TN HB2289 Gives Goverment Access to Private Medical Information
Posted by: in Breaking News, Common Sense, Health Care, More Liberty, Tennesee TipsOf all the Orwellian nightmares people have suggested you be concerned about, it would be difficult to find one more universally despised than the idea one’s medical records are available to the state. The potential for abuse and discrimination under such a scenario are legion. Some possibilities are obvious. Like the discrimination against a woman because she might become pregnant, imagine the potential impact on your credit, work or chances for a promotion because of your medical history were it to be known. Others are more fantastic and insidious, bordering on science fiction like the movie “Gattaca”, where all of society - social position, who you marry and your value as a person are based, not on your character but on your genes and how they impact your health. The point being, knowledge of and control over information, especially medical information, carries such potential for abuse and is so personal it has traditionally been held as the most private of private information.
But for how much longer?
TN House Bill 2289 (HB2289) and Senate Bill 2239 (SB2239), according to the state’s website, are innocuous bills on insurance, medical fees and accreditation typical of the uninteresting legislation passed nationwide. Reading the text of HB2289, it is anything but.
It establishes an All Payer Claims Database (APCD). The APCD requires private insurance companies to report to the state the details on the claims they process. For perspective, one particular Tennessee insurer processes 32,000 of those details every hour. That’s 250,000 details per day about private citizens the state wants turned over to them.
In fact, there are over 6000 details which might be reported about you under HB2289 including data on prescriptions, medical conditions, sexually transmitted diseases, surgeries and more. If I know Government, 6000 is nothing but a good start!
Your file is cumulative in nature, established for you with future medical details added over time. Older folks might not have large files, children would have their entire life’s medical history recorded. The Government is not asking you for it. This is not voluntary. The information is being legislated away from your control. You cannot opt out. You are not even a part of the process. The bill requires your insurance company to report to the Government all the things it did for you as its customer. Just because the Government wants to know.
The bill assures Tennesseans their data will be kept private. But from whom? While you can’t get your neighbor’s data, the state can share data with a host of entities. HB2289 promises to abide by existing HIPAA laws. But the National Institute of Health’s own account of how such data is handled notes while HIPAA laws require the removal of 18 separate personal identifiers from data before it can be released without specific authorization, such personal identifiers may be released
To health oversight agencies for oversight activities authorized by law that are necessary, for example, for the appropriate oversight of government-regulated programs. For example, because Office for Human Research Protections (OHRP) is a health oversight agency under the Privacy Rule, a covered entity may disclose PHI, without Authorization, to OHRP for purposes of determining compliance with the HHS Protection of Human Subjects Regulations.
All it takes is being designated an oversight agency and they can get all the data they want about you. Interestingly, HB2289 calls for the formation of a Tennessee Health Information Committee. Its duties, responsibilities and functions are not defined but it’s not hard to imagine it being given oversight authority.
There are fiscal and quality of care issues to consider as well.
Compliance with the legislation will require more personnel and time. That cost to doctors and insurers will be passed on to consumers in the form of higher costs and premiums making health care even more expensive. The bureaucracy to establish and manage this will increase the size of the state Government. More Government means more taxes or cuts in other services to pay for it.
Many people are already uncomfortable sharing intimate details of their life with relative strangers, even if it’s their doctor. Common sense tells us people already omit information or lie in response to diagnostic questions out of fear, embarrassment and the like. What happens when it becomes known that faceless bureaucrats have access to your health care records? What happens when someone gives a wrong answer out of fear and gets a prescription that interacts badly with another med or undergoes a procedure a doctor would never recommend if he knew the truth?
These concerns are nowhere near the full measure of just how bad this legislation is. But the solution is simple - contact your legislators. Politely tell him or her, in no uncertain terms, you consider your medical information private and you expect it will be kept that way. Politely, clearly and firmly make it known you are requesting him or her to vote against HB2289 and SB2239. Let them know you will be following up to see how s/he votes and that the matter will be a factor in deciding how you will vote. You can find your Representative and contact him or her here. Your Senator’s information is here.
Then tell your family, friends, neighbors, church members, and co-workers about HB2289/SB2239 and suggest they do the same. Give them the link to this post and return often for updates and for more information about what is happening. See you then.
Blue Collar Muse
Popularity: 31% [?]
Tags: All Payer Claims Database, HIPPA, Personal Medical Records taken by Government, Privacy Issues, Tennessee HB 2289, Tennessee SB 2239
Entries (RSS)
May 26th, 2009 at 4:11 pm
Ken - I spent over 30 minutes watching the discussion online in the Government Oversight Committee on this bill. At first, I was biased against it because of your email and post; however, the more I watched and understood what this bill does and does not do, the more I feel that discussions like yours above amount to “much ado about nothing.” No disrespect intended.
The first thing I found interesting is that there is already legislation in TN regarding hospitals and their reporting to the TN Hospital Association that essentially includes much of what this bill is desiring to monitor. That information hospitals send to TN Hospital Assn INCLUDES personally identifiable information, and has for a long long time. Where is the outrage or desire to change that? (There isn’t any.)
Secondly, our state spends billions of dollars on healthcare programs and treatment, yet we have no real means to find out if those programs are working. How might we go about collecting health outcome data as well as healthcare cost information without obtaining information like this? I am all for looking at how we spend our tax dollars and saying, “Is it working?” If we’re not willing or able to do this, then I say, “Stop funding these programs NOW!”
Third, the information this database will collect, and that any third-party provider as part of this program will collect, does not in any way include any personally identifiable information to begin with. All that information is by design of the system not included in what the insurance companies submit. It wont take it. It won’t be part of the information collected period. Have you ever run a report from Excel on only SOME of the information you had in a spreadsheet? When you run that report, does data not associated with your report somehow make it into the report at all? Is it connected to the report? Can I get that information without rerunning the report? The answer is no. So not only will the insurance agencies NOT be including that data, but it will be encrypted twice before it ever makes it to the state for analysis.
I honestly welcome this database. As someone with a chronic medical condition, I welcome the opportunity to know healthcare costs of proceedure throughout the state, as well as factual based information on whether a particular medical provider is actually performing his specialty well or not.
I hope this bill will not be crippled due to partisan posturing, that would be a shame in my opinion.
May 26th, 2009 at 5:02 pm
@ Jenci -
To each their own. I can certainly understand wanting information on whether or not my health care provider is performing well and what costs are across the state. These are not unimportant matters.
However, even if I believed that a program of this size and scope is the best way to ascertain that, I cannot envision myself also believing that the Government is the best entity to run it. Nor do I believe that the formation of a special bureaucracy in that Government is even the best way to get the comparative information you are looking for.
This is not about being for or against information gathering or being from a certain political party. It is not about Right and Left. It is about Right and Wrong. As I mentioned, the brief list of objections I raised in a blog post is not the extent of the problems with this bill.
I did not mention that it violates the 4th Amendment of the US Constitution. There we find
The point behind the 4th is that my medical records are mine and cannot be taken from me unless there is some reason to believe they are being used for a criminal purpose. Under no other circumstance would any agency of the Government be justified in pursuing access to my medical “papers”. And only then after showing probable cause. My papers are my papers. The Government can ask me for them and I may give them up. But if I choose not to, they have absolutely no right to take them from me.
I understand the 4th is an amendment to the US Constitution and I am a huge supporter of state’s rights, but the 10th amendment does not grant states a license to ignore the rest of the amendments in their exercise of authority. Thus if you choose to participate in the database for any reason of your own and participation is voluntary, then I fully support your doing so (although I may object to the expense to the taxpayers of establishing the database - another question entirely).
This bill is not voluntary and my personal information is at risk of being taken from me by force. That is decidedly not something I support nor do I see it as partisan posturing. Unless you are willing to agree that the parties are ideologically divided along the lines of “desiring unconstitutional intrusions into the lives of citizens” and “opposing unconstitutional intrusions into the lives of citizens”. Then I’ll happily admit to being partisan in this matter.
Concerning the bulk of your response that there is a good purpose and good intent in the Government’s desire for this information, let me just say that I never said their interest in it - right now - is bad. What I said was that the potential for abuse of access to such information was great and was a threat.
I stand by that assessment. I do not trust the Government to make my decisions or analysis for me. I trust that Government will do exactly what it has done since Government was invented - try to expand its control and influence in the day to day life of the populace until it is the ultimate and supreme power. By the ballot if possible and by bullets if not.
All of Government, even the necessary parts (and we can disagree as to what those are), is an exercise in control. The question is not “Should there be control?”, it is rather “Who should be in control?” The less Government, the more the individual must control his actions and do what is best for himself and in so doing do right by all those around him. The more Government the less the individual controls his own life.
If such a database is so demonstrably valuable to the whole of society that I should freely surrender my data to it in my own best interests and in the interests of my responsibility to the community then you and Tennessee are welcome to make that case and ask me for it. The rightness of it will be readily evident to men of goodwill and intelligence. Until then, forcing me to surrender what is mine because someone else is of the opinion it might be helpful is not the way to get my willing participation.
There is more that can be said. I’ll have some more posts about this, too. I’m curious what your response to my response is. Please let me know …
May 26th, 2009 at 5:04 pm
I don’t have information on your first point Jenci so I’ll cover the other two:
2) Sounds good - this sounds like a well thought out need… except the part where you make the claim that private insurance should turn over this information to help the state know which items that it funds actually works… Mandate reporting for all procedures performed using public funding.. but not my private insurance.
3) This argument is entirely invalid. We need only look to the relatively recent AOL Search history scandal (http://en.wikipedia.org/wiki/AOL_search_data_scandal) to understand that data ‘without personally identifiable information’ can still be be used to pinpoint the person it applies to using some heuristics. Moreover, it’s about not giving the government a foot hold. It’s a big jump to a database of everything about everyone cross referenced with their ID. But, if we take a few small steps -it’s easier… Who would notice in 5 years if they slipped your SSN into these records?
May 26th, 2009 at 5:32 pm
@Jenci -
Sorry - I missed a point or two you made.
Regarding the availability of personal information or data that would identify an individual not being a part of the process, I disagree.
If you follow the link in the post to the text of the bill you find the following language:
What does that mean except there is information on individuals included that must be protected?
Further, the extent of the protection is limited to the requirements of HIPAA. As I mentioned in the body of the post, HIPAA permits the release of the personal information that IS collected and associated with the data under certain circumstances. Not ever (that I can ascertain) to private individuals but most certainly to other Government agencies. This personal information is then subject to release with no authorization or process other than the request for it to certain agencies. It’s in the sections titled “Limited Data Set and Data Use Agreement” and “Other Uses and Disclosures of Protected Health Information”. These refer specifically to things like names, addresses, Socials and 15 other pieces of data.
So we’re clear … they do collect personal information and it is available to be shared with others. Otherwise the protests that they’ll be careful with it by handling it in this or that manner are meaningless.
Regarding your assertion that I am not protesting the other manners in which such information is being collected and used so my protesting of this abuse of Government power is unjustified, that assumes several facts not in evidence. Among others, it assumes that the programs you mention do, in fact, function in a similar manner; it assumes I know about them, and; it assumes that I have chosen to remain silent in the face of my knowledge.
For the record, if you can provide me with links explaining the program you mention - which I was unaware of prior to you telling me about it - and it turns out it, too, mandates my medical information be given to the state to use as it sees fit, I will happily extend my strong objections to that program as well.
I meant to say it in my first comment but forgot to. I am not at all offended by your views or objections to my points. Not only do I believe you to be a woman of integrity and intelligence, but I find you exceptionally pleasant. Thus you would REALLY have to go a long way to be offensive.
Your arguments were clear and free of profanity, name calling and insult. I still don’t agree with you and hope to persuade you of the error of your ways. But be offended with you because you disagree with me? Not going to happen …
May 27th, 2009 at 3:49 am
[…] from the Tennessee Center for Policy Research about this alarming piece of legislation. Check out Ken Marrero from Blue Collar Muse: Of all the Orwellian nightmares people have suggested you be concerned about, it would be difficult […]
May 29th, 2009 at 7:10 am
Weren’t the Democrats the ones who were complaining about privacy issues because the Bush Administration was trying to catch terrorists? But this is okay?
May 29th, 2009 at 9:11 am
@Healthy Man -
Ahhh …. yep!