. Stris, Brendan S. Maher, Radha A. Pathak, Stris & Maher LLP, Los Angeles, CA, William H. Sorrell, Attorney General, Bridget C. Asay, Solicitor General, Benjamin D. Battles, Assistant Attorney General, Office of the Attorney General, Montpelier, VT, for Petitioner.

Andrew C. Liazos, McDermott Will &, Emery LLP, Boston, MA, M. Miller Baker, McDermott Will &, Emery LLP, Washington, DC, Karen V. Morton, Nancy L. Keating, Liberty Mutual Insurance, Boston, MA, Seth P. Waxman, Paul R.Q. Wolfson, Matthew J. Thome, Jonathan A. Bressler, Wilmer Cutler Pickering, Hale and Dorr LLP, Washington, DC, for Respondent.

Justice KENNEDY delivered the opinion of the Court.

577 U.S. 315

This case presents a challenge to the applicability of a state law requiring disclosure of payments relating to health care claims and other information relating to health care services. Vermont enacted the statute so it could maintain an all-inclusive health care database. Vt. Stat. Ann., Tit. 18, § 9410(a)(1) (2015 Cum. Supp.) (V.S.A.). The state law, by its terms, applies to health plans established by employers and regulated by the Employee Retirement Income Security Act of 1974 (ERISA), 88 Stat. 829, as amended, 29 U.S.C. § 1001 et seq. The question before the Court is whether ERISA pre-empts the Vermont statute as it applies to ERISA plans.

I

A

Vermont requires certain public and private entities that provide and pay for

136 S.Ct. 941

health care services to report information to a state agency. The reported information is compiled into a database reflecting "all health care utilization, costs, and resources in [Vermont], and health care utilization and costs for services provided to Vermont residents in another state." 18 V.S.A. § 9410(b). A database of this kind is sometimes called an all-payer claims database, for it requires submission of data from all health insurers and other entities that pay for health care services. Almost 20 States have or are implementing similar databases. See Brief for State of New York et al. as Amici Curiae 1, and n. 1.

Vermont's law requires health insurers, health care providers, health care facilities, and governmental agencies to report any "information relating to health care costs, prices,

577 U.S. 316

quality, utilization, or resources required" by the state agency, including data relating to health insurance claims and enrollment. § 9410(c)(3). Health insurers must submit claims data on members, subscribers, and policyholders. § 9410(h). The Vermont law defines health insurer to include a "self-insured ... health care benefit plan," § 9402(8), as well as "any third party administrator" and any "similar entity with claims data, eligibility data, provider files, and other information relating to health care provided to a Vermont resident." § 9410( j)(1)(B). The database must be made "available as a resource for insurers, employers, providers, purchasers of health care, and State agencies to continuously review health care utilization, expenditures, and performance in Vermont." § 9410(h)(3)(B).

Vermont law leaves to a state agency the responsibility to "establish the types of information to be filed under this section, and the time and place and the manner in which such information shall be filed." § 9410(d). The law has been implemented by a regulation creating the Vermont Healthcare Claims Uniform Reporting and Evaluation System. The regulation requires the submission of "medical claims data, pharmacy claims data, member eligibility data, provider data, and other information," Reg. H–2008–01, Code of Vt. Rules 21–040–021, § 4(D) (2016) (CVR), in accordance with specific formatting, coding, and other requirements, § 5. Under the regulation, health insurers must report data about the health care services provided to Vermonters regardless of whether they are treated in Vermont or out-of-state and about non-Vermonters who are treated in Vermont. § 4(D); see also § 1. The agency at present does not collect data on denied claims, § 5(A)(8), but the statute would allow it to do so.

Covered entities (reporters) must register with the State and must submit data monthly, quarterly, or annually, depending on the number of individuals that an entity serves. The more people served, the more frequently the reports

577 U.S. 317

must be filed. §§ 4, 6(I). Entities with fewer than 200 members need not report at all, ibid., and are termed "voluntary" reporters as distinct from "mandated" reporters, § 3. Reporters can be fined for not complying with the statute or the regulation. § 10; 18 V.S.A. § 9410(g).

B

Respondent Liberty Mutual Insurance Company maintains a health plan (Plan) that provides benefits in all 50 States to over 80,000 individuals, comprising respondent's employees, their families, and former employees. The Plan is self-insured and self-funded, which means that Plan benefits are paid by respondent. The Plan, which qualifies as an "employee welfare benefit plan" under ERISA, 29 U.S.C. § 1002(1), is subject to "ERISA's comprehensive regulation," New York State Conference of Blue Cross & Blue Shield Plans

136 S.Ct. 942

v. Travelers Ins. Co., 514 U.S. 645, 650, 115 S.Ct. 1671, 131 L.Ed.2d 695 (1995). Respondent, as the Plan sponsor, is both a fiduciary and plan administrator.

The Plan uses Blue Cross Blue Shield of Massachusetts, Inc. (Blue Cross) as a third-party administrator. Blue Cross manages the "processing, review, and payment" of claims for respondent. Liberty Mut. Ins. Co. v. Donegan, 746 F.3d 497, 502 (C.A.2 2014) (case below). In its contract with Blue Cross, respondent agreed to "hold [Blue Cross] harmless for any charges, including legal fees, judgments, administrative expenses and benefit payment requirements, ... arising from or in connection with [the Plan] or due to [respondent's] failure to comply with any laws or regulations." App. 82. The Plan is a voluntary reporter under the Vermont regulation because it covers some 137 Vermonters, which is fewer than the 200–person cutoff for mandated reporting. Blue Cross, however, serves several thousand Vermonters, and so it is a mandated reporter. Blue Cross, therefore, must report the information it possesses about the Plan's members in Vermont.

577 U.S. 318

In August 2011, Vermont issued a subpoena ordering Blue Cross to transmit to a state-appointed contractor all the files it possessed on member eligibility, medical claims, and pharmacy claims for Vermont members. Id., at 33. (For clarity, the Court uses "Vermont" to refer not only to the State but also to state officials acting in their official capacity.) The penalty for noncompliance, Vermont threatened, would be a fine of up to $2,000 a day and a suspension of Blue Cross' authorization to operate in Vermont for as long as six months. Id., at 31. Respondent, concerned in part that the disclosure of confidential information regarding its members might violate its fiduciary duties under the Plan, instructed Blue Cross not to comply. Respondent then filed this action in the United States District Court for the District of Vermont. It sought a declaration that ERISA pre-empts application of Vermont's statute and regulation to the Plan and an injunction forbidding Vermont from trying to acquire data about the Plan or its members.

Vermont filed a motion to dismiss, which the District Court treated as one for summary judgment, see Fed. Rule Civ. Proc. 12(d), and respondent filed a cross-motion for summary judgment. The District Court granted summary judgment to Vermont. It first held that respondent, despite being a mere voluntary reporter, had standing to sue because it was faced with either allegedly violating its "fiduciary and administrative responsibilities to the Plan" or assuming liability for Blue Cross' withholding of the data from Vermont. Liberty Mut. Ins. Co. v. Kimbell, No. 2:11–cv–204, 2012 WL 5471225 (D.Vt., Nov. 9, 2012), p. 12. The District Court then concluded that the State's reporting scheme was not pre-empted. Although that scheme "may have some indirect effect on health benefit plans," the court reasoned that the "effect is so peripheral that the regulation cannot be considered an attempt to interfere with the administration or structure of a welfare benefit plan." Id., at 31–32.

577 U.S. 319

The Court of Appeals for the Second Circuit reversed. The panel was unanimous in concluding that...

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28 practice notes
  • Conway v. United States, 2020-1292
    • United States
    • United States Courts of Appeals. United States Court of Appeals for the Federal Circuit
    • May 17, 2021
    ...anything, § 18041(d) expresses congressional intent to preempt only a narrow class of state laws. See Gobeille v. Liberty Mut. Ins. Co ., 577 U.S. 312, 326, 136 S. Ct. 936, 194 L.Ed.2d 20 (2016) (characterizing § 18041(d) as an "anti-pre-emption provision"); St. Louis Effort for AIDS v. Huf......
  • Halperin v. Richards, 20-2793
    • United States
    • United States Courts of Appeals. United States Court of Appeals (7th Circuit)
    • July 28, 2021
    ...was not enforceable against ERISA plans). This generally encompasses two categories of state laws. Gobeille v. Liberty Mut. Ins. Co. , 577 U.S. 312, 319, 136 S.Ct. 936, 194 L.Ed.2d 20 (2016). First, "[w]here a State's law acts immediately and exclusively upon ERISA plans ... or where the ex......
  • Hendrix v. United Healthcare Ins. Co. of the River Valley, 1190107
    • United States
    • Supreme Court of Alabama
    • September 18, 2020
    ...a central matter of plan administration’ or ‘interferes with nationally uniform plan administration.’ " Gobeille v. Liberty Mut. Ins. Co., 577 U.S. 312, 136 S. Ct. 936, 943, 194 L.Ed.2d 20 (2016) (quoting Egelhoff, 532 U.S. at 148, 121 S.Ct. 1322 ). " ‘[A] state law may "relate to" a benefi......
  • Pharm. Care Mgmt. Ass'n v. Wehbi, 18-2926
    • United States
    • United States Courts of Appeals. United States Court of Appeals (8th Circuit)
    • November 17, 2021
    ...plan to adopt a certain scheme of substantive coverage or effectively restrict its choice of insurers." Gobeille v. Liberty Mut. Ins. , 577 U.S. 312, 320, 136 S.Ct. 936, 194 L.Ed.2d 20 (2016). The mere fact that a state law "affects an ERISA plan or causes some disuniformity in plan adminis......
  • Request a trial to view additional results
26 cases
  • Conway v. United States, 2020-1292
    • United States
    • United States Courts of Appeals. United States Court of Appeals for the Federal Circuit
    • May 17, 2021
    ...anything, § 18041(d) expresses congressional intent to preempt only a narrow class of state laws. See Gobeille v. Liberty Mut. Ins. Co ., 577 U.S. 312, 326, 136 S. Ct. 936, 194 L.Ed.2d 20 (2016) (characterizing § 18041(d) as an "anti-pre-emption provision"); St. Louis Effort for AIDS v. Huf......
  • Halperin v. Richards, 20-2793
    • United States
    • United States Courts of Appeals. United States Court of Appeals (7th Circuit)
    • July 28, 2021
    ...was not enforceable against ERISA plans). This generally encompasses two categories of state laws. Gobeille v. Liberty Mut. Ins. Co. , 577 U.S. 312, 319, 136 S.Ct. 936, 194 L.Ed.2d 20 (2016). First, "[w]here a State's law acts immediately and exclusively upon ERISA plans ... or where the ex......
  • Hendrix v. United Healthcare Ins. Co. of the River Valley, 1190107
    • United States
    • Supreme Court of Alabama
    • September 18, 2020
    ...a central matter of plan administration’ or ‘interferes with nationally uniform plan administration.’ " Gobeille v. Liberty Mut. Ins. Co., 577 U.S. 312, 136 S. Ct. 936, 943, 194 L.Ed.2d 20 (2016) (quoting Egelhoff, 532 U.S. at 148, 121 S.Ct. 1322 ). " ‘[A] state law may "relate to" a benefi......
  • Pharm. Care Mgmt. Ass'n v. Wehbi, 18-2926
    • United States
    • United States Courts of Appeals. United States Court of Appeals (8th Circuit)
    • November 17, 2021
    ...plan to adopt a certain scheme of substantive coverage or effectively restrict its choice of insurers." Gobeille v. Liberty Mut. Ins. , 577 U.S. 312, 320, 136 S.Ct. 936, 194 L.Ed.2d 20 (2016). The mere fact that a state law "affects an ERISA plan or causes some disuniformity in plan adminis......
  • Request a trial to view additional results
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