With all the focus in Washington on the ongoing effort to increase the debt ceiling, too little attention is being given to the work the U.S. Department of Health and Human Services is doing developing the framework for the implementation of Obamacare.
One proposed departmental rule deals with what may become a centralized database containing patient medical records and pharmaceutical claim information.
It's an extremely technical issue but Section 153.340 of a new HHS proposed rule dealing with Obamacare mandates that individual states (or the department) collect "raw claims data sets" from all insurers on all people with private coverage purchased either individually or through small employers, which includes that obtained from the new state exchanges the law requires be created. [See a collection of political cartoons on healthcare.]
HHS says these databases need to be developed to implement what healthcare policy experts call "risk adjustment methodologies," supposedly insuring that risk is fairly distributed across the insurance pool. And, starting in 2017 states may permit large employers to purchase coverage through exchanges in addition to small employers and individuals. However, there are already concerns that the information collected may somehow end up in some kind of national, centralized database that will include private information about virtually all insured Americans.
Onerous and intrusive on its face, the type of information to be collected and stored away include individual diagnoses, the type of care provided, the names of the healthcare providers seen, the amount paid, out-of-pocket liabilities, demographic data and encrypted social security number—all of which raise significant privacy concerns. [Read more about healthcare.]
A centralized government-controlled database—which HHS could develop as a default alternative simply by refusing to approve the approaches individual states take to the task at hand or by writing the federal requirements for the construction of the state databases that it could only be let to a single, specific contractor—would be extremely expensive to build and maintain. It would also give the government unprecedented access to private, proprietary information, such as the privately negotiated payment arrangements.
Allowing the federal government to create an unprecedented centralized database could be a back door to greater government control—or even a single payer system. Congress needs to do a better job keeping an eye on what HHS is doing in order to prevent further mischief before it starts.