# Petition for Writ of Certiorari — Gobeille v. Liberty Mut. Ins. Co., 135 S. Ct. 885 (2014) (No. 14-181)

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## Record

- **Collection:** Supreme Court brief
- **Document type:** Petition for Writ of Certiorari
- **Published:** January 1, 2014

## Text

14-181]

In The

Supreme Court of the Anited States

+

ALFRED J. GOBEILLE, IN HIS OFFICIAL
CAPACITY AS CHAIR OF THE VERMONT
GREEN MOUNTAIN CARE BOARD,

Petitioner.
v.

LIBERTY MUTUAL INSURANCE COMPANY,
Respondent.

¢

On Petition For Writ Of Certiorari
To The United States Court Of Appeals
For The Second Circuit

°

PETITION FOR A WRIT OF CERTIORARI

°

PETER K. STRIS WILLIAM H. SORRELL
STrRIS & MAHER LLP Attorney General
19210 S. Vermont Avenue, BRIDGET C. ASAY

Bldg. E Counsel of Record
Gardena, California 90248 Assistant Attorney General
(424) 212-7090 OFFICE OF THE
peter.stris@strismaher.com ATTORNEY GENERAL

109 State Street

Montpelier, Vermont
05609-1001

(802) 828-5500

bridget.asay@state.vt.us

—_—__

——

COCKLE LEGAL BRIEFS (800) 225 6964
WWW COCKLELEGALBRIEFS COM

i
QUESTION PRESENTED

Vermont, like many other States, requires health
care providers and health care payers to provide
claims data and related information to the State’s
health care database. The law applies to all public
and private entities that pay for health care ser-
vices, including insurers, government programs, and
third-party administrators. The State relies on the
database to inform health care policy. The question
presented is:

Did the Second Circuit — in a 2-1 panel decision
that disregarded the considered opinion advanced by
the United States as amicus — err in holding that
ERISA preempts Vermont’s health care database
law as applied to the third-party administrator for a
self-funded ERISA plan?

ii
PARTIES TO THE PROCEEDING

Petitioner Alfred J. Gobeille, in his official
capacity as Chair of the Green Mountain Care Board,
has been substituted for Commissioner Susan L.
Donegan, who was the appellee in the court of ap-
peals. See Supreme Court R. 35.3. Chair Gobeille has
been substituted because the Vermont Legislature
shifted responsibility for the unified health care data-
base to the Green Mountain Care Board, effective
June 7, 2013. 2013 Vt. Acts & Resolves, No. 79, § 40.
The original defendant in the district court was
Commissioner Stephen W. Kimbell. Commissioner
Donegan was substituted as a party when she re-
placed Commissioner Kimbell in office.

The respondent, Liberty Mutual Insurance
Company, was the appellant in the court of appeals
and the plaintiff in the district court.

ili

TABLE OF CONTENTS

Page
QUESTION PRESENTED.................cccccceseeceeeeees i
PARTIES TO THE PROCEEDING ..................... ii
Ne Ee GF IE BED cr ccccccssccccessccccccecoccscese vi
ET 1
SEE a 2
I scunenuoeny 2
CONSTITUTIONAL AND STATUTORY
PROVISIONS INVOLVED .................cccc00eeee0000 3
EERE REE 4
REASONS FOR GRANTING THE WRIT ........... 13

I. The decision below is an unprecedented
expansion of ERISA preemption that
conflicts with this Court’s decisions in
Travelers, Dillingham, and De Buono....... 16

A. Travelers and De Buono narrowed
ERISA preemption by focusing on
Congress’s intent and reaffirming the
presumption that Congress does not
intend to displace state law in areas
traditionally regulated by the States... 16

B. The lower court departed from these
settled principles and adopted a broad
interpretation of ERISA preemption
that directly conflicts with this Court's
lac ace cae ecnalbeeebiddanehembidatens 18

iv

TABLE OF CONTENTS - Continued
Page

Il. The Second Circuit’s unduly broad pre-
emption holding treads on state and federal
interests and is an important issue wor-
thy of this Court’s immediate review ........ 25

A. The lower court’s unwarranted expan-
sion of ERISA preemption is a matter
of exceptional importance to state
legislators and regulators ................... 26

B. The U.S. Department of Labor’s ap-
pearance as an amicus in the court of
appeals confirms that the scope of
ERISA preemption is a pressing and
important issue for the federal gov-

SEES ESE a ae eA 2 LOE OE 35
2 ean eee eee 38
APPENDIX:

Opinion of the United States Court of Appeals
for the Second Circuit, Liberty Mut. Ins. Co.
v. Donegan, No. 12-4881-cv (Feb. 4, 2014)......App. 1

Opinion and Order of the United States Dis-
trict Court for the District of Vermont, Liber-
ty Mut. Ins. Co. v. Donegan, No. 2:11-cv-204
Se We ihe saitcsieshcliltinacsiaicereieliidabamabeliiccisna App. 48

Order of the United States Court of Appeals for
the Second Circuit, Liberty Mut. Ins. Co. v.
Donegan, No. 12-4881 (May 16, 2014).......... App. 81

Vv

TABLE OF CONTENTS -— Continued

Page

Statutory Provisions Involved........................... App. 83

A) Eee eae App. 83

Vt. Stat. Amm. tit. 18 § O41 ...........0...0.cccccsscee App. 91

Vt. Stat. Ann. tit. 18 § 9410... App. 92
Vt. Stat. Ann. tit. 18 § 9410 [prior to 2013

I eitrchennsndcentniemcssnsasencunsseccnintduninnnes App. 99

Regulation H-2008-01 .................cccccccceeeseeeee App. 107

vi

TABLE OF AUTHORITIES
Page
CASES
Assoc. Builders & Contractors v. Mich. Dep't of
Labor, 543 F.3d 275 (6th Cir. 2008)............0........... 35
Boggs v. Boggs, 520 U.S. 833 (1997) .............ccccceceeeeee 24
Boyle v. Anderson, 68 F.3d 1093 (8th Cir. 1995)........ 33
Cal. Div. Labor Standards Enforcement v.
Dillingham Constr., 519 U.S. 316 (1997) ....... passim
De Buono v. NYSA-ILA Med. & Clinical Servs.
Fund, 520 U.S. 806 (1997)..............ssccsccsssserees passim
Hillsborough Cnty. v. Automated Med. Labs.,
Ee SIs Ce Ie Ce ceaenesietatiinattiicdsindiatinasetioneniia 1
Mackey v. Lanier Collection Agency, 486 U.S.
| ____ SEIER SAIS AE IEREEHCALC ROCRO On OS 23

N.J. Carpenters & Trs. v. Tishman Constr.
Corp., No. 13-3005, 2014 WL 3702591 (3d
Se i i icticncisericsinstensicintecmammetintinesiiiinntiins 34, 35

N.Y. State Conference of Blue Cross & Blue
Shield Plans v. Travelers Ins. Co., 514 U.S.
IIIT sis icchctsdechdtncidnatindiediailelseibehhanlciitiaiidaiaaaa passim

Self-Ins. Inst. of America, Inc. v. Snyder, No.
12-2264, 2014 WL 3804355 (6th Cir. Aug. 4,

Bei huniinnscsdsentntonnsnstiandeniidinidneniinummeininenennnnnts passim
Thiokol Corp. v. Roberts, 76 F.3d 751 (6th Cir.

ciel ieee teases ela ihlaianiiiaasin bone 33
Wright Elec., Inc. v. Minn. State Bd. of Elec.,

322 F.3d 1026 (Oth Cir. 2008) ........0.0cccccsssccccssesesees 34

Wyeth v. Levine, 555 U.S. 555 (2009) .............ccccceeeeees 17

vil

TABLE OF AUTHORITIES — Continued
Page
CONSTITUTION, STATUTES, REGULATIONS AND RULES
Federal

U.S. Const.:

Art. VI, cl. 2 (Supremacy Clause) ......................0+. 2
I al 2
I i aa ata t 33
| ESERIES C Cuneo on emer, eee Cees passim

State
yO i sccccscisicasssessieieinsienennnin’ 27
Conn. Gen. Stat. § 19a-644.................cccccsseseesessenees 32
I, Gs Ce OF I ciciccsccncsestnsesiascsvenecesctes 32
oe EE eee cee nS ae 32
I I 32
oS EES Rae RE ee 34
Conn. Gen. Stat. § 380-1091 .....................c.cceecceseees 27
Se is MIG II CII cncrdinstnisccicssnittscctivonisiososadons 32
ne a A Bt i iicininssicinencesesdidaniocnsonienie 27
Me. Rev. Stat. Ann. tit. 22, § 8703............00.0.0000... 7
Me. Rev. Stat. Ann. tit. 22, § 8704......................... 27
Md. Code Ann., Health-Gen. § 19-133.................... 27
Mass. Gen. Laws Ann. ch. 12C....................ccceeeeeeees 27

SO eS Ss eee 27

vill

TABLE OF AUTHORITIES — Continued

Page
N.H. Rev. Stat. Ann. § 420-G:1l]e-a .............. ee 27
8S nen 34
N.Y. Pub. Health Law § 2816 .......................ssssseeee 27
2p eee 27
OR 27
ee, Ce ee. Be ncecccecsecevinsnrecevsescessoessetd 27
eee 32
_ & FE neee anne 32
Utah Code Ann. § 26-33a-106.1..............::cccceeeeceeees 27
2013 Vt. Acts & Resolves, No. 79...............ccccsecseeeeees 5
We, Be, Bt, GER, Gy BH Gee ceccccnncnsesocesensesvecsssseenssennes 5
8 PS (78 ee 32
ie 8 OO ee 5
8 FO 8 ee 5, 6
LL 5, 6
ON GE" SS 4
Vu, Beet. Amam. O66. BB, B DGGE ccccccccvesesecssscscevcescesees 32
3 FF Se BS Re passim
3 FF 8 NR en 5
pe a 8 8 ean 27
Be es NO I oicccsecsncvsesensncssccessccerecesconscnsees 27

Cal. R. Prof. Conduct, Rule 4-100........................64. 34

ix

TABLE OF AUTHORITIES -— Continued

Page
N.Y. Comp. Codes R. & Regs, tit. 10, § 440.1
I ceneincncncncenbicsaissigenenintaisiinninininaainivtesinaanenes 32
ke Ba ern 34
Mamalation FE-BOOS-O1 .....cccorcscssesscsccccessoccseees 3, 6, 7, 8

Vermont Early Childhood Program Licensing
Regulations, § III(C) (Policies, Procedures,
Records and Reports), available at http://def.
vermont.gov/sites/dcf/files/pdf/cdd/care/Early_

Se I cnicstisnennscsbatnnseterenenscinnsonne 34
Vt. R. Mandatory Continuing Legal Educ.,
SOUT siuhinbscuspriatabsmncabianendasenionannddsadecdeideadesiiphitiledinnhetiones 34

OTHER MATERIALS

American Bar Association, Mandatory CLE,
http://www.americanbar.org/cle/mandatory_cle.
html (last visited Aug. 3, 2014) .................:cccceeees 34

CMS and Green Mountain Care Board, Data
Use Agreement (No. 25534), available at http://
gmcboard.vermont.gov/sites/gmcboard/files/
CMS_DUA_%2025534_SIGNED_Attachment_
Se STEN Uecspiiiittiineriisrniniiahiaiddanadeniaisitiiaiteanimnnisidtlines 22

Kaiser Family Foundation, Employer Health
Benefits 2013 Annual Survey, available at
http://kff.org/private-insurance/report/2013-
employer-health-benefits/ ...................cccccceeseeeeeeeeees 30

X

TABLE OF AUTHORITIES — Continued
Page

Chris Kardish, More States Create All-Payer
Claims Databases, Governing (Feb. 4, 2014),
available at http://www.governing.com/topics/
health-human-services/gov-states-serious-
i iieicnsccensrdsocnnncsnssctssesaccessiente 28

Maine HealthCost, https://mhdo.maine.gov/
healthcost 2014/ (last visited Aug. 3, 2014) ........... 29

Medscape, State CME Requirements, http://
www.medscape.org/public/staterequirements
ee I Gt. BD eccinceicncnnisnncsesncsnedhonnepecessa 34

Patrick B. Miller et al., State Coverage Initia-
tives, All-Payer Claims Databases: An Over-
view for Policymakers (May 2010), available
at http://www.statecoverage.org/files/SCI_AIl_

Payer_Claims_ReportREV.pdf.................... 27, 28, 29
New Hampshire HealthCost, http://www.
nhhealthcost.org/ (last visited Aug. 3, 2014).......... 29

Office of the Actuary, Centers for Medicare &
Medicaid Services, National Health Expendi-
tures Tables, available at http://www.cms.
gov/Research-Statistics-Data-and-Systems/
Statistics-Trends-and-Reports/NationalHealth
ExpendData/Downloads/tables. pdf ..................00006 28

Jo Porter et al., APCD Council, The Basics of
All-Payer Claims Databases (January 2014),
available at http://www.apcdcouncil.org/sites/
apcdcouncil.org/files/The%20 Basics%20o0f %
20All-Payer%20Claims%20 Databases. pdf......27, 28

xi
TABLE OF AUTHORITIES — Continued

U.S. Government Accountability Office, Health
Care Price Transparency (September 2011),
available at http://www.gao.gov/assets/590/

Ri eas AA

U.S. Government Accountability Office, State
and Local Governments’ Fiscal Outlook
(April 2012 Update), available at http://

www.gao.gov/assets/590/589908. pdf..................

Utah All Payer Claims Database: Description
and Background, http://health.utah.gov/hda/

apd/about.php (last visited Aug. 3, 2014)..........

Christine Vestal, Can Claims Data Crack the
Health Care Cost Riddle? USA Today
(June 17, 2014), available at http://www.
usatoday.com/story/news/nation/2014/06/17/

stateline-health-care-claims-data/106655777/....

Page

we 29

1

Alfred J. Gobeille, as Chair of the Vermont Green
Mountain Care Board, respectfully petitions for a
writ of certiorari to review the judgment of the Unit-
ed States Court of Appeals for the Second Circuit in
this case.

+

INTRODUCTION

Health care policy is a pressing concern at every
level of government. Many States, including Vermont,
rely on health care databases for accurate, complete
information to support, inform, and test health care
policies. The Second Circuit’s unjustified expansion of
ERISA preemption in this case threatens these im-
portant tools adopted by sixteen States. And the
panel majority’s reasoning — that state recordkeeping
or information-gathering requirements of any kind
intrude on core ERISA concerns — applies far more
broadly, creating uncertainty about a wide range of
health and safety regulations.

In our federal system, the “regulation of health
and safety matters is primarily, and historically, a
matter of local concern.” Hillsborough Cnty. v. Auto-
mated Med. Labs., Inc., 471 U.S. 707, 719 (1985). This
Court cautioned nearly twenty years ago that ERISA
was not intended to displace the States’ authority
over “general health care regulation.” N.Y. State
Conference of Blue Cross & Blue Shield Plans v.
Travelers Ins. Co., 514 U.S. 645, 661 (1995). The
Second Circuit disregarded this Court’s direction. It

2

adopted an expansive view of ERISA preemption that
conflicts with this Court’s holdings and substantially
undermines the States’ historic police powers. The
States’ interests in pursuing their chosen policies,
and the harm to those interests caused by the lower
court’s ruling, strongly support immediate review by
this Court.

e

OPINIONS BELOW

The opinion of the court of appeals (App. 1-47) is
reported at 746 F.3d 497. The memorandum opinion
and order of the district court (App. 48-80) is not
reported, but is available at 2012 WL 5471225.

°

JURISDICTION

The judgment of the court of appeals was entered
on February 4, 2014. Petitioner filed a timely petition
for rehearing en banc on February 18, 2014. The
petition for rehearing was denied on May 16, 2014.
App. 81-82. The jurisdiction of this Court is invoked
under 28 U.S.C. § 1254(1).

°

3

CONSTITUTIONAL AND STATUTORY
PROVISIONS INVOLVED

The Supremacy Clause of the U.S. Constitution
provides:

This Constitution, and the Laws of the Unit-
ed States which shall be made in Pursuance
thereof; and all Treaties made, or which shall
be made, under the Authority of the United
States, shall be the supreme Law of the
Land; and the Judges in every State shall be
bound thereby, any Thing in the Constitution
or Laws of any State to the Contrary not-
withstanding.

U.S. Const. art. VI, cl. 2.

The “other laws” provision of the Employee
Retirement Income Security Act (ERISA), 29 U.S.C.
§ 1144, is set forth at App. 83-90.

Vermont’s health care database statute, Vt. Stat.
Ann. tit. 18, § 9410, is set forth at App. 92-99. The
Appendix also includes the prior version of the stat-
ute, before a 2013 amendment that shifted responsi-
bility for the database to the Green Mountain Care
Board. App. 99-106.

The Regulation that governs the database, Regu-
lation H-2508-01, is set forth at App. 107-41. The
appendices to the Regulation (which include charts,
tables, and forms) are available online at http://
gmcboard.vermont.gov/sites/gmcboard/files/REG_H-
2008-01.pdf.

4

STATEMENT

1. Vermont's “unified health care database”
collects critical information that informs the State’s
health care policy, including its policy “to ensure that
all residents have access to quality health services at
costs that are affordable.” Vt. Stat. Ann. tit. 18,
§ 9401(a) (App. 91); ic’. § 9410(a)(1) (App. 92). The
database contains information supplied by health
care providers and health care “payers” — that is,
government agencies, insurers, and similar entities
that pay for health care services. Id. § 9410(c), (h), (j)
(App. 94-99). The purposes of the database include:

(A) Determining the capacity and distribu-
tion of existing resources.

(B) Identifying health care needs and in-
forming health care policy.

(C) Evaluating the effectiveness of inter-
vention programs on improving patient out-
comes.

(D) Comparing costs between various
treatment settings and approaches.

(E) Providing information to consumers
and purchasers of health care.

(F) Improving the quality and affordability
of patient health care and health care cover-
age.

Id. § 9410(a)(1A)-(F) (App. 92).

5

Vermont’s Green Mountain Care Board adminis-
ters the database, known as VHCURES.' The Board
was created in 2011 to, among other things, improve
the health of Vermont residents; reduce the growth of
health care costs while protecting access to health
care and quality of care; and simplify health care
financing and delivery. Vt. Stat. Ann. tit. 18, § 9372.

The Board has a broad array of regulatory and
innovative responsibilities, including administering
Vermont’s health care expenditure analysis, id.
§9375a; approving hospital budgets, id. § 9375(7);
overseeing payment reform pilot projects, id.
§§ 9375(1), 9377; approving health insurance rates,
id. § 9375(6); reviewing applications for certificates of
need for new health care projects, id. § 9375(b\8);
and evaluating the quality of Vermont's health care
system, id. § 9375(10).

The Board maintains and uses the health care
database to “carry out [its] duties.” Jd. § 9410 (App.
92). For example, it uses the data to inform its review
of health insurance rates and hospital budgets. Vt.
Stat. Ann. tit. 8, § 4062; Vt. Stat. Ann. tit. 18,
§§ 9375(b)(6)-(7), 9456. The Board also relies on the
data for oversight and evaluation of health care

’ The Vermont Legislature shifted responsibility for the
database from the Department of Financia) Regulation to the
Green Mountain Care Board during the litigation. 2013 Vt. Acts
& Resolves, No. 79, § 40.

6

payment and delivery system reforms. /d.
§§ 9375(b\(1), 9377.

The database statute requires “[hJealth insurers,
health care providers, health care facilities, and
governmental agencies” to “file reports, data, sched-
ules, statistics, or other information determined by
the Board to be necessary to carry out the purposes”
of the law. Jd. § 9410(c) (App. 94). For this purpose,
“health insurer” includes “any third party adminis-
trator, any pharmacy benefit manager, any entity
conducting administrative services for business, and
any other similar entity with claims data, eligibility
data, provider files, and other information relating to
health care provided to Vermont resident(s].” Jd.
§ 9410G)1B) (App. 98). The implementing rule
notes that the term “may also include, to the extent
permitted under federal law, any administrator of an
insured, self-insured, or publicly funded health care
benefit plan offered by public and private entities.”
Regulation H-2008-01, §3(X) (App. 112-13). Only
insurers with 200 or more covered members living in
Vermont (or receiving covered services in Vermont)
must provide information to the database. /d. § 3(Ab)
(App. 113).

State Regulation H-2008-01 (App. 107-41) sup-
plies the details of database administration.’ The rule

* Reg. H-2008-01, reprinted at App. 107-41, was promulgat-
ed by the Vermont Department of Financial Regulation, which
previously administered the database. The regulation remains
in effect.

7

sets forth “requirements for the submission of health
care claims data, member eligibility data, and other
information relating to health care provided to Ver-
mont residents or by Vermont health care providers.”
Id. § 1 (App. 107). The rule also provides “conditions
for the use and dissemination of such claims data.”

Id.

Information is collected and maintained so as to
protect personal privacy. The statute requires compli-
ance with the federal Health Insurance Portability
and Accountability Act (HIPAA), see Vt. Stat. Ann. tit.
18, § 9410(h\2) (App. 96), and mandates that confi-
dential information be “filed in a manner that does
not disclose the identity of the protected person.” Jd.
§ 9410(e) (App. 94-95). And it prohibits public disclo-
sure of “direct personal identifiers,” including names,
addresses, and Social Security numbers. /d.
§ 9410(hX3)\D) (App. 97-98). The statute also calls for
a confidentiality code and penalizes violation of
confidentiality requirements. Jd. § 9410(f), (g) (App.
95). The regulation provides standards for code and
encryption requirements, Reg. H-2008-01, § 5(A\(5)
(App. 119-21), and restricts submission of “direct
personal identifiers,” id. § 7(A\(5) (App. 128-29).

As permitted by HIPAA and these confidentiality
requirements, the Board may provide access to data
“as a resource for insurers, employers, providers,
purchasers of health care, and state agencies to
continuously review health care utilization, expendi-
tures, and performance in Vermont.” Vt. Stat. Ann.
tit. 18, §9410(h\3B) (App. 97). The regulation

8

carefully delineates data sets that are publicly avail-
able, data that may not be disclosed, and data that is
available to researchers that agree to protect confi-
dentiality and control access. Reg. H-2008-01, § 8
(App. 130-39).

2. Respondent Liberty Mutual is an insurance
company based in Massachusetts. Liberty Mutual
provides health care for about 80,000 employees,
retirees, and their families through a self-funded plan
governed by ERISA. Liberty Mutual is the “named
fiduciary” and “plan administrator” for ERISA pur-
poses. App. 7-8, 50.

Liberty Mutual has employees and does business
in Vermont. Its plan provides benefits for 137 Ver-
mont residents. App. 7, 50. Because of its small
number of Vermont participants, Liberty Mutual
itself is not required to provide information for Ver-
mont’'s database. App. 8, 58. Liberty Mutual, however,
contracts with a third-party administrator, Blue
Cross Blue Shield of Massachusetts, to administer
the plan. App. 8, 50-51. Blue Cross “processes medical
claims ... , receives participants’ confidential medical
records and generates claims data.” App. 50-51. Blue
Cross provides or administers benefits for about 7,000
Vermonters, including Liberty Mutual’s plan partici-
pants, Ct. App. J.A. 288, so Blue Cross is obligated to
provide its data to Vermont. App. 8. It provides that
information for other self-funded ERISA plans. App.
72-73 n.5.

9

Vermont's Department of Financial Regulation
(previously responsible for the database) subpoenaed
Blue Cross in August 2011, seeking claims data and
other required information for the database. App. 8-9.
Liberty Mutual directed Blue Cross not to report
information for its beneficiaries. Blue Cross complied
with the subpoena in all other respects, but did not
submit data for Vermont participants in Liberty
Mutual’s plan. App. 9, 56.

3. Liberty Mutual then filed this lawsuit, claim-
ing that ERISA preempts any requirement that its
third-party administrator provide information for
Vermont’s health care database. App. 9, 48, 56. The
State moved to dismiss for lack of standing and
failure to state a claim; Liberty Mutual moved for
summary judgment. App. 9, 49. With the agreement
of the parties, the district court treated the motions
as cross-motions for summary judgment. /d. In a
written decision, the district court rejected Liberty
Mutual’s preemption claim and granted judgment to
the State. App. 48-80.

The district court first held that Liberty Mutual
had standing. App. 61. Although Liberty Mutual had
no independent obligation to provide information to
the database, the regulation required Blue Cross to
provide information for Liberty Mutual’s plan. App.
58. The court reasoned that Liberty Mutual was
“subject to regulation” through the State’s regulation
of Blue Cross, the third-party administrator. App. 59.

10

Turning to Liberty Mutual’s claim of preemption,
the district court noted that a “statute that operates
in the health care field will receive the benefit of the
presumption against preemption, even if it does not
directly regulate health care providers or services.”
App. 65. The court then held that Liberty Mutual did
not “overcome the presumption against preemption.”
App. 64-66, 79.

First, the court held that the database statute
does not have a “reference” to ERISA plans. App. 69.
“Vermont's statute and regulation do not act immedi-
ately and exclusively upon ERISA plans, nor is the
existence of ERISA plans essential to their opera-
tion.” App. 69. As the court explained, the law re-
quires numerous entities, including insurers and
providers, to supply information to the database. /d.

Second, the court concluded that the database
statute does not have an impermissible “connection
with” an ERISA plan. App. 70-78. After surveying this
Court’s decisions and relevant circuit precedent, the
district court emphasized that Vermont’s law: (1) did
not “attempt to control, supersede or interfere with
the operation of an ERISA plan”; (2) “has no effect
whatsoever on the core relationships that ERISA was
designed to protect — those between participants,
beneficiaries, administrators and employers”; and (3)
has “no effect whatsoever on the core ERISA func-
tions — such as processing claims or disbursing bene-
fits.” App. 79.

11

The court recognized that even a generally appli-
cable law might be preempted if it “creates an eco-
nomic effect so acute as to dictate certain
administrative choices.” App. 72. Here, however,
Liberty Mutual had no reporting obligations at all,
and there was “no evidence” that its third-party
administrator, Blue Cross, was “laboring under any
sort of burden” in complying with the law. App. 72
n.5. Blue Cross provided the information for other
ERISA plans. App. 73 n.5. Liberty Mutual did “not
submit{[] any information about any actual burden
suffered by itself or [Blue Cross! in producing this
information.” Jd.

4. On appeal, the Second Circuit reversed in a
split decision. App. 1-47. While agreeing with the
district court that Vermont’s statute and regulation
“lack ‘reference to’ an ERISA plan,” App. 23 n.9, the
majority held that Vermont’s law has an impermissi-
ble “connection with” ERISA plans. App. 23. In a
footnote, the majority concluded that Vermont's
health care database law was not an exercise of “the
states’ historic police powers” and declined to apply
the presumption against preemption. App. 18 n.8.

The court viewed “reporting” as a core ERISA
concern that is undermined by any state requirement
for “plan record-keeping, and filing with a third
party.” App. 23-24. It emphasized that Vermont's
database “is called the ‘Vermont Healthcare Claims
Uniform Reporting and Evaluation System.’” App. 24.
The majority viewed as irrelevant the fact that

12

Vermont's database seeks information unrelated to
ERISA’s reporting requirements. App. 24 n.11.

The court concluded that, consistent with ERISA,
only a “slight reporting burden” would be permissible.
App. 24. The majority saw Vermont’s “scheme” as
“obviously intolerable,” describing the claims data
reporting requirements as “burdensome, time-
consuming, and risky.” App. 25. Other than merely
citing the regulation, however, the court pointed to no
evidence of financial costs or other burdens. The court
further reasoned that any “burdens and risks must be
multiplied” because of unspecified reporting require-
ments in other states. App. 29. The court described
Vermont’s detailed confidentiality provisions as
“complex but loose” and suggested that the regulation
was problematic because it could be changed in the

future. App. 27-28.

Based on this reasoning, the majority held Ver-
mont’s law preempted. App. 23-29. It reached this
conclusion without addressing the United States
Department of Labor’s support, as amicus curiae, for
the district court’s decision and Vermont’s position.

Judge Straub dissented. App. 30-47. The dissent
sharply criticized the majority for failing to apply the
presumption against preemption. App. 33-34. Judge
Straub also pointed out that the majority’s descrip-
tion of Vermont's reporting requirement as “time-
consuming and risky” was “pure speculation.” App.
46. “There is no evidence to support such a finding.”
Id.

13

The dissent reasoned that Vermont’s health care
database is “wholly distinct” from ERISA’s reporting
requirements and seeks “after-the-fact information
which plan administrators ... already have in their
possession.” App. 38, 39. “The Vermont statute regu-
lates health care within that state, while imposing a
purely clerical burden on ERISA plans.” App. 46. The
law “does not hinder the national administration of
employment benefit plans” or require any “distinction
in benefits between Vermont and any other state.”
App. 44. For the dissent, that “end[ed] the inquiry.”
Id.

5. Vermont filed a timely petition for rehearing
en banc, which was denied on May 16, 2014. App. 81-
82.

+

REASONS FOR GRANTING THE WRIT

This Court should grant review to address the
Second Circuit’s broad and unprecedented expansion
of ERISA preemption. The lower court’s decision
sharply conflicts with this Court’s ERISA jurispru-
dence. It will have a profound impact on health care
regulation in sixteen States with programs like the
one held preempted here. And because the Second
Circuit has introduced uncertainty into an important
area of the law, its decision, if left in place, will have a
substantial impact on state and federal regulatory
interests.

14

1. The lower court’s ruling is not merely an
erroneous application of the law. The Second Circuit
embraced an expansive view of ERISA preemption
that this Court — after many years and countless
ERISA cases — firmly rejected in New York State
Conference of Blue Cross & Blue Shield Plans uv.
Travelers Ins. Co, 514 U.S. 645, 654-56 (1995). Ver-
mont’s database statute is a generally applicable law
through which the State obtains information from the
health care industry to develop policies that support
the health and well-being of its citizens. It is not
targeted at ERISA plans. It does not regulate the
benefits provided, plan governance or finances, or the
relationship between the plan and its participants.
It is therefore not preempted by ERISA. The Second
Circuit held otherwise only by disregarding settled
principles — including the scope of the States’ historic
police powers and the presumption against preemp-
tion. The unacceptable and irreconcilable conflict
with this Court’s precedents warrants immediate
review, a conclusion supported by a recent Sixth
Circuit decision “disagreeling]” with the Second
Circuit’s “literal approach to [ERISA] preemption,”
see Self-Ins. Inst. of America, Inc. v. Snyder, No. 12-
2264, 2014 WL 3804355, at *7 (6th Cir. Aug. 4, 2014)
(hereinafter “SIJA”}.

2. The importance of the issue presented fur-
ther justifies granting the petition. The decision
below undermines efforts by at least sixteen States —
including all three States in the Second Circuit — to
create and use comprehensive health care databases.

15

The breadth of the lower court’s decision also casts a
shadow over a wide range of other state regulations.
In contrast to this Court’s holdings, which recognize
that States may permissibly impose administrative
costs and burdens on ERISA plans, the Second Cir-
cuit has deemed routine recordkeeping and submis-
sion of information to be a “core” ERISA concern. App.
23-24. The decision thus provides a basis for challeng-
ing state health care regulations, taxes, licensing,
and safety rules — all of which typically require
recordkeeping and reporting of compliance infor-
mation.

The lower court’s ruling treads on both state and
federal interests. The United States Department of
Labor voluntarily participated as amicus curiae in
the court of appeals and supported the district court’s
decision and Vermont’s position. Despite the Depart-
ment’s recognized expertise in ERISA — and its ad-
ministration of ERISA’s reporting requirements — the
2-1 panel decision of the Second Circuit rejected
(without any discussion whatsoever) the Depart-
ment’s considered position. The Department’s deci-
sion to participate as an amicus confirms that this
case — and the scope of ERISA preemption generally —
is a matter of pressing importance to the federal
government as well as the States.

16

I. The decision below is an unprecedented
expansion of ERISA preemption that con-
flicts with this Court’s decisions in Trav-
elers, Dillingham, and De Buono.

This Court has repeatedly disavowed the “expan-
sive and literal” approach to ERISA preemption that
the 2-1 panel decision of the Second Circuit adopted
in this case. De Buono v. NYSA-ILA Med. & Clinical
Servs. Fund, 520 U.S. 806, 812-14 (1997); see also
Travelers, 514 U.S. at 654-56. Instead, this Court’s
decisions establish a framework for evaluating claims
of ERISA preemption that focuses on the purposes of
ERISA and acknowledges the States’ primary role in
regulating matters of health and safety. The Second
Circuit’s decision marks a clear and unacceptable
conflict with this Court’s precedent.

A. Travelers and De Buono narrowed
ERISA preemption by focusing on
Congress’s intent and reaffirming the
presumption that Congress does not
intend to displace state law in areas
traditionally regulated by the States.

This Court’s decisions in Travelers and De Buono
narrowed and focused the scope of ERISA preemption
in three important ways. First, the Court rejected an
approach to preemption grounded in “uncritical
literalism,” instead directing courts to look to “the
objectives of the ERISA statute as a guide to the

scope of the state law that Congress understood
would survive.” Travelers, 514 U.S. at 656. Given the

17

“frustrating difficulty” of interpreting ERISA’s “un-
helpful text,” Travelers and De Buono hold that the
preemption inquiry must be guided by ERISA’s
underlying objectives and purposes. /d.; De Buono,
520 U.S. at 813.

Second, Travelers delineated the key areas in
which ERISA preempts state law. The “basic thrust of
the preemption clause ... was to avoid a multiplicity
of regulation in order to permit the nationally uni-
form administration of employee benefit plans.”
Travelers, 514 U.S. at 657. Accordingly, ERISA “pre-
empt(s] state laws that mandate[] employee benefit
structures or their administration.” /d. at 658.
Preempted state laws include coverage mandates,
anti-subrogation rules, alternative enforcement
mechanisms, and laws affecting benefit calculations.
Id. at 657-58. Later cases reiterated this core concern
with state laws that “require[] employers to provide
certain benefits” or govern the calculation of benefits.
De Buono, 520 U.S. at 815; see also Cal. Div. Labor
Standards Enforcement v. Dillingham Constr., 519
U.S. 316, 328 (1997).

Third, the Court “unequivocally concluded” that
ERISA’s preemption clause does not modify the pre-
sumption against preemption of state law. De Buono,
520 U.S. at 813. The Court explained in Travelers that
it “never assume{s] lightly that Congress has derogat-
ed state regulation.” 514 U.S. at 654; see also Wyeth v.
Levine, 555 U.S. 555, 565 (2009) (describing the
presumption against preemption as a “cornerstone” of
the Court’s preemption jurisprudence). Nothing in

18

ERISA “indicates that Congress chose to displace
general health care regulation, which historically has
been a matter of local concern.” Travelers, 514 U.S. at
661. ERISA accordingly does not preempt “‘myriad
state laws’ of general applicability that impose some
burdens on the administration of ERISA plans.” De
Buono, 520 U.S. at 815 (quoting Travelers, 514 U.S. at
668); see also Dillingham, 519 U.S. at 333-34.

These principles have provided direction to the
States and to the lower courts for almost 20 years.
Claims of ERISA preemption “generated an ava-
lanche of litigation” in the years after ERISA’s adop-
tion. De Buono, 520 U.S. at 808-09 n.1. De Buono was
the Court’s sixteenth ERISA preemption case and the
third case just that term. See id. The series of deci-
sions in Travelers, De Buono, and Dillingham cabined
ERISA preemption to a reasonable scope, and gave
state policymakers necessary guidance on the line
between federal and state authority. As explained
below, the Second Circuit in this case departed so
substantially from this controlling precedent that its
decision creates an unacceptable degree of confusion
and uncertainty.

B. The lower court departed from these
settled principles and adopted a broad
interpretation of ERISA preemption
that directly conflicts with this
Court’s holdings.

As the United States argued below, Vermont’s
law is not preempted because it “does not regulate the

19

structures or core functions of ERISA plans.” U.S. Ct.
App. Br. 11. The Second Circuit concluded otherwise
only by disregarding this Court’s teachings about the
scope of ERISA preemption.

1. The Second Circuit engaged in precisely the
kind of rigid, literal analysis that this Court disa-
vowed in Travelers and De Buono. The panel majori-
ty’s decision was predicated on its view that, because
ERISA governs plan reporting, any type of state
reporting requirement must intrude on a core ERISA
concern. Consistent with that literal approach, the
court emphasized that Vermont’s law requires Liberty
Mutual’s third-party administrator to “report” claims
data for the health care database. App. 23-24. But
Vermont’s law does not intrude on an area of core
ERISA concern merely because it seeks information
from the plan administrator. This Court explained in
Dillingham that “[iJn enacting ERISA, Congress’
primary concern was with the mismanagement of
funds accumulated to finance employee benefits and
the failure to pay employees benefits from accumu-
lated funds.” 519 U.S. at 326-27 (quotation omitted).
It was “/tlJo that end” that Congress “established
extensive reporting, disclosure, and fiduciary duty
requirements to insure against the possibility that
the employee’s expectation of the benefit would be
defeated through poor management by the plan
administrator.” Jd. (emphasis added) (quotation
omitted). The Second Circuit’s myopic focus on the
word “reporting,” instead of the purposes of ERISA,
conflicts with Travelers and Dillingham. Recognizing

20

these principles established by this Court's prece-
dents, the Sixth Circuit in SIJJA “dicagree(d]” with the
Second Circuit’s “literal approach to preemption,”
SITA, 2014 WL 3804355, at *7. The SIIA court, in line
with this Court’s rulings, acknowicdyed ERISA’s
principal concern with the financial solvency of plans,
and held that Congress did not intend ERISA’s re-
porting requirements to “preclude states from enact-
ing laws imposing administrative burdens — of any
kind — upon plan administrators and sponsors unre-
lated to the administration of the plans.” Jd. at *5.

Vermont's health care database — as the United
States observed in its filing below — is unrelated to
ERISA’s core concern with plan administrators’
fiduciary responsibilities to beneficiaries. “The focus
and purpose of Vermont’s data collection . . . are quite
different” from ERISA’s concerns. U.S. Ct. App. Br.
12. Vermont seeks claims data to improve health care
quality, affordability, and effectiveness, Vt. Stat. Ann.
tit. 18, § 9410(a) (App. 92), and seeks no information
whatsoever about plan funding or governance. By
contrast, a plan’s annual report to the Secretary of
Labor is “principally concerned with the financial
soundness of the plan.” U.S. Ct. App. Br. 12. The
Vermont law does not protect beneficiaries or provide
them with information; indeed, the law “does not
include disclosure requirements affecting the employer-
employee or plan-participant relationship.” U.S. Ct.
App. Br. 13. Given the sharp disconnect between
ERISA’s objectives and the purposes of Vermont’s
law, the dissent below aptly observed that the

21

“majority's argument misses the nuance of what
‘reporting’ means in the context of ERISA, and ig-
nores the case law’s focus on whether the administra-
tion of benefits to beneficiaries is impacted.” App. 32
(Straub, J., dissenting); see also SIJA, 2014 WL
3804355, at *7 (quoting same).

2. The lower court’s analysis also contravenes
this Court’s guidance about the types of state laws
preempted by ERISA. Together, Travelers, Dilling-
ham, and De Buono teach that ERISA’s central con-
cern is with state laws that dictate the types of
benefits provided by plans or the manner in which
plans administer those benefits. Travelers, 514 U.S.
at 657-58; Dillingham, 519 U.S. at 328, 333-34; De
Buono, 520 U.S. at 815. Vermont’s health care data-
base does not touch on these areas. The law “does not
meaningfully regulate plans’ benefit programs or
affect plans’ administration of benefits.” U.S. Ct. App.
Br. 14-15.

Instead of recognizing these limits on the scope of
ERISA preemption, the Second Circuit panel majority
mistakenly focused on the law’s supposed administra-
tive burdens. But ERISA does not preempt “‘myriad
state laws’ of general applicability that impose some
burdens on the administration of ERISA plans.” De
Buono, 520 U.S. at 815 (quoting Travelers, 514 U.S. at
668). Administrative cost or burden is relevant only if
the burden is “so acute ‘as to force an ERISA plan to
adopt a certain scheme of substantive coverage or
effectively restrict its choice of insurers.’” De Buono,
520 U.S. at 816 n.16 (quoting Travelers, 514 U.S. at

22

668). As the dissenting opinion concluded, there was
“no basis to find that the Vermont statute would
cause Liberty Mutual to increase its costs more than
a de minimus amount ... much less ... cause a
fiduciary to change a plan in any way.” App. 40-41
(Straub, J., dissenting).’

In short, the lower court's decision irreconcilably
conflicts with both the reasoning and the results
reached in this Court’s precedents. The Court has

* The majority's description of the supposed burdens is
factually unsupported and wrong. As the district court pointed
out, Liberty Mutual submitted no evidence of “any actual
burden.” App. 72-73 n.5. On appeal, Liberty Mutual merely
asserted that “all regulations have their costs” and claimed that
Vermont's law was “per se burdensome.” Liberty Mutual Ct. App.
Br. 28. The dissent highlighted Liberty Mutual's failure “to
provide any details or showing of the alleged burden,” and
sharply criticized the majority for engaging in “pure speculation”
on this point. App. 39, 46 (Straub, J., dissenting). As the dissent
noted, Vermont's law “asks for after-the-fact information which
plan administrators .. . already have” and “by all accounts [Blue
Cross] is happy to provide the data ... and .. . does so for other
clients.” App. 39 (Straub, J., dissenting). Moreover, while this
case was pending on appeal, the federal Centers for Medicare
and Medicaid Services (CMS) agreed to provide its claims data
to Vermont's database. See Data Use Agreement Between CMS
and Green Mountain Care Board (No. 25534), available at
http//gmcboard. vermont.gov/sites/gmcboard/files/CMS_DUA_%2
025534_SIGNED_Attachment_A_ExSum.pdf. That agreement
confirms the federal government's confidence in Vermont's
program, and undercuts any suggestion that the database
provides inadequate confidentiality protections. Protecting
personal privacy is critical to this program. There was “no
evidence” to support a contrary conclusion. App. 46 (Straub, J.,
dissenting).

23

repeatedly upheld state laws that challengers de-
scribed as imposing costs and burdens on ERISA
plans. In Mackey v. Lanier Collection Agency, 486
U.S. 825, 831 (1988), the plan administrators com-
plained of “substantial administrative burdens and
costs” caused by state-law garnishment proceedings.
The Court rejected the preemption claim. /d. at 832,
841. In Dillingham, the Court upheld a California
law regulating apprenticeship programs, even though
the law required a plan to either obtain state approv-
al for its program or pay a higher minimum wage to
apprentices. 519 U.S. at 319-21, 330-33.

And most relevant here, in De Buono the Court
held that New York could permissibly tax the gross
receipts of a hospital operated by an ERISA plan. 520
U.S. at 814-16. The generally applicable tax was not
preempted even though it “increase{d] the cost of
providing benefits” and had “some effect” on plan
administration. Jd. at 816. Taxation inevitably re-
quires “particular form[s) of record-keeping”; like-
wise, taxes are potentially “inconsistent” from state
to state. See App. 22-23. As the Sixth Circuit noted
in SIIA, although “neither Travelers nor De Buono
explicitly concerned reporting requirements regard-
ing the taxes ... those requirements were essential
parts of the tax schemes and drew no comment.”
SITA, 2014 WL 3804355, at *6. Moreover, the tax
upheld in De Buono directly depleted plan assets.

Given this controlling precedent, the Second
Circuit erred in holding that ERISA tolerates, at
most, only a “slight reporting burden” on plans. App.

24

24. State laws of all kinds, from employment, licens-
ing, and taxes to health and safety regulations,
require “record-keeping, and filing with a third
party.” App. 24. It cannot be that ERISA preempts
generally applicable state laws, unrelated to the
objectives of ERISA, merely because those laws
involve data collection or record-keeping.

3. The Second Circuit’s refusal to apply the
presumption against preemption also “flies in the face
of clear Supreme Court precedent.” App. 33 (Straub,
J., dissenting). In a footnote, the court held that
Vermont’s law is not an exercise of the “states’ histor-
ic police powers.” App. 18 n.8. “[CJollecting data,” the
majority opined, is not “historic” and “health data
collection laws do not regulate the safe and effective
provision of health care services.” Jd. This squarely
conflicts with De Buono. De Buono held that New
York’s tax “clearly operates in a field that has been
traditionally occupied by the States.” 520 U.S. at 814
(quotation omitted). That was true even though the
tax, first adopted in 1990, was a “revenue raising
measure, rather than a regulation of hospitals.” Jd. at
809, 814; see also id. at 814 n.10 (fact that tax targets
health care industry supports application of the
presumption).*

* The footnote concluded that “[ijn any event, the Supreme
Court has repeatedly found the presumption overcome if the
state laws ‘upset the deliberate balance central to ERISA,’ even
if those laws ‘implement policies and values lying within the
traditiona] domain of the States.’” App. 18-19 n.8 (quoting Boggs

(Continued on following page)

25

Given the “considerable burden of overcoming”
the presumption, De Buono, 520 U.S. at 814, Liberty
Mutual’s failure to prove any cost or administrative
burden should have ended the inquiry. See App. 72-73
n.5 (district court); App. 39-41, 44 (Straub, J., dissent-
ing). Yet the lower court assumed that Vermont's law
was “burdensome” and “obviously intolerable.” App.
25. Its judgment rested on speculation not just about
Vermont’s statute but about other states’ laws and
ways in which Vermont could change its program in
the future. App. 25, 27-29. Consistent with this
Court’s precedents, the Second Circuit should have
presumed the statute’s constitutionality, not the
opposite.

Il. The Second Circuit’s unduly broad
preemption holding treads on state and
federal interests and is an important issue
worthy of this Court’s immediate review.

The Second Circuit did not merely err in its
application of precedent. The lower court returned to
an expansive view of ERISA preemption that this
Court has disavowed. Its flawed analysis of burden
and cramped view of the states’ historic police powers

v. Boggs, 520 U.S. 833, 840, 854 (1997)). Nowhere in its analysis,
however, does the majority apply the presumption against
preemption or explain that the presumption is overcome. The
lower court’s holding, as the dissenting opinion recognizes, is
that the presumption does not apply. App. 33 (Straub, J.,
dissenting).

26

will sow confusion and uncertainty. That is especially
troubling in this context because, read literally,
ERISA’s preemption language suggests “a degree of
pre-emption that no sensible person could have
intended.” Dillingham, 519 U.S. at 335-36 (Scalia, J.,
concurring). This Court should grant review to correct
the Second Circuit’s broad and unjustified expansion
of ERISA preemption. And, as explained below, fur-
ther review should be immediate because the Second
Circuit’s holding poses a serious threat to important
state and federal interests.

A. The lower court’s unwarranted expan-
sion of ERISA preemption is a matter
of exceptional importance to state leg-
islators and regulators.

The Second Circuit’s ruling threatens to under-
mine efforts by at least sixteen States to create and
use databases similar to Vermont’s. The breadth of
the lower court’s decision also casts a shadow over
other state regulatory efforts in a field — health care —
that is traditionally and primarily the responsibility
of the States.

1. The Second Circuit’s decision in this case
undermines a widespread and crucial tool that States
use to inform health care policy. At least ten other
States have similar programs, known as all-payer

27

claims databases, already in place.’ Five other States
are creating databases,’ and many more are consider-
ing doing so. Jo Porter et al., APCD Council, The Ba-
sics of All-Payer Claims Databases 1 (January 2014).’
Claims databases are increasingly popular because
states need “robust information about the costs and
performance of their state’s health care delivery sys-
tem.” Patrick B. Miller et al, State Coverage Initia-
tives, All-Payer Claims Databases: An Overview for
Policymakers 2 (May 2010).° These databases “fill
critical information gaps” and allow states “to un-
derstand the cost, quality, and utilization of health
care for their citizens.” Jd.; Porter, supra, at 1. By
collecting accurate, complete information about the
provision of health care services, States are bringing
transparency to the health care market, collecting

* Colorado: Col. Rev. Stat. § 25.5-1-204; Kansas: Kan. Stat.
Ann. § 65-6804; Maine: Me. Rev. Stat. Ann. tit. 22, §§ 8703,
8704; Maryland: Md. Code Ann., Health-Gen. § 19-133; Massa-
chusetts: Mass. Gen. Laws Ann. ch. 12C, § 12; Minnesota: Minn.
Stat. Ann. § 623.321; New Hampshire: N.H. Rev. Stat. Ann.
§ 420-G:1l-a; Oregon: Or. Rev. Stat. § 442.466; Tennessee: Tenn.
Code Ann. § 56-2-125; Utah: Utah Code Ann. § 26-33a-106.1.

* Connecticut: Conn. Gen. Stat. § 38a-1091; New York: N-Y.
Pub. Health § 2816; Rhode Island: R.1. Gen. Laws § 23-17.17-10;
Virginia: Va. Code Ann. § 32.1-276.7:1; West Virginia: W. Va.
Code § 33-4A-2.

” Available at: http:/www.apedcouncil.org/sites/apedcouncil.org/
files/The%20Basics®200f ®20All-Payer%20Claims%20 Databases.
pdf.

* Available at: http://www.statecoverage.org/files/SCI_All_
Payer_Claims_ReportREV.pdf.

28

critical cost information, and improving the quality
of care.

Cost. It is impossible to overestimate the States
need for accurate and complete information about
health care spending. The “projected growth in
health-related costs” is the “primary driver of fiscal
challenges for the state and local government sector
in the long term.” U.S. Government Accountability
Office, State and Local Governments’ Fiscal Outlook
5 (April 2012 Update). Knowledge gaps “limit the
ability to identify opportunities to address rising
health care costs.” Miller, supra, at 2. A true all-
payers claims database provides this critical data.
States may use this information to inform budgeting,
rate-setting, and other policy decisions, and to
measure the impact of reforms and pilot projects.
See, e.g., Chris Kardish, More States Create All-
Payer Claims Databases, Governing (Feb. 4, 2014);"
Miller, supra, at 2, 5; Porter, supra, at 2.

* Available at: http://www.gao.gov/assets/590/589908. pdf.
National spending on health care reached $2.79 trillion in 2012,
more than double the level in 2000. Office of the Actuary,
Centers for Medicare & Medicaid Services, National Health
Expenditures Tables, Table 1, available at http://www.cms.
gov/Research-Statistics- Data-and-Systems/Statistics-Trends-and-
Reports/National HealthExpendData/Downloads/tables.pdf.

” Available at: http://www.governing.com/topics/health-
human-services/gov-states-serious-about-health-data. html.

29

Transparency. State health care databases are
bringing transparency to the health care market-
place. Lack of information about cost and quality is a
serious problem for consumers, who “generally learn
of their health care costs after receiving care, such
as when they receive a bill.” U.S. Government Ac-
countability Office, Health Care Price Transparency 2
(September 2011). Now, with a few keystrokes,
consumers in some states have access to information
that used to be burdensome or even impossible to
find. Both Maine and New Hampshire, for example,
have websites that allow consumers to compare costs
across providers.” Other States are planning similar
sites. See Christine Vestal, Can Claims Data Crack
the Health Care Cost Riddle? USA Today (June 17,
2014) (discussing Utah and Colorado).”

Quality of Care. An all-payer claims database
is a powerful public health tool. Policymakers can
evaluate access to necessary services. Researchers
can track chronic disease indicators, evaluate wheth-
er clinical care guidelines are met, and study specific
problems such as adverse drug reactions and emer-
gency room visits. Miller, supra, at 6-8. The data
allow States not just to pinpoint problems but to

" Available at: http://www.gao.gov/assets/590/585400. pdf.

“ See Maine HealthCost, https://mhdo.maine.gov/healthcost
2014/ (last visited Aug. 3, 2014); New Hampshire HealthCost,
http://www.nhhealthcost.org/ (last visited Aug. 3, 2014).

'* Available at: http://www.usatoday.com/story/news/nation/
2014/06/17/stateline-health-care-claims-data/10665577/.

30

assess whether proposed solutions are working. This
“rich and deep source of health care data”” is a criti-
cal resource that States use to protect and improve
the health and welfare of their citizens.

The Second Circuit’s decision threatens these
innovative programs. Self-insured ERISA plans, like
Liberty Mutual’s plan, provide coverage to millions of
Americans. Nationally, over 60% of workers who
receive health coverage through employment are in a
self-funded plan. See Kaiser Family Foundation,
Employer Health Benefits 2013 Annual Survey, at
176." As the United States explained below, exempt-
ing self-insured plans from the database “would leave
a large hole in the data collection the state has fash-
ioned to further its state healthcare policies” and
“seriously stymie Vermont’s efforts to improve medi-
cal outcomes for its residents.” U.S. Ct. App. Br. 10.
Nothing in ERISA suggests that Congress wanted to
create this kind of information vacuum.

This important question of ERISA preemption —
relevant to at least sixteen States — is worthy of this
Court’s immediate review. The decision below does
not address a new or emerging legal issue that needs
further consideration in the lower courts. Rather, the

“ Utah All Payer Claims Database: Description and
Background, http://health.utah.gov/hda/apd/about.php (last
visited Aug. 3, 2014).

* Available at: http://kff.org/private-insurance/report/2013-
employer-health-benefits/.

31

Second Circuit disregarded established precedent and
returned to an expansive view of ERISA preemption
that unacceptably limits state authority. Its decision
governs not just Vermont’s program, but also similar
databases under development in New York and
Connecticut. And all other States must administer (or
establish) their programs under the cloud of that
decision. The impact on these programs outweighs
any negligible benefit from allowing the issue to
develop further in the lower courts. Indeed, if this
Court denies review, other states may adhere to the
Second Circuit’s ruling rather than risk litigation —
reducing the likelihood any benefit will be gained
from percolation.

2. Review is also warranted because the Second
Circuit’s broad holding has repercussions beyond
these particular programs. As this Court recognized
almost two decades ago, nothing in ERISA “indicates
that Congress chose to displace general health care
regulation, which historically has been a matter of
local concern.” Travelers, 514 U.S. at 661. Yet the
Second Circuit essentially held that any state record-
keeping or information-gathering requirement in-
trudes on a “core” ERISA concern. App. 23-24. Many
ordinary state health-care regulations and other
health and safety standards require record-keeping
and reporting of information. The Sixth Circuit
correctly recognized, in SJJA, that such a broad view
of ERISA preemption of state reporting requirements
as extending to “paperwork” and record preservation
is unworkable, and that “ERISA does not reach so

32

far.” SIIA, 2014 WL 3804355, at *6. The Second
Circuit’s reasoning in this case creates uncertainty
across a wide swath of traditional state regulation.

Regulation of hospitals and other health
care services. As addressed in De Buono, ERISA
plans may operate their own hospitals and health
care centers. The provision of health care services is
closely regulated by state law and routinely requires
recordkeeping and reporting to state regulators. For
example, States commonly require hospitals to pro-
vide frequent reports on finances, patient census,
staffing levels and other quality and _ safety
measures.” Under the Second Circuit’s reasoning,
these frequent reports would be preempted unless the
State shows that the burdens imposed are “slight.”
App. 24.

Taxation. This Court held in De Buono that an
ERISA plan must pay a generally applicable state tax
on gross hospital receipts. 520 U.S. at 816. Courts
have rejected preemption challenges to other state
taxes, including a tax on covered health care claims.
In SIJA, the Sixth Circuit rejected an ERISA preemp-
tion challenge to Michigan’s tax on paid health care

"© See, e.g., Conn. Gen. Stat. § 19a-654 (data submission);
id. §§ 19a-644, 19a-649, § 19a-676 (hospital reports); 210 Ill.
Comp. Stat. 85/25 (Hospital Report Card Act); N.Y. Comp. Codes
R. & Regs, tit. 10, § 440.1 et seq. (hospital annual reports); Tex.
Code Ann. § 257.005 (hospital staffing reports); id. § 311.033
(financial and utilization data); Vt. Stat. Ann. tit. 18, §§ 1854,
9405b (hospital reports).

33

claims, because the state law did not alter which
benefits were offered, how they were calculated, or to
whom they were disbursed, and thus did not interfere
with plan administration. SIJA, 2014 WL 3804355, at
*3-4. The court also held that the state law reporting
and recordkeeping requirements at issue did not
create improper administrative burdens for ERISA
plans and thus did not conflict with ERISA’s report-
ing obligations. Jd. at *4-7."" See also Boyle v. Ander-
son, 68 F.3d 1093 (8th Cir. 1995) (rejecting ERISA
preemption challenge to provider tax); Thiokol Corp.
v. Roberts, 76 F.3d 751 (6th Cir. 1996) (rejecting
ERISA challenge to state business tax). Taxes neces-
sarily inveive frequent and state-specific recordkeep-
ing and reporting requirements — the same type of
requirements that the Second Circuit found unac-
ceptable in this case. The lower court’s ruling thus
creates uncertainty on an issue that was settled by
De Buono.

Licensing and safety standards. ERISA plans
may employ lawyers, to offer “prepaid legal services,”
and doctors, to offer medical and surgical care. 29
U.S.C. § 1002(1) (defining employee welfare plan).

" The Sixth Circuit’s suggestion that the Vermont database
law “actually affects the administration of plans,” SJJA, 2014
WL 3804355, at *7, is unsupported. Further, the Sixth Circuit,
like the Second Circuit, offered no support for its conclusion that
the creation of a database for the purposes of improving Ver-
monters’ health outcomes and controlling the rate of health care
cost growth is not an exercise of traditional state concern, and
thus not entitled to the presumption against preemption.

34

Doctors and lawyers must comply with state licensing
requirements, including reporting and recordkeeping
requirements for professional education and client
trust funds.” ERISA plans may operate day care
centers, id., which must be licensed and maintain
detailed records showing compliance with state
regulations.” Many ERISA plans run apprenticeship
programs, which must satisfy state-law safety stan-
dards. See, e.g., Wright Elec., Inc. v. Minn. State Bd.
of Elec., 322 F.3d 1025, 1031-32 (8th Cir. 2003) (re-
jecting ERISA preemption challenge to state regula-
tion mandating supervision of apprentices). The
Third Circuit, which recently rejected a preemption
challenge to a New Jersey prevailing wage law, noted
that the law “require{d] that every contractor and
subcontractor keep a record detailing the worker's
name, his or her craft or trade, and actual hourly rate
of wages paid to each worker.” N.J. Carpenters & Trs.

" For doctors, see, e.g., N.J. Stat. Ann. § 45:9-7.1; Conn. Gen.
Stat. § 20-10b; see also Medscape, State CME Requirements,
http://www.medscape.org/public/staterequirements (last visited
Aug. 3, 2014) (collecting requirements by state). For lawyers,
see, e.g., Cal. R. Prof. Conduct, Rule 4-100 (recordkeeping and
audit requirements for client trust funds); N.Y. R. Prof. Conduct,
Rule 1.15 (similar); Vt. R. Mandatory Continuing Legal Educ.,
§ 9 (reporting requirements for continuing legal education); see
also American Bar Association, Mandatory CLE, http//www.
americanbar.org/cle/mandatory_cle.htm! (last visited Aug. 3,
2014) (collecting education requirements by state).

See, e.g., Vermont Early Childhood Program Licensing
Regulations, § III(C) (Policies, Procedures, Records and Reports),
available at: http://dcf.vermont.gov/sites/dcf/files/pdf/cdd/care/
Early_Childhood_Program.pdf.

35

v. Tishman Constr. Corp., No. 13-3005, 2014 WL
3702591, at *2, 6 (3d Cir. July 28, 2014) (holding that
state-law claim under prevailing wage law was not
completely preempted by ERISA). Challenges to any
of these state laws could easily be recast as objections
to reporting or recordkeeping requirements.

The Sixth Circuit has observed that there is no
“state-law-free zone around everything that affects an
ERISA plan.” Assoc. Builders & Contractors v. Mich.
Dep't of Labor, 543 F.3d 275, 284 (6th Cir. 2008)
(discussing potential consequences of a broad view of
ERISA preemption). The Second Circuit’s reasoning,
however, risks just that result. And even if other
courts ultimately narrow or decline to follow the
Second Circuit’s approach in this case, the lower
court’s ruling may generate another “avalanche” of
ERISA litigation. Cf’ De Buono, 520 U.S. at 809 n.1.
The threat of litigation alone burdens States and
influences state policy choices. The decision below
thus has serious implications for state legislation and
regulation far beyond the context of all-payer data-
bases. It should not be allowed to stand.

B. The U.S. Department of Labor’s ap-
pearance as an amicus in the court of
appeals confirms that the scope of
ERISA preemption is a pressing and
important issue for the federal gov-
ernment.

The fact that the United States participated in
this case as amicus curiae and argued against

36

preemption confirms the importance of the issue. The
United States Department of Labor administers
ERISA, including the law’s reporting requirements.
The Department took the unusual step of appearing
as an amicus in the court of appeals to defend the
decision of the district court. The Department’s
amicus filing shows that the scope of ERISA preemp-
tion is an important issue for the federal government,
as well as the States.

The Second Circuit ignored the views of the
United States and applied ERISA preemption far
more broadly than the Department advocated. The
Department, through its Employee Benefit Security
Administration, creates and administers reporting
requirements for ERISA plans. The Department
explained to the court of appeals that Vermont’s law
does not conflict with ERISA’s reporting require-
ments; that the “focus and purpose of Vermont’s data
collection” are “quite different” from ERISA’s finan-
cial reporting and disclosure requirements; and thus
the database statute “is like any other ‘tenuous,
remote or peripheral’ law that requires information
from businesses or other entities for regulatory
purposes.” U.S. Ct. App. Br. 12 (quoting Travelers,
514 U.S. at 661). Despite the Department’s obvious
expertise and interest, the panel majority did not
even acknowledge the Department’s position.

As the Department’s amicus participation shows,
the decision below adversely affects federal as well as
state interests. The federal government has a sub-
stantial interest in the division of state and federal

37

regulatory authority in areas such as health care.
Collecting claims data is not something the Depart-
ment does and is not, in the Department’s view, a
matter with which ERISA is concerned. The federal
government is careful to guard those areas that
ERISA shields from state regulation, but it also
recognizes the States’ traditional authority over
“‘general health care regulation.’” U.S. Ct. App. Br.
10 (quoting Travelers, 514 U.S. at 661). By holding
Vermont’s law preempted, the Second Circuit has
effectively challenged the Department’s view of the
scope and purpose of ERISA’s reporting requirements.

SJ

The decision below broke sharply with this
Court’s controlling precedents, in a way that harms
state interests and creates uncertainty for States and
lower courts. Its sweeping expansion of ERISA
preemption calis for immediate review.

:

CONCLUSION
The petition for writ of certiorari should be

granted.

Respectfully submitted,

PETER K. STRIS

Stris & MAHER LLP

19210 S. Vermont Avenue,
Bldg. E

Gardena, California 90248

(424) 212-7090

peter.stris@strismaher.com

August 13, 2014

WILLIAM H. SORRELL
Attorney General
BRIDGET C. ASAY
Counsel of Record
Assistant Attorney General
OFFICE OF THE
ATTORNEY GENERAL
109 State Street
Montpelier, Vermont
05609-1001
(802) 828-5500
bridget.asay@state.vt.us

App. 1

UNITED STATES COURT OF APPEALS
FOR THE SECOND CIRCUIT
August Term, 2013
(Argued: November 18,2013 Decided: February 4, 2014)
Docket No. 12-4881-cv

LIBERTY MUTUAL
INSURANCE COMPANY,

iff-Appellant,
-V.-

SUSAN L. DONEGAN, IN HER CAPACITY
AS THE COMMISSIONER OF THE VERMONT
DEPARTMENT OF FINANCIAL REGULATION,

Defendant-Appellee.

Before: KEARSE, JACOBS, and STRAUB, Cir-
cuit Judges.

Liberty Mutual Insurance Co. appeals from a
judgment entered in the United States District Court
for the District of Vermont (Sessions, J.). The district
court concluded that the Employee Retirement In-
come Security Act of 1974 does not preempt a Ver-
mont statute and regulation requiring self-insured
employee health plans to report to the state, in speci-
fied format, claims data and “other information re-
lating to health care.” For the following reasons, we

App. 2

reverse and remand with instructions to enter judg-
ment for Liberty Mutual.

Judge STRAUB dissents in part and concurs in
part in a separate opinion.

NANCY G. ROSS, McDermott Will
& Emery LLP, Chicago, IL (John A.
Litwinski, McDermott Will & Emery
LLP, Chicago, IL; M. Miller Baker,
McDermott Will & Emery LLP,
Washington, DC, on the brief), for
Appellant.

BRIDGET C. ASAY, Assistant Attor-
ney General, Office of the Attorney
General, Montpelier, VT for William
H. Sorrell, Attorney General, State
of Vermont, for Appellee.

KATHRYN COMERFORD TODD,
National Chamber Litigation Center,
Washington, DC (Jane E. Holman,
National Chamber Litigation Cen-
ter, Washington, DC; Carol Connor
Cohen and Nancy S. Heermans,
Arent Fox LLP, Washington, DC, on
the brief), for amicus curiae Cham-
ber of Commerce of the United States
of America in support of Appellant.

MELISSA MOORE, U.S. Department
of Labor, Washington, DC (M. Patricia
Smith, Solicitor of Labor; Timothy
D. Hauser, Associate Solicitor; Na-
thaniel I. Spiller, Counsel for Appel-
late and Special Litigation, on the

App. 3

brief), for amicus curiae Acting Sec-
retary of the United States Depart-
ment of Labor in support of Appellee.

DENNIS JACOBS, Circuit Judge:

Liberty Mutual Insurance Co. operates a self-
insured employee health plan. A Vermont statute re-
quires all “health insurers” (including self-insured
plans) to file with the State reports containing claims
data and other “information relating to health care.”
A State regulation specifies how such information
must be recorded and transmitted.

When Vermont subpoenaed claims data from the
Liberty Mutual plan’s third-party administrator, this
suit was commenced in the United States District
Court for the District of Vermont (Sessions, -J.). Lib-
erty Mutual sought a declaration that the Employee
Retirement Income Security Act of 1974 (“ERISA”)
preempts the Vermont statute and regulation. The
district court granted summary judgment in favor of
Vermont.

The ERISA preemption clause is not self-reading
and ERISA preemption doctrine is not static. The
early judicial consensus, based on the broad wording
of the preemption clause (and legislative history),
was to construe preemption broadly. More recent
precedent has pulled back by setting a rebuttable
presumption against preemption of state health care
regulations. Two constants, however, remain: (1) recog-
nition that ERISA’s preemption clause is intended to
avoid a multiplicity of burdensome state requirements

App. 4

for ERISA plan administration; and (2) acknowledg-
ment that “reporting” is a core ERISA administrative
function. These two considerations lead us to con-
clude that the Vermont law, as applied to compel the
reporting of Liberty Mutual plan data, is preempted.
We therefore reverse and remand for entry of judg-
ment in favor of Liberty Mutual.

BACKGROUND
I

The Vermont statute establishes and provides for
the maintenance of “a unified health care database.”
Vt. Stat. Ann. tit. 18, §9410(aX1). The database
“enable[s]” the State’s Department of Banking, Insur-
ance, Securities and Health Care Administration
(“Department”)' “to carry out [its] duties ... , includ-
ing”:

(A) determining the capacity and distribu-

tion of existing resources;

(B) identifying health care needs and in-
forming health care policy;

(C) evaluating the effectiveness of inter-
vention programs on improving patient out-
comes;

' The Department is now called the Department of Finan-
cial Regulation. Many of the Department’s health care database
responsibilities were recently transferred to Vermont’s Green
Mountain Care Board. See id. § 9410.

App. 5

(D) comparing costs between various treat-
ment settings and approaches;

(E) providing information to consumers and
purchasers of health care; and

(F) improving the quality and affordability
of patient health care and health care cover-
age.

Id.

To populate the database, the statute requires
“(hjealth insurers, health care providers, health care
facilities, and governmental agencies” to “file reports,
data, schedules, statistics, or other information,” as
the Department deems necessary, at the time and
place and in the manner the Department requires. /d.
at § 9410(c)-(d). The statute authorizes the Depart-
ment to require the filing of “health insurance claims
and enrollment information used by health insurers”
and “any other information relating to health care
costs, prices, quality, utilization, or resources.” Jd. at
§ 9410(c).

Knowing and willful failure to comply is punish-
able by penalty of not more than $10,000 per viola-
tion. See id. at § 9410(g).

In 2008, the Department promulgated a regula-
tion to implement the statute and create the Vermont
Healthcare Claims Uniform Reporting and Evalua-
tion System (the “Reporting System”). See Regulation
H-2008-01, 21-040-021 Vt. Code R. § 1 (“Regulation
H-2008-01”). The regulation requires reporting of

App. 6

myriad categories of claims data. See infra 26-29.
“Health Insurers” are required to “regularly submit
medical claims data, pharmacy claims data, member
eligibility data, provider data, and other information
relating to health care provided to Vermont residents
and health care provided by Vermont health care
providers and facilities to both Vermont residents and
non-residents in specified electronic format to the
Department for each health line of business ... per
the data submission requirements contained in”
appendices to the regulation. Regulation H-2008-01
§ 4(D).

A “{hJjealth insurer” is defined broadly to include
“any health insurance company, ... third party ad-
ministrator, ... and any entity conducting adminis-
trative services for business or possessing claims
data, eligibility data, provider files, and other infor-
mation relating to health care provided to Vermont
residents or by Vermont health care providers and
facilities.” Jd. § 3(X).

Begging the preemption question, the term “(health
insurer” “may also include, to the extent permitted un-
der federal law, any administrator of an insured, self-
insured, or publicly funded health care benefit plan
offered by public and private entities.” Jd. (emphasis
added). A health insurer with 200 or more enrolled or
covered members in each month during a calendar
year is designated a “Mandated Reporter.” Jd. § 3(Ab).
All other entities are “Voluntary Reporter(s].” Id.
§ 3(As).

App. 7

The Department makes the collected data “avail-
able as a resource for insurers, employers, providers,
purchasers of health care, and state agencies to con-
tinuously review health care utilization, expenditures,
and performance in Vermont.” Vt. Stat. Ann. tit. 18,
§ 9410(hX3)(B). The Department decides “the extent”
of such disclosure “allowed by HIPAA,” the federal
Health Insurance Portability and Accountability Act
of 1996, id., and maintains the “confidentiality code”
by which filed information “is handled in an ethical
manner,” id. § 9410(f). “[D]irect personal] identifiers,”
such as name, address, and Social Security number,
may not be publicly disclosed. Jd. § 9410(h\(3)(D).

Sixteen other states collect health care data for
their own health care claims databases. J.A. 368-74
(State Health Reporting Laws Summary Table). Data
submission requirements vary. Some states provide
only for voluntary reporting. See id. Some expressly
exclude self-insured employee plan data from their
database reporting laws. See id. The majority, how-
ever, follow Vermont in requiring such plans to report
claims data. See id.

II

Liberty Mutual Insurance Co. is the administra-
tor and named fiduciary of a health plan (the “Plan”)
that provides benefits to 137 individuals in Vermont
and to over 80,000 individuals nationwide. The Plan
is “self-insured” or “self-funded,” i.e., health care
claims are paid from Liberty Mutual’s general assets.

App. 8

Plan documents provide that the “Plan has been
established for the exclusive benefit of Participants
and except as otherwise provided ... , all contribu-
tions under the Plan may be used only for such pur-
pose.” J.A. 39. The documents also represent that
medical records, such as those related to risk factor
screening, are kept “strictly confidential.” J.A. 71-72.
The Plan represents, however, that it “shall comply
with all other state and federal law to the extent not
preempted by ERISA and to the extent such laws
require compliance by the Plan.” J.A. 41.

Like many self-insured employer health plans,
the Plan uses a third-party administrator (“I'PA”).
Blue Cross Blue Shield of Massachusetts, Inc. (“Blue
Cross”), as the Plan’s TPA for Vermont participants,
does claims-handling: processing, review, and pay-
ment. Under its contract with Liberty Mutual, any
information transferred to Blue Cross must be used
solely for the purpose of administering the Plan, and
Blue Cross auditors must guard against unauthorized
disclosure of health care information. See J.A. 57-58.
Liberty Mutual itself is a Voluntary Reporter because
it has fewer than 200 covered members in Vermont
(and has presumably decided not to volunteer); but
because Blue Cross qualifies as a Mandated Reporter
and possesses the Plan’s claims data, the reporting of
its data is mandatory.

In August 2011, Vermont issued a subpoena de-
manding that Blue Cross supply the Plan’s “[elligi-
bility files,” “[mJedical claims files,” and “[p]harmacy
claims files” and threatened that noncompliance

App. 9

might result in fines and a suspension of Blue Cross’s
authority to do business. J.A. 24-25. Liberty Mutual
instructed Blue Cross not to comply and filed this
suit, seeking (1) a declaration that ERISA preempts
the Vermont statute and regulation; and (2) an in-
junction blocking enforcement of the subpoena.
Vermont agreed to stay enforcement of the subpoena
pending judicial resolution of the ERISA preemption
question.

In dueling motions, Vermont sought to dismiss
the complaint for lack of standing and for failure to
state a claim, and Liberty Mutual moved for sum-
mary judgment. With the consent of the parties, the
district court treated the motions as cross-motions for
summary judgment. See Liberty Mut. Ins. Co. v.
Kimbell, No. 2:11-cv-204, 2012 WL 5471225, at *1 (D.
Vt. Nov. 9, 2012).

The court concluded that Liberty Mutual had
Article III standing but that ERISA did not preempt
the Vermont statute and regulation and that Vermont
was therefore entitled to summary judgment. See id.

DISCUSSION
I

We agree with the district court that Liberty
Mutual has standing to challenge the subpoena

App. 10

issued to Blue Cross.’ Liberty Mutual has demon-
strated “the irreducible constitutional minimum of
standing”: (1) “an invasion of a legally protected in-
terest which is (a) concrete and particularized; and
(b) actual or imminent, not conjectural or hypothet-
ical”; (2) “a causal connection between the injury and
the conduct complained of”; and (3) that the injury
will likely be redressed by a favorable decision. Lujan
v. Defenders of Wildlife, 504 U.S. 555, 560-61 (1992)
(footnote, citations, and internal quotation marks
omitted).

It is of no moment that the subpoena was issued
to Blue Cross and not directly to Liberty Mutual. The
TPA agreement provides that Liberty Mutual will
hold Blue Cross harmless for any financial charges
“arising from or in connection with” the Plan. J.A. 54-
55. Liberty Mutual therefore faces a choice between
(1) allowing Blue Cross to turn over the Plan’s data in
what Liberty Mutual considers a violation of its du-
ties as Plan administrator and fiduciary; or (2) direct-
ing non-compliance, and indemnifying Blue Cross for
the ensuing civil penalties. Either way, under Lujan,
Liberty Mutual suffers a redressable injury-in-fact as
a direct result of Vermont’s threatened, imminent
action.

* The parties have not briefed the standing issue on appeal,
but Article III standing “is the threshold question in every fed-
eral case, determining the power of the court to entertain the
suit.” Warth v. Seldin, 422 U.S. 490, 498 (1975).

App. 11

II

We review de novo the grant of summary judg-
ment on the preemption question. See, e.g., Wrobel v.
Cnty. of Erie, 692 F.3d 22, 27 (2d Cir. 2012). Summary
judgment is appropriate if the record shows “there is
no genuine dispute as to any material fact and the
movant is entitled to judgment as a matter of law.”
Fed. R. Civ. P. 56(a). “[WJe may reverse the grant of
summary judgment and order judgment for the non-
moving party if we find undisputed support in the
record entitling the non-moving party to judgment as
a matter of law.” New England Health Care Emps.
Union v. Mount Sinai Hosp., 65 F.3d 1024, 1030 (2d
Cir. 1995).

A

ERISA’s comprehensive regulatory scheme gov-
erns most employee benefit plans, including self-
insured health plans. See 29 U.S.C. § 1003. ERISA
requires plan administrators to file annually with the
Department of Labor reports detailing financial and
actuarial information. See id. §§ 1021-1024. The De-
partment of Labor is authorized “to undertake re-
search and surveys and in connection therewith to
collect, compile, analyze and publish data, infor-
mation, and statistics relating to employee benefit
plans.” Jd. § 1143. ERISA broadly preempts “any and
all State laws insofar as they may now or hereafter
relate to any employee benefit plan.” Id. § 1144(a) (em-
phasis added). With remarkable consistency, the

App. 12

legislative history reflects that this broad wording
was purposeful: it was intended to eliminate the
threat of a multiplicity of conflicting or inconsistent
state laws,’ and to achieve broad preemptive effect
in the areas of record-keeping, reporting, and disclo-

sure.*

Vermont argues — and the district court agreed —
that Congress could not have intended broad preemp-
tion of state reporting laws because the same Con-
gress also passed the National Health Planning and

* See 120 Cong. Rec. 29197 (1974) (Statement of Rep. Dent)
(“I wish to make note of what is to many the crowning achieve-
ment of this legislation, the reservation to Federal authority the
sole power to regulate the field of employee benefit plans. With
the preemption of the field, we round out the protection afforded
participants by eliminating the threat of conflicting and incon-
sistent State and local regulation.”); id. at 29933 (Statement of
Sen. Williams) (discussing “inten[t) to preempt the field for Fed-
eral regulations, thus eliminating the threat of conflicting or in-
consistent State and local regulation of employee benefit plans”
and stating that “[t)his principle is intended to apply in its broadest
sense to all actions of State or local governments, or any instru-
mentality thereof, which have the force or effect of law”).

* See S. Rep. No. 93-127, at 35 (1973), reprinted in 1974
U.S.S.C.A.N. 4838, 4871 (“Because of the interstate character of
employee benefit plans, the Committee believes it essential to
provide for a uniform source of law in the areas of vesting, fund-
ing, insurance and portability standards, for evaluating fidu-
ciary conduct, and for creating a single reporting and disclosure
system in lieu of burdensome multiple reports.” (emphasis
added)); H.R. Rep. No. 93-533, at 17 (1973), reprinted in 1974
U.S.S.C.A.N. 4639, 4655 (virtually the same); see also 120 Cong.
Rec. 29942 (1974) (Statement of Sen. Javits) (“In view of Federal
preemption, State laws compelling disclosure from private wel-
fare or pension plans .. . will be superseded.”).

App. 13

Resources Development Act of 1974 (“NHPRDA”).
The NHPRDA provided for the establishment of state
health planning agencies and authorized these agencies
to “assemble and analyze data concerning” health;
health care delivery, resources, and use; and related
environmental factors. See Pub. L. No. 93-641, 88
Stat. 2225, at § 1513(b) (1975). The Supreme Court
consulted the NHPRDA to decide ERISA preemption
in a case in which the NHPRDA expressly contem-
plated a state regulatory measure. See N.Y. State
Conference of Blue Cross & Blue Shield Plans uv.
Travelers Ins. Co., 514 U.S. 645, 665-67 (1995). Here,
however, the NHPRDA is not similarly indicative.”
And if there were tension between NHPRDA and
ERISA, it was relieved in 1986 when the NHPRDA
was repealed.

B

The Supreme Court, and this Court, initially
applied ERISA preemption as broadly as the statu-
tory phrase (“relate to any employee benefit plan”)
seemed to require.

* The NHPRDA’s encouragement of state data collection is
not necessarily inconsistent with ERISA’s preemptive reach. A
lot of data can be collected from health care providers, and from
health care payers other than ERISA plans. Nothing in the
NHPRDA compels the conclusion that, contrary to every indica-
tion in ERISA’s text and history, Congress intended to allow a
multiplicity of state record-keeping and reporting requirements
for self-insured employee plans.

App. 14

As explained in Shaw v. Delta Air Lines, Inc., the
“breadth of [ERISA’s] pre-emptive reach is apparent
from that section’s language.” 463 U.S. 85, 96 (1983);
see id. at 98 (“Congress used the words ‘relate to’...
in their broad sense.”).° Shaw formulated the modern
ERISA preemption test: a state law is preempted if “it
{1] has a connection with or [2] reference to [an
ERISA] plan.” Jd. at 96-97 (emphases added). The
Court treated as obvious that ERISA preempted
“state laws dealing with the subject matters covered
by ERISA — reporting, disclosure, fiduciary responsi-
bility, and the like.” Jd. at 98 (emphases added). The
open question was whether preemption went beyond
these core areas, and the Court held it did. See id. at
96-97. The one note of caution in Shaw was consigned
to a footnote:

Some state actions may affect employee ben-
efits plans in too tenuous, remote, or pe-
ripheral a manner to warrant a finding that
the law “relates to” the plan. Cf. Am. Tel. &
Tel. Co. v. Merry, 592 F.2d 118, 121 (CA2
1979) (state garnishment of a spouse’s pen-
sion income to enforce alimony and support
orders is not pre-empted). The present litiga-
tion plainly does not present a border-line
question, and we express no views about

* That interpretation was supported by ERISA’s exemption
for generally applicable state criminal statutes, an exemption
that would be unnecessary if preemption “applied only to state
laws dealing specifically with ERISA plans.” Shaw, 463 U.S. at
98 (discussing 29 U.S.C. § 1144(bX4)).

App. 15

where it would be appropriate to draw the
line.

Id. at 100 n.21.

For another decade, the Supreme Court and this
Court followed Shaw and repeatedly emphasized the
broad reach of ERISA preemption. See, e.g., FMC
Corp. v. Holliday, 498 U.S. 52, 58 (1990) (“The pre-
emption clause is conspicuous for its breadth.”); Gen.
Elec. Co. v. N.Y. State Dep’t of Labor, 891 F.2d 25, 29
(2d Cir. 1989) (“ERISA was intended to have a ‘sweep-
ing preemptive effect in the employee benefit plan
field.’ Congress intended ERISA to occupy and reg-
ulate the field of employee benefit plans.” (citation
omitted)). The threat of conflicting state and local reg-
ulation was consistently cited as a paramount reason
for preemption: Preemption “was intended to ensure
that plans and plan sponsors would be subject to a
uniform body of benefits law; the goal was to mini-
mize the administrative and financial burden of com-
plying with conflicting directives among States or
between States and the Federal Government.” /nger-
soll-Rand Co. v. McClendon, 498 U.S. 133, 142 (1990);
see Fort Halifax Packing Co. v. Coyne, 482 U.S. 1, 10
(1987) (“We have not hesitated to enforce ERISA’s
pre-emption provision where state law created the
prospect that an employer’s administrative scheme
would be subject to conflicting requirements. . . . Such
a situation would produce considerable inefficiencies,
which the employer might choose to offset by lowering
benefit levels.”); Howard v. Gleason Corp., 901 F.2d
1154, 1157 (2d Cir. 1990) (“[TJhe express pre-emption

App. 16

provisions of ERISA are deliberately expansive, and
designed to establish pension plan regulation as ex-
clusively a federal concern in order to afford employ-
ers the advantages of a uniform set of administrative
procedures governed by a single set of regulations.”
(citations and internal quotation marks omitted)).

These cases specifically re-emphasized that “re-
porting” and “disclosure” are core ERISA functions
subject to a uniform federal standard. See Ingersoll-
Rand, 498 U.S. at 137 (“[ERISA) sets various uniform
standards, including rules concerning reporting, dis-
closure, and fiduciary responsibility... .”); FMC
Corp., 498 U.S. at 58 (listing “reporting” and “disclo-
sure” as “subject matters covered by ERISA”).

The Supreme Court has explained the impor-
tance of having uniform federal record-keeping and
reporting requirements:

{The legislative history] reflect[s] recognition
of the administrative realities of employee
benefit plans. An employer that makes a
commitment systematically to pay certain ben-
efits undertakes a host of obligations, such
as determining the eligibility of claimants,
calculating benefit levels, making disburse-
ments, monitoring the availability of funds
for benefit payments, and keeping appropri-
ate records in order to comply with applicable
reporting requirements. The most efficient
way to meet these responsibilities is to estab-
lish a uniform administrative scheme, which
provides a set of standard procedures to
guide processing of claims and disbursement

App. 17

of benefits. Such a system is difficult to
achieve, however, if a benefit plan is subject to
differing regulatory requirements in differing
States. A plan would be required to keep cer-
tain records in some States but not in others;
to make certain benefits available in some
States but not in others; to process claims
in a certain way in some States but not in
others; and to comply with certain fiduciary
standards in some States but not in others.

Fort Halifax, 482 U.S. at 9 (emphases added).

Liberty Mutual places great weight on the Su-
preme Court’s summary affirmance of one of these
early preemption cases, Standard Oil Co. v. Agsalud,
633 F.2d 760, 763 (9th Cir. 1980). We need not rest
our ruling on that case or on so perfunctory a disposi-
tion as summary affirmance.’ At the same time, it is

* The district court in Agsalud held that a Hawaii law (1)
requiring workers to be covered by a comprehensive prepaid
health care plan and (2) imposing “certain reporting require-
ments which differ{ed) from those of ERISA,” was preempted.
442 F.Supp. 695, 696, 706-07 (N.D. Cal. 1977). Though the
ruling rested mainly on the state’s comprehensive prepaid plan
requirement, the court added that the ERISA preemption clause
“was intended at the very least to preempt state laws regulating
disclosure [and] reporting.” Jd. at 706 n.11. The Ninth Circuit
agreed with the district court, 633 F.2d 760, 763 (9th Cir. 1980),
and the Supreme Court summarily affirmed, Agsalud v. Standard
Oil Co., 454 U.S. 801 (1981). However, “the precedential effect of a
summary affirmance extends no further than the precise issues
presented and necessarily decided by those actions.” Anderson v.
Celebrezze, 460 U.S. 780, 784 n.5 (1983) (internal quotation
marks omitted).

App. 18

telling that when Congress amended ERISA in 1983
“to exempt from pre-emption certain provisions of the
Hawaii Act,” it “did not exempt from pre-emption
those portions of the law dealing with reporting, dis-
closure, and fiduciary requirements.” Fort Halifax,
482 U.S. at 13 n.7; see H.R. Rep. No. 97-984, at 18
(Dec. 21, 1982) (Conf. Rep.) (“The provision continues
Federal preemption of State law with respect to mat-
ters governed by the reporting and disclosure and the
fiduciary responsibility provisions of ERISA. . . .”).

C

The Supreme Court’s 1995 decision in New York
State Conference of Blue Cross & Blue Shield Plans
v. Travelers Insurance Co. marked something of a
pivot in ERISA preemption. See 514 U.S. 645 (1995).
The Court began “with the starting presumption that
Congress does not intend to supplant state law,”
especially if the “state action foccurs] in fields of
traditional state regulation,” like health care." Jd. at

* The dissent relies on this presumption. See Dissenting Op.
at 4-5. We acknowledge that the presumption applies when the
state law “operates in a field that has been traditionally occu-
pied by the States,” and that “the historic police powers of the
State include the regulation of matters of health and safety.” De
Buono v. NYSA-ILA Med. & Clinical Servs. Fund, 520 U.S. 806,
814 (1997) (internal quotation marks omitted). However, state
health data collection laws do not regulate the safe and effective
provision of health care services, which is among the states’ his-
toric police powers. And collecting data can hardly be deemed
“historic” — most such laws were enacted only within the last ten
years. See J.A. 368-74. In any event, the Supreme Court has

(Continued on following page)

App. 19

654-55. To preempt, a “clear and manifest purpose” by
Congress is required. Jd. at 655. Following on this
presumption, the Court pulled back on its broad,
literal reading of “relate to”: if the phrase “were taken
to extend to the furthest stretch of its indeterminacy,
then for all practical purposes pre-emption would
never run its course.” Jd.

Applying the two-part Shaw test in light of these
new principles, the Court concluded that a state
statute requiring hospitals to collect a surcharge from
patients covered by commercial insurers was not
preempted. See id. at 656. The Court explained that
state law is preempted if it “mandate[s] employee
benefit structures or their administration” or “pro-
vidies] alternative enforcement mechanisms.” Jd. at
658. The state surcharge law withstood preemption in
Travelers because it had no more than an “indirect
economic influence” on ERISA plans, it did “not bind
plan administrators to any particular choice and thus
function as a regulation of an ERISA plan itself,” and
it did not “preclude uniform administrative practice
or the provision of a uniform interstate benefit pack-
age if a plan wishes to provide one.” Jd. at 659-60.

The Court again recognized the central roles of
reporting and disclosure: ERISA “controls the admin-
istration of benefit plans, as by imposing reporting

repeatedly found the presumption overcome if the state laws “up-
set{ ] the deliberate balance central to ERISA,” even if those laws
“implement policies and values lying within the traditional do-
main of the States.” Boggs v. Boggs, 520 U.S. 833, 840, 854 (1997).

App. 20

and disclosure mandates.” Id. at 651 (emphasis
added) (citation omitted). “Congress’s extension of
pre-emption to all state laws relating to benefit plans
was meant to sweep more broadly than state laws
dealing with the subject matters covered by ERISA,
reporting, disclosure, fiduciary responsibility, and the
like.” Jd. at 661 (emphases added) (internal quotation
marks and brackets omitted).

Applying Travelers, cases conclude that state laws
having only an “indirect economic effect on ERISA
plans” lack sufficient “connection with” or “reference
to” an ERISA plan to “trigger ERISA preemption.”
New England Health Care Emps. Union v. Mount
Sinai Hosp., 65 F.3d 1024, 1030-33 (2d Cir. 1995); see
also De Buono v. NYSA-ILA Med. & Clinical Servs.
Fund, 520 U.S. 806, 809 (1997) (state hospital tax not
preempted); NYS Health Maint. Org. Conference uv.
Curiale, 64 F.3d 794, 801-03 (2d Cir. 1995) (“[O]nly
link [state surcharge law] has with ERISA plans is its
indirect effect on rate diversification among insur-
ers.”). Nevertheless, the Supreme Court teaches that
Travelers and its progeny do not disturb the long-
standing principle that “state statutes that mandate[]
employee benefit structures or their administration”
have a “connection with” ERISA plans and are there-
fore preempted. Cal. Div. of Labor Standards En-
forcement v. Dillingham Constr., 519 U.S. 316, 328
(1997) (emphasis added) (internal quotation marks
omitted). Like Travelers itself, later cases reiterate
that “ERISA is expressly concerned” with “reporting,
disclosure, fiduciary responsibility, and the like.” Jd.

App. 21

at 330 (internal quotation marks omitted); sce also
Boggs v. Boggs, 520 U.S. 833, 841 (1997); Plumbing
Indus. Bd. v. E.W. Howell Co., 126 F.3d 61, 66 (2d Cir.
1997).

The use of preemption to avoid proliferation of
state administrative regimes also remains a vital fea-
ture of the law. “[D]iffering state regulations affecting
an ERISA plan’s system for processing claims and
paying benefits impose precisely the burden that
ERISA pre-emption was intended to avoid.” Egelhoff
v. Egelhoff, 532 U.S. 141, 150 (2001) (emphasis add-
ed) (internal quotation marks omitted); see Romney v.
Lin, 94 F.3d 74, 80 (2d Cir. 1996) (“basic purpose” of
ERISA preemption is to “avoid a multiplicity of reg-
ulation in order to permit the nationally uniform ad-
ministration of employee benefit plans”).

It is true that this Court’s three most recent
cases focus primarily on “the relationships among the
core ERISA entities,” and caution against preemption
of generally applicable state laws. See Stevenson v.
Bank of N.Y. Co., 609 F.3d 56, 61 (2d Cir. 2010);
Hattem v. Schwarzenegger, 449 F.3d 423, 429-31 (2d
Cir. 2006); Gerosa v. Savasta & Co., 329 F.3d 317, 324
(2d Cir. 2003). But these cases involve either a state
income tax with only indirect economic effects (the
kind of law Travelers expressly permits), see Hattem,
449 F.3d at 425, or state law causes of action that
have “little to do with the conduct of the plan,”
Gerosa, 329 F.3d at 328; see also Stevenson, 609 F.3d
at 61 (noting that state law suit did not implicate
“actual administration” of the plan). They do not

App. 22

purport to save state laws that subject plans to “sets
of inconsistent state obligations” or that “tend to con-
trol or supersede central ERISA functions.” Gerosa,
329 F.3d at 324, 328.

When this Court has allowed a state reporting
requirement to withstand preemption, as it has in
two post-Travelers cases, the requirement:

(1) imposed no “particular form” of record-
keeping and created burdens “so slight” as to
“create[] no impediment to an employer’s
adoption of a uniform benefit administration
scheme,” Burgio & Campofelice, Inc. v. NYS
Dep't of Labor, 107 F.3d 1000, 1009 (2d Cir.
1997) (internal quotation marks omitted); or

(2) “sought information readily obtain-
able from an employer” without specifying
“a particular form of record-keeping,” HMI
Mech. Sys., Inc. v. McGowan, 266 F.3d 142,
150-51 (2d Cir. 2001).

In effect, these cases adhere to the intact pre-
Travelers principle against preemption of laws “cre-
atling] no impediment to an employer’s adoption of a
uniform benefit administration scheme,” Fort Hali-
fax, 482 U.S. at 14, and with “too tenuous, remote, or
peripheral” an effect on employee benefit plans,
Shaw, 463 U.S. at 100 n.21. Thus HMI (which Ver-
mont relies on heavily) cautioned that state subpoe-
nas would indeed be “overbroad to the extent that
they seek the amount of benefits that employees
receive” or “examin(e] employer contributions on a
benefit by benefit basis.” HMI, 266 F.3d at 151.

App. 23

D

We hold that the reporting requirements of the
Vermont statute and regulation have a “connection
with” ERISA plans (though no “reference to” them”)
and are therefore preempted as applied. Our holding
is supported by the principle (undisturbed in Travel-
ers) that “reporting” is a core ERISA function shielded
from potentially inconsistent and burdensome state
regulation.”

ERISA preempts “state laws dealing with the
subject matters covered by ERISA — reporting, disclo-
sure, fiduciary responsibility, and the like.” Shaw, 463
U.S. at 98 (emphases added). “[Rjeporting” is neces-
sarily a function distinct from the disclosure that ad-
ministrators provide beneficiaries; otherwise “reporting”

* The Vermont statute and regulation lack “reference to” an
ERISA plan because they apply to all health care payers and do
not act “exclusively upon ERISA plans.” Dillingham, 519 U.S. at
325; Travelers, 514 U.S. at 656. A “connection with” an ERISA
plan is sufficient, however, for preemption. Shaw, 463 U.S. at
96-97 (setting out disjunctive test).

It is of no moment that the law is being applied to, and
the subpoena targeted at, Liberty Mutual’s TPA rather than
Liberty Mutual itself. See Pharm. Care Mgmt. Ass'n v. Dist. of
Columbia, 613 F.3d 179, 182 (D.C. Cir. 2010) (holding ERISA
preempts state law provisions “insofar as they apply to a phar-
maceutical benefits manager .. . under contract with an employee
benefit plan (EBP) because they ‘relate to’ an EBP”). We agree
with the D.C. Circuit that “the objective of uniformity in plan
administration” is not “for some reason inapplicable simply be-
cause a plan has contracted with a third party to provide ad-
ministrative services.” Jd. at 185.

App. 24

would be subsumed by “disclosure” and rendered su-
perfluous. Rather, “reporting” entails what Vermont
requires be done: plan record-keeping, and filing with
a third-party.

But whatever the scope of plan “reporting,” Ver-
mont cannot deny that that is what it is seeking. The
relevant database is called the “Vermont Healthcare
Claims Uniform Reporting and Evaluation System”
and the operative section of the regulation is titled
“Reporting Requirements.”"' Regulation H-2008-01
§§ 3(Ar), 4 (emphases added).

Not every state law imposing a reporting require-
ment is preempted. Burgio and HMI allow a slight
reporting burden to be laid on plans, consistent with
the preemption rule tolerating laws that “create[ | no
impediment to an employer’s adoption of a uniform
benefit administration scheme,” Fort Halifax, 482
U.S. at 14, and with “too tenuous, remote, or periph-
eral” an effect on employee benefit plans, Shaw, 463
U.S. at 100 n.21.

" The dissent argues that the “reporting requirement im-
posed by the Vermont statute differs in kind from the ‘reporting’
that is required by ERISA and therefore was not the kind of
state law Congress intended to preempt.” Dissenting Op. at 1.
But the conclusion does not follow from the premise. To the con-
trary: A hodge-podge of state reporting laws, each more onerous
than ERISA’s uniform federal reporting regime, and seeking
different and additional data, is exactly the threat that moti-
vates ERISA preemption.

App. 25

But the reporting mandated by the Vermont stat-
ute and regulation is burdensome, time-consuming,
and risky. Even considered alone, the Vermont scheme
triggers preemption; considered as one of several or a
score of uncoordinated state reporting regimes, it is
obviously intolerable.

A quick overview of the Reporting System is

telling:

Plans must periodically report:

(1) “medical claims data” “composed of ser-
vice level remittance information for all non-
denied adjudicated claims for each billed
service including, but not limited to member
demographics, provider information, charge/
payment information, and clinical diagnosis
and procedure codes, and ... includ[ing)
all claims related to behavioral or mental
health”;

(2) “pharmacy claims data” “containing ser-
vice level remittance information from all
non-denied adjudicated claims for each pre-
scription including, but not limited to: mem-
ber demographics|,] provider information|,|
charge/payment information[,} and national

drug codes”;

(2) “member eligibility data” “containing
demographic information for each individual
member eligible for medica) or pharmacy
benefits for one or more days of coverage at
any time during the reporting month’;

App. 26

(4) and any “other information relating to
health care provided to Vermont residents
and health care provided by Vermont health
care providers and facilities to both Vermont
residents and non-residents ... for each
health line of business.” Regulation H-2008-
01 §§ 3-4.

Plans must report their data frequently.
Thus plans with 500 to 1,999 covered mem-
bers must report quarterly and plans with
2,000 or more covered members must report
monthly. See id. §6(1). Compare this to
ERISA, which requires a single report annu-
ally. See 29 U.S.C. § 1021.

Data must be coded under the appropriate
source code system. See Regulation H-2008-
01 § 5(AX5)(a). Sixteen source code systems
are provided, including the “Admission
Source Code” (“[a} variety of codes explaining
who recommended admission to a medical
facility”) and the “International Classifica-
tion of Diseases, 9th Revision, Clinical Modi-
fication” code (“describes the classification of
morbidity and mortality information for sta-
tistical purposes and for the indexing of hos-
pital records by disease and operations”). Jd.
Appendix A.

“Individual data elements, data types, field
lengths, field description/code assignments,
and mapping locators” for each file must con-
form to specified requirements. Id. § 5(B).
Fields include “Admission Hour” and “Dis-
charge Hour,” thirteen “Diagnosis” fields,

App. 27

three “Procedure” fields, and the “Drug
Name” and “Quantity Dispensed”. Jd. Ap-
pendices C-1-E-2.

¢ “(Tjhe social security number of the mem-
ber/subscriber and the subscriber and mem-
ber names” must be encrypted prior to
submission by “utilizing a standard encryp-
tion methodology provided.” Id. § 5(A)(5)(b).
(Encryption is not required for other data
fields.)

And nothing prevents the Department from changing
these myriad requirements from time to time, so long
as the Department complies with the broad mandate
of the statute.

The confidentiality provisions of the Vermont
scheme are complex but loose, and impair or (at least)
reassign the obligation in the Plan documents to keep
medical records strictly confidential, as well as the
undertaking by Blue Cross as TPA to use information
solely for Plan administration purposes and to pre-
vent unauthorized disclosure.” The regulation specif-
ically contemplates “access to health care claims data
sets and related information” by “persons other than

‘* Whether disclosure to Vermont is authorized under the
Plan documents may turn on whether Vermont law creates au-
thorization, because the Plan undertakes to comply with state
law; but compliance is allowed only “to the extent not preempted
by ERISA,” a limitation that leaves the Plan and the TPA in a
complex and expensive legal muddle.

App. 28

the Department.” Jd. § 8. Each data field is classified
into one of three “use and release” categories:

(1) “Unavailable Data Elements”: not
available for general use and release.

(2) “Restricted Data Elements”: only
available for use and release as part of a
“Limited Use Research Health Care Claims
Data Set” approved by the Department. These
elements, and information that can be de-
rived from these elements, include the mem-
ber’s city and zip code, the admission and
discharge dates and hours, and the service
provider and pharmacy names.

(3) “Unrestricted Data Elements”: “avail-
able for general use and public release... .
upon written request.” These publicly avail-
able elements, and information that can be
derived from these elements, include the
member’s gender, age, medical coverage, pre-
scription drug coverage, and diagnosis; the
type of procedure; the service provider’s spe-
ciality and zip code; and the name and price
of any drugs prescribed.

Id. § 8 & Appendices J-1-J-14. Specific as these cate-
gories are, they may be illusory, because the Depart-
ment can ease public release restrictions on data that
is currently restricted or unavailable, so long as “di-
rect” personal identifiers are not published and the
data is (in the Department’s opinion) handled in an
“ethical manner.” Vt. Stat. Ann. tit. 18, § 9410(e)-(f),
(hX3XD).

App. 29

Since other states can impose their own regimes
for reporting — and many do — these burdens and
risks must be multiplied.

The trend toward narrowing ERISA preemption
does not allow one of ERISA’s core functions — report-
ing — to be laden with burdens, subjected to incompat-
ible, multiple and variable demands, and freighted
with risk of fines, breach of duty, and legal expense.”

* The dissent draws a “distinction between general admin-
istration and administration of plans, claims, and benefits” and
concludes that ERISA preemption doctrine does not reach state
reporting laws that implicate the former. Dissenting Op. at 14.
Essentially, the dissent would preempt state reporting laws only
if they require plans to submit financial statements. The dis-
sent’s view of ERISA plan “administration” and “reporting” is
unduly narrow.

The overview of requirements (set out above) makes clear
that Vermont requires ERISA plans to record, in specified for-
mat, massive amounts of claims information and to report that
information to third parties, creating significant (and obvious)
privacy risks and financial burdens that will be passed from the
TPA to the Plan and from the Plan to the beneficiaries. That is not
a proper allocation of plan assets. See 29 U.S.C. § 1104(a\(1XA)
(“[A] fiduciary shall discharge his duties with respect to a plan
solely in the interest of the participants and beneficiaries and
... for the exclusive purpose of... providing benefits to partici-
pants and their beneficiaries; and ... defraying reasonable ex-
penses of administering the plan[.]”). Modest financial burdens
may be tolerable when the state laws imposing them do not di-
rectly implicate an ERISA core administrative concern. But the
statute and regulation here require reporting of health claims,
pharmacy claims, etc., information about the essential function-
ing of employee health plans.

App. 30

CONCLUSION

For the foregoing reasons, we reverse and re-
mand with instructions to enter judgment for Liberty
Mutual.

—_——-—- --+

STRAUB, Circuit Judge, dissenting in part and con-
curring in part:

I respectfully dissent in part and concur in part.

I concur with part I of the discussion section of
the majority opinion finding that Liberty Mutual has
standing. For the reasons that follow, I dissent from
the majority’s holding that the Vermont statute is
preempted by ERISA.

The majority finds that the burden imposed by
the Vermont reporting requirement warrants preemp-
tion of the statute. This conclusion falters for two
primary reasons. First, the reporting requirement
imposed by the Vermont statute differs in kind from
the “reporting” that is required by ERISA and there-
fore was not the kind of state law Congress intended
to preempt. Second, Liberty Mutual has failed to show
any actual burden, much less a burden that triggers
ERISA preemption. Rather, the Vermont statute, like
others we have previously upheld, does not interfere
with an ERISA plan’s administration of benefits. For
these reasons, our precedent and that of the Supreme
Court do not support the conclusion that the Vermont
statute’s reporting requirements pose the sort of
threat to “the nationally uniform administration of

App. 31

employee benefit plans” that would trigger preemp-
tion. N.Y. State Conference of Blue Cross & Blue
Shield Plans v. Travelers Ins. Co., 514 U.S. 645, 657
(1995) (hereinafter “Travelers “).

Looking at the objectives of ERISA and the im-
pact of the Vermont statute on ERISA plans, as we
must in order to determine whether the statute has
an improper “connection with” ERISA plans, I con-
clude that this is not the type of statute that Con-
gress intended to preempt.

ANALYSIS

The preemption clause of the ERISA statute
provides that, with certain exceptions not relevant
here, ERISA “shall supersede any and all State laws
insofar as they may now or hereafter relate to any
employee benefit plan.” 29 U.S.C. § 1144(a). The Su-
preme Court has stated that the “basic thrust of the
preemption clause ... was to avoid a multiplicity of
regulation in order to permit the nationally uniform
administration of employee benefit plans.” Travelers,
514 U.S. at 657. “Pre-emption does not occur, how-
ever, if the state law has only a ‘tenuous, remote, or
peripheral’ connection with covered plans, as is the
case with many laws of general applicability.” Burgio
& Campofelice, Inc. v. N.Y. State Dep’t of Labor, 107
F.3d 1000, 1008 (2d Cir. 1997) (internal quotations
marks omitted) (quoting Shaw v. Delta Air Lines,
Inc., 463 U.S. 85, 100 n.21 (1983)).

App. 32

“Two kinds of state laws relate to ERISA for
purposes of preemption: those that mandate em-
ployee benefit structures or their administration, and
those that provide alternative enforcement mecha-
nisms.” HMI Mech. Sys., Inc. v. McGowan, 266 F.3d
142, 149 (2d Cir. 2001) (internal quotation marks and
brackets omitted). The Vermont statute does neither.
We have noted that courts are “reluctant to find that
Congress intended to preempt state laws that do not
affect the relationships among” “the core ERISA en-
tities: beneficiaries, participants, administrators, em-
ployers, trustees and other fiduciaries, and the plan
itself.” Gerosa v. Savasta & Co., 329 F.3d 317, 324 (2d
Cir. 2003). The Vermont statute does not even argu-
ably regulate these relationships. Moreover, the Ver-
mont statute does not impose regulations on how
plans are to be run or how benefits are to be adminis-

tered.

Yet the majority takes up Liberty Mutual’s in-
vitation to give the term “reporting” its broadest
meaning, and finds the statute is preempted because
“reporting” is a “core ERISA function shielded from
potentially inconsistent and burdensome state regu-
lation.” (Maj. Op. at 24-25) While it is certainly true
that ERISA’s core areas include “reporting, disclo-
sure, [and] fiduciary responsibility,” Shaw, 463 U.S.
at 98, and that “state laws that would tend to control
or supersede central ERISA functions ... have typi-
cally been found to be preempted,” Gerosa, 329 F.3d

at 324, the majority’s argument misses the nuance of
what “reporting” means in the context of ERISA, and

App. 33

ignores the case law’s focus on whether the admin-
istration of benefits to beneficiaries is impacted, an
issue on which there is no showing.

A. Traditional State Regulation of Health Care
and the Presumption Against Preemption

The majority’s finding, hidden in a footnote, that
the presumption against preemption does not apply
here, flies in the face of clear Supreme Court prece-
dent instructing us to begin with the “presumption
that Congress does not intend to supplant state law.”
Travelers, 514 U.S. at 654-55. “[I]n cases like this one
where federal law is said to bar state action in fields
of traditional state regulation, we have worked on the
assumption that the historic police powers of the
States were not to be superseded by the Federal Act
unless that was the clear and manifest purpose of
Congress.” Jd. at 655 (internal citations and quotation
marks omitted). This is because “nothing in the lan-
guage of [ERISA] or the context of its passage indi-
cates that Congress chose to displace general health
care regulation, which historically has been a matter
of local concern.” Jd. at 661.

The majority nonetheless holds that the pre-
sumption against preemption does not apply here
because “state health data collection laws do not reg-
ulate the safe and effective provision of health care
services.” (Maj. Op. at 19 n.8) This contradicts the
very Supreme Court precedent the majority relies
upon: DeBuono v. NYSA-ILA Medical and Clinical

App. 34

Services Fund, 520 U.S. 806 (1997). In that case, New
York imposed a tax on patient services at various
health care providers. 520 U.S. at 808. The Court
applied the presumption, reasoning that although the
New York law was “a revenue raising measure, rather
than a regulation of hospitals, it clearly operates in a
field that ‘has been traditionally occupied by the
States.’” Jd. at 814. The Court further stated that the
fact that the challenged law “targets only the health
care industry ... supports the application of the
‘starting presumption’ against pre-emption,” because
“the historic police powers of the State include the
regulation of matters of health and safety.” Jd. at 814
& n.10. DeBuono is indistinguishable from the case at
hand. Here, the Vermont statute “targets only the
health care industry” and, even if it is not a regula-
tion of health care entities, it certainly “operates in
[the] field” of health and safety. Indeed, the stated
purpose of the Vermont statute is to help improve
health care quality. See Vt. Stat. Ann. tit. 18 § 9410(aX1)
(listing purposes, including “improving the quality
and affordability of patient health care”). There
should be no question, therefore, that the pre-
sumption applies here.

B. There is No Improper “Connection With”
ERISA Plans

When analyzing whether ERISA preempts a
state law, we apply the two-pronged Shaw test, as
narrowed by Travelers’ presumption against preemp-
tion. Under that test, we analyze whether a state law

App. 35

has an impermissible “connection with” or “reference
to” an ERISA plan. See, e.g., Hattem v. Schwarzenegger,
449 F.3d 423, 428 (2d Cir. 2006). Despite paying lip
service to the Shaw test, the majority eschews a full
analysis in favor of a talismanic recitation of the word
“reporting.”

I agree with the majority that because the Ver-
mont statute requires data collection from entities
other than ERISA plans, such as hospitals, health in-
surers, and pharmacy benefit managers, it “functions
irrespective of the existence of an ERISA plan” and
therefore does not make an improper “reference to”
ERISA plans. See Cal. Div. of Labor Standards En-
forcement v. Dillingham Constr., N.A., Inc., 519 U.S.
316, 328 (1997) (internal quotation marks and ellipsis
omitted). The “connection with” prong, on which the
majority hangs its hat, instructs us to examine both
“the objectives of the ERISA statute as a guide to the
scope of the state law that Congress understood
would survive” and the “effect of the state law on
ERISA plans.” See Egelhoff v. Egelhoff ex rel. Breiner,
532 U.S. 141, 147 (2001) (internal quotation marks
omitted); see also HMI, 266 F.3d at 148 (“Analyzing a
state law’s ‘connection’ with ERISA plans requires the
courts to consider ERISA’s objectives and the effect of
the state law on ERISA plans.”). This analysis leads
to the conclusion that the Vermont statute is not pre-
empted.

App. 36

1. Objectives of ERISA

The objectives of the ERISA statute are not in
dispute. Congress “enacted ERISA in 1974 to respond
to growing concerns about the risk of employers de-
faulting on pension plans, which were increasingly
widespread but little regulated.” See Mallory Jensen,
Is ERISA Preemption Superfluous In the New Age
of Health Care Reform?, 2011 Colum. Bus. L. Rev.
464, 472 (2011) (internal footnotes omitted); see also
Brendan S. Maher and Peter K. Stris, ERISA and
Uncertainty, 88 Wash. U. L. Rev. 433, 440 n.29 (2010)
(“Few dispute that the statute was passed, in part, as
a response to several high-profile pension defaults
that arose from company failures that devastated the
pensions of many workers.”) (citing J.A. Wooten, The
Most Glorious Story of Failure in the Business: The
Studebaker-Packard Corp. & the Origins of ERISA,
49 Buff. L. Rev. 683, 683-84 (2001)). Indeed, the stat-
ute itself declares that, in passing ERISA, Congress
sought to

protect interstate commerce and the inter-
ests of participants in employee benefit plans
and their beneficiaries, by requiring the dis-
closure and reporting to participants and
beneficiaries of financial and other infor-
mation with respect thereto, by establish-
ing standards of conduct, responsibility, and
obligation for fiduciaries of employee bene-
fit plans, and by providing for appropriate

App. 37

remedies, sanctions, and ready access to the
Federal courts.

29 U.S.C. § 1001(b).’

These objectives are reflected in the ERISA re-
porting and disclosure requirements, which are con-
cerned with the mismanagement of funds and failure
to pay employee benefits, and seek information on
plan assets or allocation. See 29 U.S.C. § 1023 (re-
quiring publication of annual report to include a fi-
nancial statement of assets and liabilities, changes in
fund balance, disclosures about changes made in the
plan, and financial commitments, including loans,
leases, and transactions, and an actuarial statement).
The plain language of the ERISA reporting require-
ments shows that they are limited to the furnishing
of a summary plan description to plan participants
and an annual report to the Secretary. See 29 U.S.C.
§§ 1021-30. The former is essentially a plain-English
summary of key plan terms, id. §§ 1021-22, while the

' The Supreme Court has also noted that Representative
Dent, the House sponsor of the legislation, “represented that
ERISA’s fiduciary standards ‘will prevent abuses of the special
responsibilities borne by those dealing with plans,’” and that the
“disclosure and reporting requirements ‘will enable both partici-
pants and the Federal Government to monitor the plans’ opera-
tions.’” Fort Halifax Packing Co. v. Coyne, 482 U.S. 1, 15 (1987)
(quoting 120 Cong. Rec. 29197 and 29935 (1974)). “Senator Williams,
the Senate sponsor, stated that these fiduciary standards would
safeguard employees from ‘such abuses as self-dealing, impru-
dent investing, and misappropriation of plan funds.’” Id. (quot-
ing 120 Cong. Rec. 29932).

App. 38

latter is concerned with the financial soundness of
the plan, id. § 1023. Thus, under ERISA, plans must
report information that goes to the financial integrity
of the plan.

It is important to r

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Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40385016_0342%3A02. Public record. Not legal advice.
