Kalish: Vermont At SCOTUS

Sep 28, 2015

It’s not often that a case from Vermont makes it to the United States Supreme Court. But, this year, the Justices will hear a dispute from Vermont over VHCURES – the Health Care Uniform Reporting and Evaluation System.

VHCURES is a database. It collects information from medical and pharmacy claims from sources like insurance companies, Medicare, and Medicaid.

The information is anonymous and statistical. And it tells us things like how much Vermont spends on healthcare as compared to other states, and whether or not Vermont has sufficient resources to meet our healthcare needs.

Such databases can be important tools for assessing the quality of programs, for maximizing healthcare affordability, and for improving patient care.

The question is whether Vermont’s law is pre-empted by a federal employee benefits law – the Employee Retirement Income Security Act, or ERISA.

The Supreme Court must decide whether ERISA prevents Vermont from adding reporting responsibilities to the ones health-plan administrators must fulfill under the federal law.

The question arises because, Article 6, Section 2 of the United States Constitution - the “Supremacy Clause” - says that if federal and state law conflict, federal law wins.

The case has important implications not just for Vermont, but for 16 other states, all of which either have or are in the process of creating similar healthcare databases.

For those following Vermont politics, this database law should not be confused with a different healthcare database law – the Vermont Health Information Exchange.

While VHCURES uses claim information that’s been stripped of identifying markers, the Vermont Health Information Exchange uses identifiable medical information.

The Health Information Exchange does exactly what its name implies: it shares health information among healthcare providers. So, no matter where you’re being treated, providers can access things like lab test results, medication history, demographic information, and so on.

To be part of this system, you need to give consent. Then “any authorized health care provider at any organization who is involved in your care can view your information.”

This is the law that’s caused some concern among privacy advocates. They worry that information in this database is too easily accessible. They note that even though only those “involved in your care” are supposed to see your information, anyone with access to the system is able to.

We live in a world of databases. But, using this information for the “public good” also means using it responsibly and with respect for the very lives we’re trying to protect.