[Med-privacy] The Narional Journal: Lobbying & Law - Partisan Rift Over Patient Privacy

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The National Journal=20
=20
07-01-2006
Lobbying & Law - Partisan Rift Over Patient Privacy
Danielle Belopotosky=20
=C2=A9 National Journal Group, Inc.

Legislation to help foster a nationwide electronic health care system was su=
pposed to be an easy win on Capitol Hill this year. But in June, as the Hous=
e Energy and Commerce Committee marked up a health-information technology bi=
ll to modernize one of the last bastions of the pre-Internet age, a partisan=
 rift emerged over whether to include tough language on privacy.

Committee Democrats made repeated but unsuccessful attempts to pass amendmen=
ts that would set new rules to protect patients' health information. At one=20=
point, the panel's ranking member, Rep. John Dingell, D-Mich., tried to pers=
uade Republicans by reminding them of President Bush's own words on health p=
rivacy. "I presume I'm like most Americans," the president said in January 2=
005, "I think my medical records should be private."

The Patient Privacy Rights Foundation, an advocacy group that supported the=20=
Democratic push, dug up a series of Bush's comments on medical privacy over=20=
the past two years. Deborah Peel, chairwoman of the foundation and a promine=
nt psychiatrist and psychoanalyst from Austin, has briefed anyone on "the Hi=
ll who will listen. There "has been no exploration of the downside of wiring=
 all these records," she said.

According to Peel, data from the Health and Human Services Department show t=
hat more than 600,000 entities -- from solo practitioners to credit bureaus=20=
to large government agencies -- can legally grab personal medical informatio=
n without a patient's knowledge. She briefed Rep. Nathan Deal, R-Ga., the ch=
airman of the panel's Health Subcommittee, who, she said, has had "a lot of=20=
sympathy for privacy." But in the markup, Deal strongly urged his colleagues=
 to reject additional privacy language, citing the need to avoid "piecemeal=20=
action" on any bill dealing with data security.

A coalition of 21 organizations pushing for patient privacy -- including the=
 American Association of Practicing Psychiatrists, the California Medical As=
sociation, and the National Coalition of Mental Health Professionals and Con=
sumers -- declared in a letter to Committee Chairman Joe Barton, R-Texas, an=
d Dingell that unauthorized disclosure of medical histories has caused peopl=
e to lose jobs, be denied credit and insurance, and get expelled from colleg=
e.

"There are countless stories of people being harmed and discriminated agains=
t when others know information about their health care treatments," the coal=
ition's letter stated, adding that any health-information technology bill th=
at does not have "ironclad privacy rights is a prescription for disaster."

The AFL-CIO, the American Federation of Teachers, the March of Dimes, and ot=
her groups also sent letters to House members urging stronger privacy and se=
curity protections.

With the recent security breach at the Veterans Affairs Department -- which=20=
put 26.5 million people at risk of identity theft -- as the backdrop, the Am=
erican Psychoanalytic Association noted in a letter to Deal that a Bush-appo=
inted commission of computer security experts has reported that the "nation'=
s electronic information systems are 'highly vulnerable' to corruption by ha=
ckers and others."

Peel asks, "Must Congress sit and wait for its own hurricane-level disaster=20=
in medical privacy, when we can see it coming?"

But Republicans have resisted the call to amend the decade-old Health Insura=
nce Portability and Accountability Act, the main federal health-information=20=
privacy law. Rep. Charlie Norwood, R-Ga., who sits on Energy and Commerce, h=
as noted that HIPAA's privacy rule, which was implemented in 2001, is "many,=
 many pages long and very sophisticated" and that any changes need to fit in=
to existing law.

References to "HIPAA wars" have been floating around the halls of Congress i=
n recent weeks, said Scott Wallace, president and CEO of the National Allian=
ce for Health Information Technology, which represents health plans, employe=
rs, and other purchasers of health care, as well as information-technology v=
endors and medical groups. "People behave as though they have been in some s=
ort of combat situation," he said.

Democrats also tried to strengthen privacy protections when the House Ways a=
nd Means Committee marked up its version of health-information technology le=
gislation, authored by Rep. Nancy Johnson, R-Conn. The Democratic-sponsored=20=
amendments failed along party lines.

Johnson's bill requires HHS to study the similarities and differences betwee=
n state and federal confidentiality and information-security laws, to determ=
ine what the effect has been on the flow of health information.

The national alliance supports the privacy language in Johnson's bill, but W=
allace says the Ways and Means debate raised important questions about the n=
eed for a common set of laws. Moreover, he said, given the bipartisan suppor=
t for health-information technology over the past three years, the current "=
partisanship has been a surprise to me. To see party-line votes on amendment=
s has been disappointing."

Meanwhile, the technology industry, which wants to see a bill cross the fini=
sh line before the August recess, has been lobbying House members to keep le=
gislation on track. The industry has a clear idea of what it wants the gover=
nment to do: remove regulatory and policy hurdles and make the private marke=
tplace the engine for driving the adoption of health-information technology.

Given the vastness of this initiative, the technology industry sees unpreced=
ented opportunity. "There is a real stake here" for the tech industry, David=
 Brailer, HHS's former "e-czar," told National Journal. "A lot of tech compa=
nies are seeing potential" in developing communications and networking tools=
 and in allowing medical records to be accessed anytime, from any computer,=20=
he said.

While the health care sector has adopted emerging technologies, it has yet t=
o be propelled into the digital age, Intel Chairman Craig Barrett said at a=20=
technology briefing earlier this year. The Technology CEO Council, which Bar=
rett formerly chaired, is just one lobbying group that has elevated health-i=
nformation technology legislation to a priority goal.

Last August, an article in the Annals of Internal Medicine estimated that it=
 would cost $156 billion over five years, plus $48 billion in annual operati=
ng costs, to establish electronic medical records on a wide basis across the=
 United States. Today, fewer than 25 percent of hospitals and 15 percent of=20=
doctors use some form of electronic records, according to a study published=20=
in the September 2005 issue of Health Affairs.

The goal is to reduce medical errors, improve the quality of health care, an=
d reduce costs. A recent study by Rand estimates savings of $77 billion per=20=
year once 90 percent of facilities and practitioners adopt electronic record=
s. Through the use of health-information technology such as e-medical record=
s, the clipboard could one day be rendered extinct, duplicative tests could=20=
be eliminated, and personal health information could be made portable.

With most of the country's 800,000 licensed physicians and pharmacists, 12 m=
illion health care workers, and 6,000 hospitals and health care centers stil=
l off-line, it is not surprising that the technology sector quickly jumped b=
ehind a 2004 Bush plan to transform the $1.7 trillion U.S. health care indus=
try.

Through a series of ad campaigns, policy recommendations, and shoe-leather l=
obbying on Capitol Hill, big tech players and e-health advocates have aligne=
d their forces to deliver the message that it's not technology that will hin=
der the adoption of health-information technology. Rather, it's a fight over=
 whether Congress will put up the money and streamline regulations to foster=
 the adoption of a health IT system.

Over the past year, Intel and other tech-industry heavy hitters have been co=
nducting weekly conference calls for what's known as the "Friday group," sai=
d Jeremy Bonfini, Intel's health issues lobbyist. Tech interests have also h=
eld hundreds of meetings with congressional staffers since 2004, when the pr=
esident promised every American access to an electronic medical record withi=
n 10 years.

The National Alliance for Health Information Technology, AARP, the U.S. Cham=
ber of Commerce, Dell, eHealth Initiative, IBM, Intel, and dozens of other c=
ompanies and groups have backed a bipartisan Senate bill that includes fundi=
ng mechanisms to foster the adoption of e-medical records among practitioner=
s but steers clear of establishing new privacy rules. Tech interests are als=
o focused on ensuring that HHS adopts national standards for sharing and sto=
ring electronic data.

As health-information technology legislation has been put on the fast track,=
 Bonfini said, "we want to maintain a balance of Congress creating a lot of=20=
energy around standards without stifling industry."

While the House continues to reconcile the two health-information technology=
 bills from the Energy and Commerce and the Ways and Means committees, the p=
rivacy issue is so difficult, said Rep. Lois Capps, D-Calif., who sits on En=
ergy and Commerce, that it isn't likely to be resolved until a final floor v=
ote, or even until a House-Senate conference.

Sources said that Energy and Commerce Chairman Barton is considering an omni=
bus bill to cover all data-related privacy and security regulations, not jus=
t health-information technology. Sen. Hillary Rodham Clinton, D-N.Y., meanwh=
ile, said in late June that she will introduce comprehensive privacy legisla=
tion, which will include a medical privacy provision.

"We cannot wait," Capps argues, adding that health-information technology le=
gislation "must contain privacy protections."


=20
________________________________________________________________________
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<H3 style=3D"LINE-HEIGHT: 13.5pt"><B><FONT face=3D"Trebuchet MS" color=3Dbla=
ck size=3D3><SPAN style=3D"FONT-SIZE: 12pt">07-01-2006</SPAN></FONT></B></H3=
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<H3 style=3D"LINE-HEIGHT: 13.5pt"><B><FONT face=3D"Trebuchet MS" color=3Dbla=
ck size=3D3><SPAN style=3D"FONT-SIZE: 12pt"></SPAN></FONT></B><B><FONT face=
=3D"Trebuchet MS" color=3Dblack size=3D4><SPAN style=3D"FONT-SIZE: 14pt">Lob=
bying &amp; Law - Partisan Rift Over Patient Privacy<o:p></o:p></SPAN></FONT=
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<DIV class=3DMsoNormal style=3D"LINE-HEIGHT: 13.5pt"><FONT face=3DTimes size=
=3D3><SPAN style=3D"FONT-SIZE: 12pt; FONT-FAMILY: Times">Danielle Belopotosk=
y <BR>=C2=A9 National Journal Group, Inc.<BR><BR>Legislation to help foster=20=
a nationwide electronic health care system was supposed to be an easy win on=
 Capitol Hill this year. But in June, as the House Energy and Commerce Commi=
ttee marked up a health-information technology bill to modernize one of the=20=
last bastions of the pre-Internet age, a partisan rift emerged over whether=20=
to include tough language on privacy.<BR><BR>Committee Democrats made repeat=
ed but unsuccessful attempts to pass amendments that would set new rules to=20=
protect patients' health information. At one point, the panel's ranking memb=
er, Rep. <B><SPAN style=3D"FONT-WEIGHT: bold">John Dingell</SPAN></B>, D-Mic=
h., tried to persuade Republicans by reminding them of President Bush's own=20=
words on health privacy. "I presume I'm like most Americans," the president=20=
said in January 2005, "I think my medical records should be private."<BR><BR=
>The Patient Privacy Rights Foundation, an advocacy group that supported the=
 Democratic push, dug up a series of Bush's comments on medical privacy over=
 the past two years. Deborah Peel, chairwoman of the foundation and a promin=
ent psychiatrist and psychoanalyst from <?xml:namespace prefix =3D st1 ns=20=
=3D "urn:schemas-microsoft-com:office:smarttags" /><st1:place w:st=3D"on"><s=
t1:City w:st=3D"on">Austin</st1:City></st1:place>, has briefed anyone on "th=
e Hill who will listen. There "has been no exploration of the downside of wi=
ring all these records," she said.<BR><BR>According to Peel, data from the H=
ealth and Human Services Department show that more than 600,000 entities --=20=
from solo practitioners to credit bureaus to large government agencies -- ca=
n legally grab personal medical information without a patient's knowledge. S=
he briefed Rep. <B><SPAN style=3D"FONT-WEIGHT: bold">Nathan Deal</SPAN></B>,=
 R-Ga., the chairman of the panel's Health Subcommittee, who, she said, has=20=
had "a lot of sympathy for privacy." But in the markup, Deal strongly urged=20=
his colleagues to reject additional privacy language, citing the need to avo=
id "piecemeal action" on any bill dealing with data security.<BR><BR>A coali=
tion of 21 organizations pushing for patient privacy -- including the Americ=
an Association of Practicing Psychiatrists, the California Medical Associati=
on, and the National Coalition of Mental Health Professionals and Consumers=20=
-- declared in a letter to Committee Chairman <B><SPAN style=3D"FONT-WEIGHT:=
 bold">Joe Barton</SPAN></B>, R-Texas, and Dingell that unauthorized disclos=
ure of medical histories has caused people to lose jobs, be denied credit an=
d insurance, and get expelled from college.<BR><BR>"There are countless stor=
ies of people being harmed and discriminated against when others know inform=
ation about their health care treatments," the coalition's letter stated, ad=
ding that any health-information technology bill that does not have "ironcla=
d privacy rights is a prescription for disaster."<BR><BR>The AFL-CIO, the Am=
erican Federation of Teachers, the March of Dimes, and other groups also sen=
t letters to House members urging stronger privacy and security protections.=
<BR><BR>With the recent security breach at the Veterans Affairs Department -=
- which put 26.5 million people at risk of identity theft -- as the backdrop=
, the American Psychoanalytic Association noted in a letter to Deal that a B=
ush-appointed commission of computer security experts has reported that the=20=
"nation's electronic information systems are 'highly vulnerable' to corrupti=
on by hackers and others."<BR><BR>Peel asks, "Must Congress sit and wait for=
 its own hurricane-level disaster in medical privacy, when we can see it com=
ing?"<BR><BR>But Republicans have resisted the call to amend the decade-old=20=
Health Insurance Portability and Accountability Act, the main federal health=
-information privacy law. Rep. <B><SPAN style=3D"FONT-WEIGHT: bold">Charlie=20=
Norwood</SPAN></B>, R-Ga., who sits on Energy and Commerce, has noted that H=
IPAA's privacy rule, which was implemented in 2001, is "many, many pages lon=
g and very sophisticated" and that any changes need to fit into existing law=
.<BR><BR>References to "HIPAA wars" have been floating around the halls of C=
ongress in recent weeks, said Scott Wallace, president and CEO of the Nation=
al Alliance for Health Information Technology, which represents health plans=
, employers, and other purchasers of health care, as well as information-tec=
hnology vendors and medical groups. "People behave as though they have been=20=
in some sort of combat situation," he said.<BR><BR>Democrats also tried to s=
trengthen privacy protections when the <st1:Street w:st=3D"on"><st1:address=20=
w:st=3D"on">House Ways</st1:address></st1:Street> and Means Committee marked=
 up its version of health-information technology legislation, authored by Re=
p. <B><SPAN style=3D"FONT-WEIGHT: bold">Nancy Johnson</SPAN></B>, R-Conn. Th=
e Democratic-sponsored amendments failed along party lines.<BR><BR>Johnson's=
 bill requires HHS to study the similarities and differences between state a=
nd federal confidentiality and information-security laws, to determine what=20=
the effect has been on the flow of health information.<BR><BR>The national a=
lliance supports the privacy language in Johnson's bill, but Wallace says th=
e Ways and Means debate raised important questions about the need for a comm=
on set of laws. Moreover, he said, given the bipartisan support for health-i=
nformation technology over the past three years, the current "partisanship h=
as been a surprise to me. To see party-line votes on amendments has been dis=
appointing."<BR><BR>Meanwhile, the technology industry, which wants to see a=
 bill cross the finish line before the August recess, has been lobbying Hous=
e members to keep legislation on track. The industry has a clear idea of wha=
t it wants the government to do: remove regulatory and policy hurdles and ma=
ke the private marketplace the engine for driving the adoption of health-inf=
ormation technology.<BR><BR>Given the vastness of this initiative, the techn=
ology industry sees unprecedented opportunity. "There is a real stake here"=20=
for the tech industry, David Brailer, HHS's former "e-czar," told <I><SPAN s=
tyle=3D"FONT-STYLE: italic">National Journal</SPAN></I>. "A lot of tech comp=
anies are seeing potential" in developing communications and networking tool=
s and in allowing medical records to be accessed anytime, from any computer,=
 he said.<BR><BR>While the health care sector has adopted emerging technolog=
ies, it has yet to be propelled into the digital age, Intel Chairman Craig B=
arrett said at a technology briefing earlier this year. The Technology CEO C=
ouncil, which Barrett formerly chaired, is just one lobbying group that has=20=
elevated health-information technology legislation to a priority goal.<BR><B=
R>Last August, an article in the Annals of Internal Medicine estimated that=20=
it would cost $156 billion over five years, plus $48 billion in annual opera=
ting costs, to establish electronic medical records on a wide basis across t=
he <st1:place w:st=3D"on"><st1:country-region w:st=3D"on">United States</st1=
:country-region></st1:place>. Today, fewer than 25 percent of hospitals and=20=
15 percent of doctors use some form of electronic records, according to a st=
udy published in the September 2005 issue of Health Affairs.<BR><BR>The goal=
 is to reduce medical errors, improve the quality of health care, and reduce=
 costs. A recent study by <st1:place w:st=3D"on">Rand</st1:place> estimates=20=
savings of $77 billion per year once 90 percent of facilities and practition=
ers adopt electronic records. Through the use of health-information technolo=
gy such as e-medical records, the clipboard could one day be rendered extinc=
t, duplicative tests could be eliminated, and personal health information co=
uld be made portable.<BR><BR>With most of the country's 800,000 licensed phy=
sicians and pharmacists, 12 million health care workers, and 6,000 hospitals=
 and health care centers still off-line, it is not surprising that the techn=
ology sector quickly jumped behind a 2004 Bush plan to transform the $1.7 tr=
illion <st1:place w:st=3D"on"><st1:country-region w:st=3D"on">U.S.</st1:coun=
try-region></st1:place> health care industry.<BR><BR>Through a series of ad=20=
campaigns, policy recommendations, and shoe-leather lobbying on Capitol Hill=
, big tech players and e-health advocates have aligned their forces to deliv=
er the message that it's not technology that will hinder the adoption of hea=
lth-information technology. Rather, it's a fight over whether Congress will=20=
put up the money and streamline regulations to foster the adoption of a heal=
th IT system.<BR><BR>Over the past year, Intel and other tech-industry heavy=
 hitters have been conducting weekly conference calls for what's known as th=
e "Friday group," said Jeremy Bonfini, Intel's health issues lobbyist. Tech=20=
interests have also held hundreds of meetings with congressional staffers si=
nce 2004, when the president promised every American access to an electronic=
 medical record within 10 years.<BR><BR>The National Alliance for Health Inf=
ormation Technology, AARP, the U.S. Chamber of Commerce, Dell, eHealth Initi=
ative, IBM, Intel, and dozens of other companies and groups have backed a bi=
partisan Senate bill that includes funding mechanisms to foster the adoption=
 of e-medical records among practitioners but steers clear of establishing n=
ew privacy rules. Tech interests are also focused on ensuring that HHS adopt=
s national standards for sharing and storing electronic data.<BR><BR>As heal=
th-information technology legislation has been put on the fast track, Bonfin=
i said, "we want to maintain a balance of Congress creating a lot of energy=20=
around standards without stifling industry."<BR><BR>While the House continue=
s to reconcile the two health-information technology bills from the Energy a=
nd Commerce and the Ways and Means committees, the privacy issue is so diffi=
cult, said Rep. <B><SPAN style=3D"FONT-WEIGHT: bold">Lois Capps</SPAN></B>,=20=
D-Calif., who sits on Energy and Commerce, that it isn't likely to be resolv=
ed until a final floor vote, or even until a House-Senate conference.<BR><BR=
>Sources said that Energy and Commerce Chairman Barton is considering an omn=
ibus bill to cover all data-related privacy and security regulations, not ju=
st health-information technology. Sen. <B><SPAN style=3D"FONT-WEIGHT: bold">=
Hillary Rodham Clinton</SPAN></B>, D-N.Y., meanwhile, said in late June that=
 she will introduce comprehensive privacy legislation, which will include a=20=
medical privacy provision.<BR><BR>"We cannot wait," Capps argues, adding tha=
t health-information technology legislation "must contain privacy protection=
s."<FONT color=3Dblack><SPAN style=3D"COLOR: black"><o:p></o:p></SPAN></FONT=
></SPAN></FONT></DIV></TD></TR></TBODY></TABLE>
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