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Health Freedom Watch
December 2006

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Massachusetts Blue Cross Blue Shield to Collect Mental Health Information

Blue Cross Blue Shield of Massachusetts, the largest health insurer in the state, plans to collect detailed personal information on enrollees seeking mental health treatment, the Boston Globe reports.

The insurer previously required psychiatrists and therapists to file progress reports on patients. But in 2007 it will ask patients to answer 58 personal questions (on paper or through a secure website), including questions about their moods, feelings, and sex lives. [The questionnaire is online: http://graphics.boston.com/business/pdf/test.pdf] Patients will be asked to complete the questionnaire after every eight counseling sessions—or more often if the insurer wishes. Patient participation is supposed to be voluntary. However, if enough patients don’t comply, their doctors or therapists could be denied annual increases in reimbursement.

Some psychiatrists and mental health-service organizations have already voiced concern over the policy. Dr. Marc Whaley, a psychiatrist and president of the Southeastern Massachusetts Psychiatric Society, asked, “Who in their right mind would fill out such a form?” Bruce Mermelstein, president of Comprehensive Outpatient Services, told the Globe, “We generally don’t feel positive about sharing any information with an outside source. That’s a legitimate worry.” He stressed that patients should be concerned about their privacy. Even so, for the past two years the state’s second largest insurer, Harvard Pilgrim Health Care, has distributed similar forms to mental health patients, and about 60 percent of patients have filled them out.

It’s clear that as health-care costs continue to rise insurers will increasingly manage access to treatment in their attempt to curb costs. In doing so they will continually expand their access to patients’ personal information.

Perhaps it’s time for Massachusetts residents—and all citizens across the country—to put health-care decision-making power back in the hands of consumers to ensure the right to privacy. One step to achieve this important goal would be to reduce state and federal income tax rates for all citizens, and simultaneously eliminate the federal tax advantage employers receive for purchasing health insurance. This policy change would empower consumers to pay out-of-pocket for routine health-care services, thereby increasing their privacy (while maintaining catastrophic insurance for major expenses).

Citizens in a free country should have the liberty to seek the treatment of their choice and pay for it privately, without having to go through an insurance bureaucracy or having their privacy invaded.

Source: “Insurer Seeks Personal Details on Mental Health Form: Experts Question Plan by Blue Cross,” by Christopher Rowland, Boston Globe (online), November 11, 2006: (http://www.boston.com/business/globe/articles/2006/11/11/insurer_seeks_personal_details_on_mental_health_form/).

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Massachusetts Universal Health Insurance Raises Questions about Patient Privacy

Massachusetts residents should consider how their new universal health insurance law will affect patient privacy. The law creates a new “health care quality and cost council” authorized to “collect, analyze and aggregate data related to costs and quality across the health care continuum.” The council will be established “within, but not subject to control of, the executive office of health and human services.” It will consist of 13 representatives, including the attorney general (or his designee) and the state commissioner of insurance.

Health-care providers and insurers are mandated to submit data to the council or to an independent organization collecting data on behalf of the council. The law states that “If any insurer or health care provider fails to submit required data to the council on a timely basis, the council shall provide written notice to the insurer or provider. If the insurer or health care provider fails, without just cause, to provide the required information within 2 weeks following receipt of said written notice, the insurer or provider may be required to pay a penalty of $1,000 for each week of delay; provided, however, that the maximum penalty under this section shall be $50,000.”

Establishment of the council raises some important questions:

  • What privacy law governs the new council and the collection of patient data in Massachusetts?
  • What rights to privacy do patients in the state have?
  • Who owns people’s health data in Massachusetts: individuals, providers, insurers, or employers? (For example, if a patient uses employer-sponsored health insurance for dental services, who has a legal right to the resulting information?)
  • Will patients be informed that their data is being shared with the council?
  • Will patients have a right to know what data is collected about them and held by the council?

The council is required to hold annual public hearings to obtain input from health-care industry representatives, health-care consumers and the general public. Massachusetts residents who care greatly about their health-care choices and privacy should seek clarification of these important issues and perhaps demand a stronger state medical-privacy law, one that cannot be preempted by the so-called federal medical privacy rule (which does not guarantee true confidentiality).

Source: “Chapter 58 of the [Massachusetts] Acts of 2006: An Act Providing Access to Affordable, Quality, Accountable Health Care,” Approved (in part) April 12, 2006: (http://www.mass.gov/legis/laws/seslaw06/sl060058.htm).

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What Every Worker Should Know about Electronic Medical Records

The Wall Street Journal recently reported that corporate giants Intel, Wal-Mart, British Petroleum and other companies are planning to digitize their workers’ health records and store them in a multimillion-dollar database. The Journal also reported that, according to the companies, the records will be the property of employees. But unless the federal medical-privacy law is revised or employer-employee contracts state clearly that employee-owned electronic medical records cannot be shared without patient consent, the promise of employee ownership will be no guarantee of privacy. Here is why:

The privacy rule actually permits over 600,000 doctors, insurers, and others to share individuals’ electronic medical records—without consent—for purposes related to treatment, payment, or health-care operations, a very broad category. About that rule, Journal reporter Theo Francis recently wrote in “Taking Control: Setting the Records Straight”:

  • “Over the past three years, millions of Americans visiting doctors’ offices, pharmacies and hospitals have been handed forms and brochures discussing privacy rules under the Health Insurance Portability and Accountability Act, or HIPAA. Many assume signing somehow protects their privacy. It doesn't.
  • “In fact, the disclosure notice essentially details the many ways a doctor can use and disclose medical information—often without a patient’s consent or knowledge. Medical providers have to ask for a signature. But signing isn't mandatory. And failing to sign usually doesn't change what a doctor can and can't do with a person's medical information….
  • “Health plans and medical providers also must track some kinds of disclosures, and give patients a list if asked, including disclosures for public-health purposes, but not routine uses for treatment, payment or health-care operations.” [Emphasis added.]

Thus even though big companies promise employees they will own their electronic medical records, workers won’t control access to them unless (1) the privacy rule is changed or (2) company contracts guarantee control.

Americans would never accept the notion that although they own their homes, the government or their employers have the authority to determine access to them. They should reject the same notion with respect to employees’ health records.

Sources:

  • “Big Employers Plan Electronic Health Records,” by Gary McWilliams, Wall Street Journal, November 29, 2006.
  • “Taking Control: Setting the Records Straight,” by Theo Francis, Wall Street Journal, October 21, 2006.

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President’s Message: Looking Ahead
By Sue A. Blevins

The Institute for Health Freedom (IHF) is so very grateful for the support—both financial and otherwise—that we’ve received this past year from diverse donors and readers. It’s clear from readers’ feedback that we’re providing an invaluable service. Some have stressed that IHF is providing important information they’re not getting elsewhere. For example, donors informed us that they had not heard about the Citizens’ Health Care Working Group and the opportunity for public comment, until reading about it in Health Freedom Watch.

Given that Congress is mandated by law to hold hearings on national health reform (see: www.forhealthfreedom.org/Newsletter/June2006.html#Article1), 2007 is going to be a crucial time for monitoring proposals and educating policymakers. Just what do we want our national health policies to look like? And how have this past year’s health policy changes affected health-care costs, choices, and privacy?

National policymakers can learn from their successes as well as their errors as they debate health reform in the coming year. In April I explained how the 2006 Massachusetts universal health insurance law could adversely affect all citizens’ privacy because the plan requires insurers and health-care providers to submit patient data to a new council—a centralized clearinghouse.

Sally Pipes, president of the California-based Pacific Research Institute, recently reported that already the law is projected to cost more than the public was led to believe—clearly a major public-policy error. Pipes noted, “Led by Republican Gov. Mitt Romney, supporters promised that health insurance could be provided with only a slight increase in expenditures. Skeptics at the time pointed out that this would not be possible, but were dismissed….

“Administration officials are now telling Wall Street they expect the plan to be quite expensive. In an Aug. 17 filing to support general obligation bonds, officials project that the new plan will increase Massachusetts government health spending by $276.4 million in 2007. That’s a $151 million boost over what the public was told the plan would cost as recently as April. ‘Somebody once told me: if you want to know what is really going on in state government, look at the bond documents,’ the writers at HealthyBlog, who are tracking the details of the implementation process, pointed out, when posting the filings. ‘They can say whatever they want to the public, but they can go to jail for fibbing to Wall Street.’”

When it comes to freedom and privacy, we can’t afford to miss the mark on these issues. That is why health-freedom supporters should get ready to voice their opinions on national health reform. And IHF looks forward to sharing helpful research, analyses, and ideas that you can use as talking points in the coming year.

Sue A. Blevins is founder and president of the Institute for Health Freedom.

Sources:

  • “Mass Medical Mess,” by Sally C. Pipes, Washington Times, November 5, 2006: (http://washingtontimes.com/commentary/20061104-103214-9246r.htm).
  • “How MA Explains Health Reform to Wall Street,” A Healthy Blog maintained by Health Care for All, September 12, 2006: (http://blog.hcfama.org/?m=200609&paged=4).

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Health Freedom Watch is published by the Insitute for Health Freedom. Editor: Sue Blevins; Assistant Editor: Deborah Grady. Copyright 2006 Institute for Health Freedom.