Activism Change

SPECIAL ALERT III KILL S.1028/HR 3103- The Texan Hereby Called Out.

Question:

Friends, the American Medical Assn. was strongly behind passage of H.R. 3103 and yet even the docs have problems with the final wording. The following is from the AMA’s grassroots page on the Web. FINAL PASSAGE UPDATE HEALTH REFORM BILL The House of Representatives passed the "Health Coverage Availability and Affordability Act of 1996," H.R. 3103, on March 28, 1996. While the intent of the legislation to provide portability and continuity of health care coverage is laudable, a consequence of the bill is that it would place the privacy of patients’ medical records in jeopardy. Details and talking points are available. Late Thursday March 28th, the House of Representatives passed the Health Insurance Reform Bill, HR 3103, by a vote of 267 to 151. Thirty-eight Democrats voted for final passage while only one Republican, Congresswoman Roukema (NJ), voted against the legislation. The legislation included medical liability reforms ($250,000 cap), Medical Savings Account language, and provisions to combat "waste, fraud, and abuse" in the health care market. It will also *simplify* the administration of health insurance. Under the modified closed rules, no amendments other than the Democratic substitute were allowed. Once again, organized medicine succeeded in securing passage of legislation which has a dramatic impact and positive influence on the nation*s health care delivery system. The Senate is scheduled to begin debate on the Kassebaum-Kennedy insurance reform bill after the two week recess which begins today. While the Senate bill is much narrower in scope (strictly insurance reforms), there may be an effort by several Senators to expand the bill to include the House provisions. Two issues not addressed in the health reform legislation were the reform of the Clinical Laboratory Improvement Act of 1988(CLIA) and antitrust reform for physicians. The AMA has been assured by the House Leadership that these issues will be considered on the House floor this year. Please contact your Representative and Senators to urge cosponsorship of Congressman Archer*s CLIA reform bill (HR 1386), Senator Kay Bailey Hutchison*s CLIA reform legislation (S 877), and Congressman Hyde*s Antitrust bill (HR 2925). [ HERE ARE THE AMA's TALKING POINTS ] Patient confidentiality threatened by administrative simplification provisions in the "Health Coverage Availability and Affordability Act of 1996" (H.R. 3103) Background: The House of Representatives passed the "Health Coverage Availability and Affordability Act of 1996," H.R. 3103, on March 28, 1996. While the intent of the legislation to provide portability and continuity of health care coverage is laudable, a consequence of the bill is that it would place the privacy of patients’ medical records in jeopardy. Specifically, the "Administrative Simplification" provisions contained in Subtitle F — which apply to both the public and private sectors — would statutorily require that the cost of any administrative simplification scheme be considered over and before any confidentiality concerns. In addition, this subtitle creates an electronic universe in which law enforcement and others are able to access a patient’s personal medical information without that patient’s knowledge or consent. * Patient confidentiality will be sacrificed to save money. HR 3103 establishes the following litmus test for any administrative simplification standard: "Does it reduce administrative costs?" If the answer is "No," a standard will not be adopted, even if that standard would protect patient confidentiality. Since the standards necessary to protect confidential medical information are likely to increase administrative costs, rather than reduce them, patient privacy will inevitably be forfeited in favor of lower administrative costs. The responsibility for developing standards to protect patients’ confidential medical records is turned over entirely to the Secretary of HHS. The administrative simplification provisions completely abdicate responsibility for protecting a patient’s right to expect that his or her confidential medical information will remain private. Any legislative provisions addressing the confidentiality of patients’ medical records should set out clear principles by which patient privacy shall be protected, rather than handing over full discretion to bureaucrats.   * There is no requirement for the patient’s consent to release confidential medical information. Neither patients, nor their physicians, will know when sensitive information is released or to whom. In fact, read in conjunction with the "Fraud and Abuse" provisions, the bills would allow law enforcement to access whatever private medical records it desires by subpoenaing information from "transaction clearinghouses," with no notice to either patient or physician. This is not limited to programs paid for by the federal government. The Attorney General may issue subpoenas requiring the production of any records relevant to a law enforcement inquiry. No court order is required and those who release information under this section cannot be held liable.   * The public health reporting provision completely removes any safeguards for health information under "any law providing for the reporting of disease or injury, child abuse, birth or death, public health surveillance, or public health investigation or intervention." There is no requirement that the public purpose must be of such  significance as to countervail the patient’s right to privacy.   * There is no limitation on what or how much confidential information is released. There is no requirement that aggregate, "de-identified" data be used whenever possible. * There is no representation from the physician or provider communities on the "Health Information Advisory Committee" established to advise the Secretary of HHS and the Congress regarding the implementation of administrative simplification standards. The standards to be implemented under the administrative simplification provisions would have medically substantive consequences, as well as addressing the form in which medical information is recorded and transmitted. Thus, the omission of any physician or health care provider on the Advisory Committee is a glaring oversight with the potential to harm patient care. ACTION REQUESTED: Please contact your Senators and Representative to express your concern that the Administrative Simplification section of H.R. 3103 fails to protect the confidentiality of your medical records. These provisions are not "fixable." Ask them to support striking the entire section from the bill. Since the Congressional Budget Office (CBO) has designated the section as budget neutral, deleting it will not have a fiscal impact on the remaining portions of the bill. Perhaps we can work with the AMA to get this legislation fixed! Internet Strategist                   phone: 214.891.6111          fax: 214.891.6115

Response:

The American Preventive Medical Association, their Executive Director Candace Campbell, and their attorney Jonathan Emord have carefully analyzed the Suzanne Harris/LEF legal interpretation of S.1028/HR 3103, and totally agree with our position, as you can see from their letter below to Senator Kassebaum. APMA agrees with our assessment that the legislation would do great harm to alternative practitioners if it passes in its current form.

TOTALLY AGREE? I wouldn’t characterize APMA’s thoughtful and well reasoned letter as totally supporting your position that citizens contact their Senators and urge them to oppose S.1028 because it might have a harmful effect on alternative health care practitioners. Your shrill pleas to "Act Now, Your Life May Depend On It!" have to potential to misdirect popular sentiment and cause citizens to behave irrationally as they phone and FAX Congress as you suggested. APMA’s letter to committee chairman Kassebaum is an example of appropriate communication with Congress. I encourage everyone to carefully study it and seek to emulate it whenever possible.

Filed under: Lobbying

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