Source: http://docplayer.net/16089817-1-in-the-supreme-court-of-the-united-states-2-x-3-alfred-gobeille-in-his-4-official-capacity-as-chair-5-of-the-vermont-green-mountain.html
Timestamp: 2018-06-20 10:29:13
Document Index: 709512669

Matched Legal Cases: ['art 7', 'art 7', 'art 7', 'art 7', 'art 7', 'arty 24']

1 IN THE SUPREME COURT OF THE UNITED STATES. 2 x 3 ALFRED GOBEILLE, IN HIS : 4 OFFICIAL CAPACITY AS CHAIR : 5 OF THE VERMONT GREEN MOUNTAIN : - PDF
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1 1 IN THE SUPREME COURT OF THE UNITED STATES 1 2 x 3 ALFRED GOBEILLE, IN HIS : 4 OFFICIAL CAPACITY AS CHAIR : 5 OF THE VERMONT GREEN MOUNTAIN : 6 CARE BOARD, : 7 Petitioner : No v. : 9 LIBERTY MUTUAL INSURANCE : 10 COMPANY. : 11 x 12 Washington, D.C. 13 Wednesday, December 2, The above entitled matter came on for oral 16 argument before the Supreme Court of the United States 17 at 10:03 a.m. 18 APPEARANCES: 19 BRIDGET C. ASAY, ESQ., Vermont Solicitor General, 20 Montpelier, Vt.; on behalf of Petitioner. 21 JOHN F. BASH, ESQ., Assistant to the Solicitor General, 22 Department of Justice, Washington, D.C.; for United 23 States, as amicus curiae, supporting Petitioner. 24 SETH P. WAXMAN, ESQ., Washington, D.C.; on behalf of 25 Respondent.
2 1 C O N T E N T S 2 2 ORAL ARGUMENT OF PAGE 3 BRIDGET C. ASAY, ESQ. 4 On behalf of the Petitioner 3 5 ORAL ARGUMENT OF 6 JOHN F. BASH, ESQ. 7 For United States, as amicus curiae, 8 supporting the Petitioner 18 9 ORAL ARGUMENT OF 10 SETH P. WAXMAN, ESQ. 11 On behalf of the Respondent REBUTTAL ARGUMENT OF 13 BRIDGET C. ASAY, ESQ. 14 On behalf of the Petitioner
3 1 P R O C E E D I N G S 3 2 (10:03 a.m.) 3 CHIEF JUSTICE ROBERTS: We'll hear argument 4 this morning in Case , Gobeille v. Liberty Mutual 5 Insurance Company. 6 Ms. Asay. 7 ORAL ARGUMENT OF BRIDGET C. ASAY 8 ON BEHALF OF THE PETITIONER 9 MS. ASAY: Mr. Chief Justice, and may it 10 please the Court: 11 Under under the principles this Court 12 adopted in Travelers, Vermont's collection of health 13 care data is not preempted. The database statute does 14 not affect ERISA plans in any way that undermines 15 ERISA's core objectives, does not require plans to offer 16 benefits, affect the financing or fiduciary standards 17 for plans, or change the way the plans administer 18 benefits to their members. 19 Vermont is merely collecting standardized 20 data that Blue Cross necessarily generates and already 21 provides to the State for itself and other entities. 22 JUSTICE KENNEDY: And it hasn't been argued 23 by Liberty, and we can ask them about that, that this is 24 burdensome, that it might be different from State to 25 State and so forth, and it may be that this sounds more
4 1 in conflict preemption than statutory preemption. But 4 2 can you just answer a few questions? 3 Does this apply to people that are not 4 residents in Vermont but that have been treated in 5 Vermont? 6 And does it also apply to people that are 7 outside of that are Vermonters but are treated 8 outside Vermont? 9 I mean, what who is the universe to whom 10 these this applies? 11 And it seems to me that that would be 12 difficult for plans to to figure out. 13 MS. ASAY: As implemented by the board, Your 14 Honor, the the database requirements apply to 15 Vermonters receiving health care services from a covered 16 insurer regardless of their location, so both inside 17 Vermont and outside Vermont, if it's paid for by a 18 covered insurer. It does not the board has chosen 19 not to require data from non Vermont residents receiving 20 care in Vermont. 21 With respect to the to the burden and 22 with respect to the burden issue 23 JUSTICE SCALIA: You say it's chosen to. 24 Does the statute authorize it to? 25 MS. ASAY: The statute authorizes it to do
5 1 either, Your Honor. 5 2 JUSTICE SCALIA: We we we ought to 3 consider that, don't you think? 4 MS. ASAY: I don't I don't believe so, 5 Your Honor, because the the program that has been 6 challenged here by Liberty Mutual is the program as it 7 has been implemented by the board, and that that is 8 how it has been implemented. 9 And this kind of generally applicable health 10 care regulation is not preempted for the reasons that 11 this Court has expressed in a series of decisions, 12 including Travelers, De Buono, Mackey, and Dillingham. 13 JUSTICE GINSBURG: What of the point that 14 Justice Kennedy suggested, that that States can have 15 different reporting requirements? So it's a little bit 16 like Egelhoff in that respect, that if there were 17 uniform requirements, that would be less burdensome, but 18 if each State has its own specifications, then that 19 becomes burdensome and costly. 20 MS. ASAY: Your Honor, two responses to 21 that. The first is that there is simply no evidence in 22 this record that there is any cognizable burden on the 23 third party administrators who are health care insurers 24 who generate this data and are providing it already in 25 their capacity as insurers.
6 1 Second, certainly some States may choose to 6 2 do these programs differently, but as several of the 3 amicus briefs explain, including the brief from the 4 National Association of Health Data Organizations, these 5 are carefully designed programs that track the 6 electronic transaction rule under HIPAA that provides 7 national standards for electronic claims transactions. 8 JUSTICE KENNEDY: Suppose States had 9 different reporting requirements and the plan showed 10 they haven't I don't think showed, but suppose they 11 showed that this was burdensome. Does that affect the 12 analysis of the preemption question? 13 MS. ASAY: Only in this way, Your Honor: I 14 think that the Court's holding in Travelers can be 15 distilled to basically three questions. The first 16 question is: 17 Does the plan does the State law 18 specifically and directly regulate ERISA plans only? 19 That's not at issue in this case. It does not. 20 The second question is whether the State is 21 regulating in an area that Congress reserved to the 22 States or is regulating in an area with which ERISA is 23 principally concerned. And here the State is engaging 24 in classic health care regulation, so on that question 25 the answer is no.
7 1 And then Travelers leaves open 7 2 JUSTICE SCALIA: Excuse me. You could say 3 that it's engaged in health care regulation. You could 4 also say it's it is engaged in data collection. And 5 if you say the latter, that is something that that 6 ERISA covers. 7 MS. ASAY: Your Honor, ERISA governs plan 8 financial reporting and plan disclosures to the members. 9 It primarily the reporting requirements that ERISA 10 sets out are about the plan finances: actuarial 11 statements, statements of audited financial statements, 12 information about how the plan is about the the 13 degree of the plan's financial soundness. And nothing 14 that Vermont is doing has anything to do 15 JUSTICE ALITO: Is that still true 16 CHIEF JUSTICE ROBERTS: Well 17 JUSTICE ALITO: after the Affordable Care 18 Act? Doesn't the Affordable Care Act include in ERISA a 19 section authorizing the Secretary to gather information 20 from plans for the purpose of improving health outcomes? 21 MS. ASAY: Yes. The Affordable Care Act 22 made a technical amendment to ERISA, which in turn 23 incorporated the Act's amendments to the Public Health 24 Services Act. Those do not change the test for ERISA 25 preemption. They're not part of the plan's annual
8 1 reporting to the Department of Labor. 8 2 There's a couple of reasons for that. One 3 is that the Affordable Care Act itself has a has a 4 an almost an anti preemption provision, a provision 5 that says that the Affordable Care Act only prevents 6 those State laws that prevent the application of the 7 Act. 8 Part 7 of ERISA also, which has those 9 amendments in it, is not part of ERISA as it was 10 originally passed. That was added by HIPAA. And Part 7 11 itself has a provision that says it does not 12 JUSTICE ALITO: But why does it matter 13 MS. ASAY: affect the 14 JUSTICE ALITO: why does it matter 15 whether it was in ERISA as originally passed? It is in 16 ERISA now. And it is sort of true that there is an 17 anti preemption provision, but there is also a provision 18 in the Affordable Care Act that says that the the 19 provisions that are added have no effect on the ERISA 20 preemption provision. 21 MS. ASAY: That's right, Your Honor. 22 JUSTICE ALITO: So what do you make of that? 23 MS. ASAY: What I make of that is that it 24 does not change the test for preemption either way. And 25 when when Congress passed the Affordable Care Act,
9 1 Travelers had been on the books for years. The 9 2 standards set forth in Travelers, which reserved, to the 3 State's, health care regulation, was understood by by 4 Traveler was understood by Congress, and it was not 5 changed. 6 And this program that that Vermont has 7 adopted is a classic health care regulation. The 8 data 9 JUSTICE BREYER: It is health care 10 regulation. Vermont also has laws that govern 11 fiduciaries. So could they have a statute which says 12 all fiduciaries, including fiduciaries ERISA 13 fiduciaries must report fill out the following forms 14 about how they how they invest their money. 15 Can they do that? 16 MS. ASAY: They could they could have a 17 standard for 18 JUSTICE BREYER: No, no, no. Can they do 19 just what I said? Is or is that preempted? 20 MS. ASAY: It would be preempted 21 JUSTICE BREYER: Correct. 22 MS. ASAY: as applied to the ERISA plan. 23 JUSTICE BREYER: Now, suppose, instead of 24 that, what they say is, what we would like is that all 25 fiduciaries of ERISA plans send us each month a report
10 1 of all of the benefits under the retirement plan that 10 2 they have paid to any member. 3 Can they do that? 4 MS. ASAY: Your Honor, I think the answer to 5 that probably depends on the area in which the State is 6 regulating. 7 JUSTICE BREYER: So what they're doing is 8 they have their their Secretary of Health and Human 9 Services that would like to know how wealthy or poor the 10 workers are. So that's why they do it. 11 MS. ASAY: I think that would prevent a very 12 close question. 13 JUSTICE BREYER: You think that's a close 14 question? 15 MS. ASAY: That is a close question. 16 JUSTICE BREYER: Gee, I see case after case 17 here that says that reporting requirements are a central 18 function. You know, I you've read them just as well 19 as I. And and it seems to me surprising that they 20 can do that. 21 Isn't that the job of the Labor Department. 22 MS. ASAY: I think that is primarily the job 23 of the Labor Department. And I I say that it 24 JUSTICE BREYER: Because obviously, my 25 question it's a good answer, because you're saying
11 1 I'm not getting anywhere with this line of because 11 2 you're because I'm going to say what about health 3 care. That's the next question. 4 My actual question I'm driving at is this: 5 You should have the information. I have no doubt about 6 that. But the question is whether you have to go to the 7 Labor Department first or HHS and say, we want uniform 8 rules here, or whether they have to come to you when the 9 rules of 50 States turn out to be a mess. 10 And you you you say you want to go 11 first and let them come after me, and I think the other 12 side says no. If you want to do what you want to do, go 13 to the Labor Department, get a national rule that gives 14 you large range to get what you want. 15 MS. ASAY: And 16 JUSTICE BREYER: And I don't know the answer 17 to that question. That's why I ask it. 18 MS. ASAY: And, Your Honor, the answer to 19 that question is that, because this is classic health 20 care regulation for which States are responsible 21 insurance rate review, budget review, health care 22 research it is an area in which States are permitted 23 to regulate. And they're permitted to regulate even 24 slightly differently from State to State. 25 And as the Department of Labor, the Federal
12 1 government agrees with us that this is an area that 12 2 ERISA leaves to the States, even though it involves data 3 collection, because ERISA cannot possibly have been 4 intended to sweep away all collection of information 5 from plans by States. Congress adopted a deliberately 6 expansive definition of a welfare benefit plan and ERISA 7 that includes, not just the direct provision of medical 8 care, but also day care centers, apprenticeship 9 programs, prepaid legal services. These are all areas 10 in which when plans would act, they would necessarily be 11 providing information to States. 12 JUSTICE ALITO: I I see that I I 13 see that argument as to ERISA as originally enacted, but 14 I am very troubled by the fact that it now authorizes 15 the collection of data for the purpose of improving 16 health outcomes health care outcomes. I I don't 17 see how that unless the anti preemption provision 18 saves the day, I don't see how that does not undermine 19 your principal argument, which is that ERISA may preempt 20 reporting of financial data and that sort of thing, but 21 it doesn't preempt the collection of data regarding 22 health care. 23 MS. ASAY: Your Honor, the the scope of 24 ERISA's preemption provision in 1144 is governed by what 25 Congress intended when it passed ERISA in And the
13 1 later amendments to ERISA regarding group health plans 13 2 include the language that says, "does not affect or 3 modify that standard." And so this Court, when it is 4 considering the scope of the of the areas that 5 Congress left to the States in JUSTICE ALITO: I really don't see how that 7 can possibly be. If Congress enacted an amendment 8 tomorrow that says one of the core purposes of ERISA is 9 to collect health care information, and here is a 10 here is the health care collecting requirement, you 11 would say, well, that's not preempted, because that 12 wasn't the purpose when they enacted the preemption 13 provision, originally. 14 MS. ASAY: I would certainly say that was 15 not preempted if it was added to Part 7, which says that 16 Part 7 does not affect the test for ERISA preemption in JUSTICE SCALIA: Well, saying it doesn't 19 affect the test is quite different from saying that 20 that that nothing changes. The test remains the 21 same, but now, that test is applied to collection, 22 which which the Labor Department is itself 23 conducting, or is itself authorized to conduct. That's 24 not changing the test. It's simply it's simply 25 changing the facts to which the test has been applied
14 1 or the law to which the test has been applied MS. ASAY: It would change the test, Your 3 Honor, because if ERISA was now considered to have a 4 broader, expansive scope that intruded into health care, 5 that would change this Court's settled precedent in 6 Travelers and De Buono. And again, Congress 7 JUSTICE SCALIA: Well, that doesn't change 8 the test. Our test would still be the same whether it's 9 a core function of ERISA or not, and and it has made 10 it a core function of ERISA. 11 MS. ASAY: It has not made it a core 12 function of ERISA. It has there were it's the 13 Affordable Care Act's amendment to ERISA, and again, 14 there's also in addition to Part 7's preemption 15 language, there is the Affordable Care Act's 16 anti preemption language, and to think that when 17 Congress passed the Affordable Care Act, which 18 contemplated a robust Federal State partnership in 19 health experimentation, which included language that 20 authorized the Department of Health and Human Services 21 to provide Medicare 22 JUSTICE BREYER: But this is no problem for 23 you. All you have to do is go to DOL or HHS. The State 24 representative says, this is what we want to do, will 25 you please promulgate a regulation. you can do it
15 15 1 maybe in 90 days or 120 days which says that this and 2 similar things are fine. And in our opinion, it is 3 not it is not preempted. I think you could do that. 4 That's my opinion. I may be the only one who thinks 5 that. So I I think it's just a question of which 6 forms you have to go through. 7 But if we take you and say, I'm going to ask 8 I'm really asking the government this question, 9 because I don't see why they're on your side, and 10 they'll have an answer to that. See, I want to find 11 out. But what I want to find out is this: The factor I 12 saw was 93 million people have these plans. And if million people have these plans, there can be 50 States 14 with 50 different sets of regulations imposing a huge 15 financial burden upon health care. 16 And were that to happen, suddenly all the 17 people we're trying to help under this plan will find 18 themselves much worse off, and purely for bureaucratic 19 reasons. If I take their side of it, I can have some 20 assurance that the purpose of Congress in these statutes 21 will be fulfilled, because there will not be 22 unnecessary, conflicting reporting requirements, which 23 sound like nothing, but they're very expensive to to 24 actually implement. 25 Now, that's my basic problem. The same
16 1 question for you, for the government, and for the other 16 2 side, but the other side will agree with the way I put 3 the question. 4 MS. ASAY: And if I may try responding this 5 way, Your Honor. The the notion that it's more 6 efficient for the Department of Labor to collect a 7 subset of standardized 8 JUSTICE BREYER: You're not going to collect 9 anything. All they're going to say is in our reg, you 10 have permission to go and impose these requirements. 11 But by having to go to them first, we prevent the 12 conflicting requirements of 50 different systems. 13 MS. ASAY: And it's possible that they may 14 be able to do that. I'm not sure where that authority 15 would come from 16 JUSTICE SCALIA: It it it isn't clear 17 that they're able to do that, is it? 18 MS. ASAY: No. 19 JUSTICE SCALIA: It isn't clear that a 20 Federal agency can eliminate preemption by simply 21 saying, okay, you can go ahead and do it. 22 JUSTICE BREYER: I'm only asking. My 23 point 24 JUSTICE SCALIA: Even though it's otherwise 25 preempted under the statute, we say it's okay. I I
17 1 think that's not a not a not a clear a clear 17 2 question. 3 MS. ASAY: It's I think it's not clear 4 that they can do that. And again, I think the question 5 for the Court is not what the Department of Labor can 6 do, but what Congress reserved to the States. 7 JUSTICE KENNEDY: I I know your time is 8 running up, but consider two cases. Case one: Vermont 9 is the only State that requires this. Case two: states requirement require this and it's all 11 different and it's burdensome. 12 Same preemption analysis? 13 MS. ASAY: Yes, Your Honor, same preemption 14 analysis as in Travelers and De Buono and Mackey. 15 JUSTICE KENNEDY: And same result? 16 MS. ASAY: Yes, Your Honor, same result. As 17 in Mackey, where this Court held that State garnishment 18 litigation procedures as applied to the very benefits 19 that the plan was paying out were permissible. Clearly, 20 those were going to vary State by State, and involve the 21 plans in State by State regulation. 22 JUSTICE SOTOMAYOR: On rebuttal, because I 23 don't want to eat up more of your time, would you go 24 through the through more careful more slowly, the 25 fact that this information is all electronic, all of it
18 1 already set out in the HIPAA regulations. And so it's 18 2 just a question of and and now, all reporting is 3 being done in one system, ICD 10, right? Everybody has 4 to use the one computer system. 5 MS. ASAY: I am not actually familiar with 6 that, but I will if I may reserve my remaining time. 7 CHIEF JUSTICE ROBERTS: Thank you, counsel. 8 MS. ASAY: Thank you. 9 CHIEF JUSTICE ROBERTS: Mr. Bash. 10 ORAL ARGUMENT OF JOHN F. BASH 11 FOR UNITED STATES, AS AMICUS CURIAE, 12 SUPPORTING THE PETITIONER 13 MR. BASH: Mr. Chief Justice, and may it 14 please the Court: 15 I would like to start, if I could, with 16 Justice Breyer's questions, and then hopefully I can 17 move on to Justice Alito's questions about the ACA and 18 Justice Kennedy's questions about the burden here. Let 19 me set out how we see the interaction of the preemption 20 framework and recordkeeping requirements, and then turn 21 to what I think DOL's role is here. 22 Both sides agree, essentially, that ERISA 23 plans can be subject to some reporting requirements, 24 probably many reporting requirements, incident to State 25 laws in other substantive fields. So, for example, the
19 1 Solicitor General gave the example of day care centers ERISA plans can run day care centers. I don't think 3 anyone doubts that you can have all sorts of reporting 4 requirements to make sure the staff is trained, the 5 facilities are safe. And so forth. 6 This Court's case in De Buono upheld a tax 7 imposed on employer contributions to an ERISA medical 8 benefit plan that provided the medical benefits 9 directly. And we told the Court at the time that that 10 tax had all sorts of reporting requirements. So 11 essentially, the question is here, where to draw the 12 line between reporting requirements that are permissible 13 and those that are nonpermissible. 14 As I take Respondent's view, it's that 15 they're it's certain information that is so core to 16 the plan that you simply can't have State law reporting 17 requirements about that information. 18 I don't think that can be right. Take, for 19 example, real property held in trust by a pension plan. 20 DOL requires reporting on that. Obviously, you need to 21 know the assets the pension plan has, but certainly a 22 State taxing authority can require reporting about that 23 same information to assess a property tax. 24 The same was true with the tax in De Buono. 25 The same is true, by the way, in Dillingham. That was a
20 1 case about an ERISA run apprentice program. And 20 2 California law said, you either follow our standards for 3 apprenticeship, or you have to pay a higher wage. I 4 mean, that was as core as you get. It was literally the 5 way the apprenticeship program was set up. 6 So I don't think the test can be whether the 7 information is, in some sense, core to ERISA. I think 8 the test has to be, is this reporting requirement 9 incident to a law in the field governed by ERISA, 10 vesting, funding, fiduciary duties and so forth or is 11 it incident to a law in health care, or in day care 12 center regulation? 13 Here, I don't think anyone disputes: This 14 information is used for hospital budget review, for 15 health insurance rate review, for medical research. 16 There's no question that it's incident to classic State 17 health care regulation. 18 JUSTICE KAGAN: Why isn't there also a 19 requirement that the law just not be burdensome over a 20 certain level? 21 MR. BASH: It it is, Justice Kagan. And 22 I I think I cut short my test. 23 The first inquiry is: Is this incident to a 24 field that ERISA doesn't govern? I think that's 25 satisfied here.
21 1 But then there's still another question 21 2 under Travelers, which looked to both purpose and 3 effects of whether the effect of the law is so 4 burdensome that effectively frustrates or impedes the 5 design of ERISA plans or the administration of ERISA 6 plans. And I think a law like this that imposes 7 reporting requirements on a claim could theoretically be 8 that burdensome. And so when 9 JUSTICE KENNEDY: How is that any different 10 than conflict preemption? How does that give any 11 special effect to the statute here? I mean, you could 12 make that argument if there was no preemption provision. 13 MR. BASH: Well, I I think the way it's 14 different than conflict preemption, or at least one 15 way,1. 16 Is that if it actually is in the core field 17 governed by ERISA, I mean, if the State said, we just 18 want to make sure these pension plans are well funded, 19 so we're going to ask for reports incident to that role, 20 it would be preempted even if the requirements weren't 21 particularly burdensome. 22 I mean, the Court has never held that in a 23 specific case, but I think the Court's analysis leans 24 towards that direction. So it could either be within 25 the preempted field, in which case it relates to ERISA
22 22 1 plans and it's out, or it could be so burdensome that it 2 effectively frustrates the purpose of a uniform ERISA 3 JUSTICE SCALIA: The former sounds to me 4 like standard field preemption and the latter like 5 standard conflict preemption. 6 MR. BASH: Well, I think there have been 7 JUSTICE SCALIA: Is that what you're saying? 8 MR. BASH: There have been some well written 9 separate opinions in this area that 10 JUSTICE SCALIA: I know that. 11 (Laughter.) 12 MR. BASH: I don't think I don't think 13 and here's what I would say about that: I mean, I know 14 your opinion and the opinion of a few other justices 15 have suggested we should shift to field preemption. I 16 think if the Court were to say what we've been doing all 17 along is field preemption, and it makes more sense 18 doctrinally to classify it that way, from the Department 19 of Labor's perspective, that would be fine. 20 I think we would be a little bit concerned 21 if the Court signaled to lower courts in its opinion 22 that it was marking a big shift in its jurisprudence 23 that could destabilize the law. We think 24 JUSTICE BREYER: Why aren't you on the other 25 side of the case? That is, I was fine with you until I
23 1 read a few of these amicus briefs, and then suddenly I 23 2 saw 93 million people. And there are associations all 3 over the place that are worried about this problem. And 4 they have a big chart where they show the possibilities 5 of of conflict. You yourself are worried about 6 conflict. Conflict among States in requirements means 7 money. A lot of money. That's what they say, and 8 that's plausible. 9 So what I want to know is: What do you all 10 propose to do about that in the U.S. government? One 11 thing to do about it and I've looked up the regs, so 12 maybe Justice Scalia disagrees, but I'm talking about 13 what I think. All right? 14 The the it seems like they would have 15 authority to issue regs either way; blocking, or getting 16 permission first. That's where I ended up, and that's 17 what I wanted your view about. You see what I'm saying? 18 MR. BASH: I see what you're saying. 19 There's two pieces there, whether this actually has a 20 burden and what we could do about it if there was. I 21 didn't mean to suggest we think it has a burden. 22 It's the view of the Department of Justice 23 that the significant burden has not been shown the 24 Department of Labor that the significant burden has not 25 been shown here. So that starting premise, we do not
24 1 agree with that. All I'm saying is that if a party 24 2 could show that burden, that would raise a substantial 3 preemption question and would be highly relevant to the 4 preemption analysis. 5 JUSTICE KAGAN: Then why hasn't that burden 6 been shown? 7 MR. BASH: Respondent submitted nothing 8 below. I mean, really. They submitted an Internet fax 9 sheet 10 JUSTICE KAGAN: There's something very 11 intuitive about their argument, and it's it's 12 essentially what Justice Kennedy said. It's it's 13 when 50 States devise 50 different requirements for 14 this, different formatting, different particular 15 information requested, that just all adds up to a lot of 16 hassle, which all adds up to a lot of money. 17 MR. BASH: Two points. I mean, first it 18 seems far less burdensome than State laws this Court has 19 already upheld, or that State laws that I think most 20 people would agree have to be upheld. 21 I mean, the tax or the surcharge in 22 Travelers that was the case where you bought 23 commercial insurance, you had to pay a surcharge up to percent more on medical purchases, that's 25 unbelievably burdensome, and surely had reporting
25 1 requirements associated with it. And having to pay 25 2 vastly different surcharges in 50 States could be 3 burdensome too. 4 What this Court's precedents have said, 5 including Travelers and Dillingham and De Buono is that 6 a mere burden is not enough. What has to be shown is 7 that it interferes with the administration of benefits. 8 So in Egelhoff 9 CHIEF JUSTICE ROBERTS: Well, but a 10 consistent theme in our cases, when you say a mere 11 burden is not enough, is that the government wants 12 employers to, one, set things up they don't have to 13 and two, they want the money to go to benefits, not 14 to go to administrative and bureaucracy expenses. 15 Is it your view in analyzing this question, 16 do we look at what would happen if 50 States adopted 17 different programs, or do we look at just Vermont 18 because Vermont happens to be first? 19 MR. BASH: The former. Our view is you have 20 to contemplate the 50 States would adopt different 21 regimes? 22 CHIEF JUSTICE ROBERTS: Yeah, I think that's 23 right. So you don't think 50 different regimes of 24 reporting is going to require a significant diversion of 25 money away from benefits to administration?
26 1 MR. BASH: Not not on this record. Mr Chief Justice, recall 3 CHIEF JUSTICE ROBERTS: What kind of a 4 record do you need to show that? 5 MR. BASH: Well 6 CHIEF JUSTICE ROBERTS: Of course you can't 7 have a record of what 50 States are doing if it's a 8 hypothetical question. 9 MR. BASH: Well, I think there's a couple 10 ways Respondent could have made the showing here. I 11 mean, at minimum, Respondent could have had its own 12 third party administrator come in and say these 13 reporting requirements are burdensome; this is what 14 we've had to do. We've had to change the way we process 15 claims because they're so burdensome. I suspect they 16 could not have made that showing 17 JUSTICE BREYER: But you have pages 26 and of the Blue Cross Blue Shield brief. And there they 19 have a big chart, and there are all these organizations 20 out there that are trying, like the Uniform Law 21 Commissioners, to create uniformity. That's why I say 22 that's why I'm puzzled as to what to do. 23 Am I supposed to write an opinion that says 24 even though Blue Cross Blue Shield feels it's a big mess 25 and trying to straighten it out, they didn't make the
27 27 1 right record in the Vermont trial court? How do I write 2 that opinion? 3 MR. BASH: Going to the the chart point, 4 I mean, the chart actually doesn't show conflicting 5 requirements. Most of the counterpoints they have is 6 like not required. I don't think there are conflicting 7 requirements. 8 And even if you look at the end of the Blue 9 Cross Blue Shield brief, they never actually say this 10 is 11 JUSTICE BREYER: I mean, I'm serious. How 12 do I write the opinion? I suppose it could happen, but 13 it hasn't happened yet. How do I write the opinion? 14 MR. BASH: I think I think the opinion is 15 written like this: One, this is a reporting requirement 16 incident to a field that is not governed by ERISA, 17 health care regulation. It's presumptively valid, but 18 we're going to look and see if Respondent has made a 19 showing that it's so burdensome, it fundamentally 20 changes the way plans are administered or designed. 21 Respondent has not made that showing here. That is how 22 the opinion is written. 23 I mean, this Court has never actually said 24 that a burden is so bad that it's preempted, even if it 25 operates in a field outside of ERISA. It has suggested
28 1 in dicta that it's possible, but that is inherently a 28 2 factual determination, and it's hard to see how the 3 Court could reach that conclusion without some factual 4 showing 5 CHIEF JUSTICE ROBERTS: So we go through at 6 one point all of a sudden there the 11th State 7 that does this, and it's the 11 different things, we say 8 is that a burden? Is that a sufficient burden? We say 9 no. But then when 30 States do it, maybe it's a 10 different answer. That seems like a very odd preemption 11 analysis. 12 MR. BASH: Well, I I don't think it 13 should turn on that, Mr. Chief Justice. I do think it's 14 appropriate for a court to consider what if 50 States 15 impose different requirements like this. But just like different States might have different requirements 17 for daycare centers, or for prepaid legal services, 18 that, I don't think, is the sort of burden 19 CHIEF JUSTICE ROBERTS: Well, but this goes 20 to basic, very comprehensive reporting of data. It's 21 not simply, well, if you run a daycare center, you have 22 to comply with the rules about daycare centers. Of 23 course you do. It's quite different. 24 One of the things ERISA plans do is report 25 data and compile data. And it seems to me that the
29 29 1 analysis that says, well, daycare centers you can. That 2 seems a little bit off basis. 3 MR. BASH: May I respond, Mr. Chief Justice? 4 CHIEF JUSTICE ROBERTS: No. 5 Of course you can. 6 (Laughter.) 7 CHIEF JUSTICE ROBERTS: Please. 8 MR. BASH: I think that the I'll try to 9 do it in two sentences. 10 I think that the burden here is far less 11 substantial than the burden of complying with State 12 apprenticeship regulations for the way you designed the 13 program in Dillingham. Here, most self insured plans 14 use third party administrators. And often those 15 third party administrators are insurance companies that 16 already have the infrastructure in place for reporting 17 requirements as applied to them which cannot be 18 preempted under ERISA. 19 CHIEF JUSTICE ROBERTS: Thank you, counsel. 20 Mr. Waxman. 21 ORAL ARGUMENT OF SETH P. WAXMAN 22 ON BEHALF OF THE RESPONDENT 23 MR. WAXMAN: Mr. Chief Justice, and may it 24 please the Court: 25 A signal goal of ERISA enacted in 1974 was
30 1 to foster employee benefit plans that could operate 30 2 nationally under nationally uniform rules of 3 administration, first and foremost, rules about 4 recordkeeping and reporting. 5 Now, of course ERISA plans, like other 6 regular businesses, are subject to ancillary regulation 7 like maintaining a safe workplace, paying minimum wage 8 and prevailing wage laws, paying their State real estate 9 taxes on their headquarters, and if they choose to run a 10 hospital, run a law firm for their legal services, 11 benefit program, run a childcare center, they are 12 subject to local regulation like other providers of 13 those local services. 14 But in every single case in this Court, and 15 every lower court decision that I have found in which 16 courts have upheld, State by State, reporting 17 requirements, it has always been incident to a 18 substantive obligation that the State could impose. And 19 no one contends that Vermont could impose substantive 20 regulations on the claims that Liberty Mutual pays under 21 its employment plan. 22 Now, I want to go to the point of 23 JUSTICE KAGAN: Mr. Waxman, why was it that 24 you introduced absolutely no evidence of burden in the 25 lower courts here?
31 1 MR. WAXMAN: That is not true, Justice 31 2 Kagan. What we did not introduce any evidence about 3 what it would cost us in dollars and cents to have Blue 4 Cross Blue Shield comply with the Vermont request that 5 is the subject to the subpoena. But we did introduce 6 substantial evidence in the record below, and and 7 some of it is included in the Joint Appendix, and all 8 the pages that are extra long folded in, about what it 9 is that we have to do, both in Vermont and in the then other States that imposed very, very different 11 reporting obligations. 12 So we didn't put a dollars and cents in, but 13 we did make the lower court, the district court, on its 14 request, very aware of this very substantial burden. 15 And Congress, in determining in in 16 deciding to, in exchange for blanket Federal regulation 17 of these fostered national plans, to grant a very broad 18 preemption provision that says this is going to be 19 Federal regulation 20 JUSTICE BREYER: What about the converse 21 MR. WAXMAN: not State regulation. 22 JUSTICE BREYER: What about the converse? 23 What about the converse point for you that I was making 24 before? The number that jumped out from the page is the million people this affects. Now, that's a huge
32 1 number, and therefore the risk of conflicting 32 2 regulations is serious 3 MR. WAXMAN: It's 4 JUSTICE BREYER: in raising costs. 5 That's for you. But they say it hasn't been shown 6 yet 7 MR. WAXMAN: Well, that 8 JUSTICE BREYER: so I ask you: If it 9 does come about, if it should come about and you lost 10 this case, why can't your clients go right to the 11 Department of Labor, whose regulations I've read, or 12 possibly ACCA, and say, we want you to impose a uniform 13 national data collection system or the equivalent, put 14 limits, and then preempt the conflicting State limits? 15 Now, it may be other members of the Court do 16 not agree with this approach, but I've written a case, 17 MetroMedia, where I think the agencies have a lot of 18 power there, and I think they have more capacity to 19 decide this kind of thing than a group of judges. 20 So what about that for you? 21 MR. WAXMAN: Justice Breyer, on a couple of 22 points: 23 First, in the lower court and in this Court, 24 neither party on the other side has disputed what I 25 think is the self evident proposition, that the
33 1 Department of Labor and now the Department of Labor and 33 2 the Department of Health and Human Services, absolutely 3 have the statutory authority under ERISA to impose the 4 kind of recordkeeping and reporting requirements that 5 Vermont and now 17 or 19 other States do. They have 6 never disavowed that. The the SG's brief at both the 7 invitation stage and the merits stage sort of coyly 8 suggests that that's right, and 9 JUSTICE KAGAN: Well, that sounds like a 10 one size fits all solution, and there's some value to 11 States being able to think about their own health care 12 needs. 13 MR. WAXMAN: Of course. 14 JUSTICE KAGAN: And to think about what 15 things they want. 16 So I mean, just again, let's go back to this 17 burden because it is a very intuitive idea that you have 18 on your side: 50 different States; that's a lot of 19 money. But I guess I wonder why it is a lot of money. 20 I mean, as I understand what's going on here, that all 21 the data that's being requested is data that Blue Cross 22 Blue Shield generates anyway. That all the data that's 23 being requested is data that Blue Cross Blue Shield 24 reports for other people. That really this is a 25 formatting question, even with respect to the wide
34 1 variety of States, that the States have started getting 34 2 their formatting more uniform. 3 So I I mean, you know, it's you can 4 say it's 93 million people, but, you know, in the end 5 what's the cost? 6 MR. WAXMAN: Oh. 7 JUSTICE KAGAN: And why don't you have it in 8 the record? 9 MR. WAXMAN: Okay. I there is not a 10 with respect to burden, Congress, in enacting the 11 preemption provision and their we we've cited to 12 the Court place after place in the conference reports, 13 the House reports, the statements of the sponsors, the 14 recognition in in repealing the Disclosure Act, which 15 set a reporting a national reporting floor and 16 allowed the States to add onto it and record evidence 17 before Congress that small plans were spending up to percent of their entire assets on State reporting. 19 Congress made the determination that this Court has 20 reflected in many, many of its decisions, including 21 Egelhoff, that the very fact that there could be different State regulations is the burden that the 23 preemption provision is designed to address. 24 And the notion and that 25 JUSTICE GINSBURG: Well, we know we know,
35 1 Mr. Waxman, that Blue Blue Cross is providing this 35 2 information with respect to individuals that its own 3 plans insure, and we're told that it is providing the 4 information for other self insured ERISA plans who 5 didn't make this objection. So do we know at least what 6 is the burden of providing that information for the 7 other self insured ERISA plans that Blue Cross is is 8 providing the information for? 9 MR. WAXMAN: Justice Ginsburg, the Blue 10 Cross Blue Shield Association has actually filed a brief 11 in its in this case, and it explains at great detail, 12 as does the brief of the multi employer plans, which 13 like Liberty Mutual operate in 50 States, about the 14 burden, about the fact that Blue Cross Blue Shield 15 doesn't have all this information in the normal course, 16 the multi employer plans don't have it, and Blue Cross 17 Blue Shield, as a third party administrator, has told 18 this Court just exactly how burdensome and how expensive 19 it is. 20 Of course they could do it for Liberty 21 Mutual in Vermont. The only question is how much it's 22 going to cost and how much they're going to charge. 23 But look, for example, at since this 24 since this litigation began, the Commonwealth of 25 Massachusetts has now told Liberty Mutual that it wants
36 1 reporting under its APCD statute. And as we recount at 36 2 page 36 of our brief, their regulations require, among 3 other things, the premiums the plan charges, its 4 actuarial assumptions, the summary of its plan designs, 5 the plan's reserves, its surplus, its provider payments, 6 its provider levels, and information about medical 7 procedures whose claims are denied. And the chart that 8 we submitted in the district court reflects the wide 9 variation in States. 10 There is the the burden that Congress 11 foresaw is coming to play before our very eyes as 12 States more and more States adopt these mandatory 13 plans. 14 CHIEF JUSTICE ROBERTS: Is that information, 15 the the the laundry list you went through, is that 16 already available at Blue Cross Blue Shield and being 17 reported somewhere else? 18 MR. WAXMAN: No, it is not. Absolutely not. 19 And the Blue Cross Blue Shield Association amicus brief 20 reports that. The multi employer plan brief reports 21 that they only that their plans generally have about to 80 percent of the information that's required by 23 any one of these States. And to go to I think it was 24 Justice Breyer's hypothetical look, the same rules 25 that apply here are going to apply to pension plans.
37 37 1 And the State of Vermont, like many other States now, is 2 concerned not just about health care costs and 3 delivering good health care outcomes, but it's concerned 4 about the financial well being of its senior citizens. 5 And in fact, they've asked the Department of Labor to 6 permit State States to operate their own ERISA 7 pension plans for their residents. 8 Now, they could pass a database statute that 9 says, we're really concerned about whether elderly, you 10 know, Vermonters are going to have enough money in their 11 elder years, and we know that 93 million people are 12 covered by employer pension plans, and we just want you 13 to report you can pay whatever you want, but we want 14 you to keep records and report to us about what your 15 plan is and how much money people are going to have when 16 they retire. Every single dollar 17 JUSTICE BREYER: Why can't you do this? 18 MR. WAXMAN: Well, every 19 JUSTICE BREYER: Why can't you why can't 20 you simply go and the statute says, 1143(a)(1) the 21 statute says that the Secretary of Labor and the 22 authorities broad in these has authority to 23 undertake surveys and collect, compile, analyze, publish 24 data information and statistics on welfare plans. Okay? 25 That's ERISA welfare plans.
38 1 So you go to them MR. WAXMAN: Well 3 JUSTICE BREYER: And you say, DOL, we want 4 you to promulgate a reg that says you will collect some 5 of this information, but even if you collect don't 6 collect it all, you let the States collect the rest. 7 MR. WAXMAN: Just 8 JUSTICE BREYER: Now, they can prevent it 9 from being burdensome. 10 MR. WAXMAN: Justice Breyer, I know how 11 exciting it is to get in the middle of a jurisprudential 12 debate between you and Justice Scalia. 13 JUSTICE BREYER: But this 14 MR. WAXMAN: I 15 JUSTICE BREYER: I don't see this is not 16 go ahead. 17 MR. WAXMAN: I'm my my fingers are 18 tingling at the prospect. I am not sure 19 (Laughter.) 20 MR. WAXMAN: I am not sure that the 21 Department of Labor has the regulatory authority to 22 essentially excuse the preemption provision, but and 23 you don't have to just go to the provision of ERISA that 24 you quoted in 1024(a)(2)(B) of ERISA, it authorizes 25 the Secretary of Labor to require the production of,
39 39 1 quote, "any information or data from an ERISA plan where 2 he finds that such data or information is necessary to 3 carry out the purposes of this subchapter." And 4 adverting to Justice Alito's comments, in the AHCA, the 5 Secretary has the authority to require the production 6 of from plans of, quote, "any other information as 7 determined appropriate by the Secretary." 8 So the notion that preemption here is sort 9 of like an operates like an accordion if the 10 Department of Labor has the authority to get it but 11 hasn't chosen to exercise, it's not preempted; but if 12 they did promulgate a regulation, either of your color 13 or Justice Scalia's color, that it would be preempted 14 is a crazy is a crazy notion. 15 JUSTICE BREYER: You might think this is not 16 sane, but what I'm the way I'm seeing it here is 17 there are two competing problems. One is they should be 18 able to get information like this in the States. 19 But two, there is a problem of burden. 20 And I think there are probably 100 or people in Department of Labor and HHS that could write 22 regs that reconcile those problems and allow both. But 23 I can't, because I'm a judge. 24 So what I'm trying to figure out is how to 25 interpret this statute in a way that achieves those
40 1 objectives MR. WAXMAN: How to interpret this statute 3 as to say that in exchange for blanket Federal 4 regulation of these plans, now augmented in the context 5 of health care plans by the Affordable Care Act, the 6 by the Federal government, the States are preempted from 7 regulating the core functions of what an ERISA plan 8 does. And there is nothing more core than the payment 9 of benefits. 10 If the State is attempting to regulate, 11 whether it's by substantively regulating or imposing a 12 recordkeeping or reporting obligation about the very 13 activity that defines it as an as an ERISA plan, the 14 payment of benefits, that State law necessarily relates 15 to, because it has a connection with, an ERISA plan. 16 And frankly, it's pretty ironic that the 17 Petitioner and the government claim on the one hand that 18 it is so important to get this information from these 19 plans because 60 percent of all citizens in the 20 United States get their health care from these 21 self funded plans, and yet requiring them to keep the 22 particular records that the State wants and to report it 23 on a quarterly, annually, or monthly basis, has no 24 relation to or connection with the plan. I don't 25 understand how both of those thoughts can inhere at the
41 1 same time JUSTICE KAGAN: Mr. Waxman, I guess I just 3 don't understand this argument. I I I mean, I 4 I understand completely that there should be some 5 restriction on overly burdensome State regulations of 6 whatever kind. You know, it could be taxes, it could be 7 day care, it could be anything. Right? But why is it 8 that this regulation falls in a different category than 9 taxes or childcare or anything else? Because the State 10 here clearly is not attempting to, and is not 11 regulating, payment of benefits. It's doing something 12 that has an effect on your operations, no doubt, but the 13 State is operating in a completely separate area for 14 completely separate purposes in a way that does not 15 trump or conflict with, or anything else, the choices 16 that ERISA has made as to payment of benefits. 17 MR. WAXMAN: Okay. I I want to I want 18 to come to the end and dispute that premise that you 19 the end of your question. But if the if you look at 20 this Court's cases that have set about to evaluate the 21 burden, or at least included, as in the last section of 22 Travelers, a section that says of course if this were 23 terribly burdensome there might be another question, 24 those are cases and it's Travelers, Dillingham, and 25 De Buono. We all agree on that those were all cases
42 1 in which there was a burden being placed on an entity 42 2 that wasn't in Travelers it was hospitals; in 3 De Buono it was hospitals; in Dillingham it was 4 apprenticeship programs, all of which affected the price 5 that ERISA plans might have to pay to get benefits or 6 services from those kinds of providers. 7 And so it took several sentences in each of 8 those several paragraphs in each of those opinions 9 even to explain how putting a tax on the non Blue Cross 10 insurance plans in Travelers, or respecting the 11 prevailing wage rate in California, actually had an 12 effect on any ERISA plan anyway, because they weren't 13 regulation of the plans, per se. They were indirect 14 regulations. And when the regulation is indirect, that 15 is, it is not a regulation that is directed at the very 16 activity that makes the plan an ERISA plan, you do look 17 at burden. And indirect regulation obviously can occur. 18 But if as this Court explained in the last section of 19 Travelers, if it's too burdensome, it might be 20 preempted. 21 But where the regulation is direct, where 22 the State is requiring reporting because the self 23 because the self insured plan is engaged in the very 24 activity that brings it under ERISA that qualifies it as 25 an ERISA plan, that obviously relates to and has a
43 1 connection with the plan, and is preempted JUSTICE GINSBURG: You're you're saying 3 that the State simply cannot have an all all payer 4 database, that that's out because ERISA precludes it, 5 even though it's going to leave a big hole in the 6 information that the State has about that health care 7 being given to its citizens, 8 MR. WAXMAN: I don't think that that's at 9 all the case, Justice Ginsburg, and I don't want to be 10 misunderstood about this. 11 The State of Vermont, just to take one 12 example: The database statute authorizes the relevant 13 Secretary to obtain this information from everybody, not 14 only who pays for health care in Vermont, but the 15 hospitals and clinics that provide it. But the 16 Secretary, the executive official has chosen not to 17 require that information from hospitals and clinics and 18 doctors in Vermont. 19 There is also no doubt that if all payer 20 claims databases so badly need the information from 21 self funded plans, and it turns out that the self funded 22 plan a significant number of self funded plans say 23 no, that's preempted, the Federal government has all the 24 authority it needs to get that information and require 25 that that information be provided, either to the
UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK ------------------------------X Docket#
UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK ------------------------------X Docket# TUMMINO, : 05-CV-355(erk) Plaintiff, : : - versus - : U.S. Courthouse : Brooklyn, New York ANDREW C. von
ERISA Implications for State Pay or Play Employer-Based Coverage
ERISA Implications for State Pay or Play Employer-Based Coverage Supplement D to the Report: Challenges and Alternatives for Employer Pay-or-Play Program Design: An Implementation and Alternative Scenario