Clinton Issues Health Privacy Rules
President Clinton issued sweeping new
privacy protections Wednesday, December 20, 2000 that, for the first time, will
sharply limit doctors, hospitals and insurance companies from sharing
confidential medical information about their patients.
"Nothing is more
private than someone's medical or psychiatric records," Clinton said. "If we
are to make freedom fully meaningful in the information age, when most of our
stuff is on some computer somewhere, we have to protect the privacy of
individual health records."
Until now, there's been no federal law
protecting medical privacy, even as technology allows personal information to
bounce swiftly from one computer to the next. Clinton said his actions
Wednesday were the most he could do to protect individual medical records, and
called on Congress to pass more protections.
Nearly a decade in the
making, the new rules were intensely debated as privacy advocates sought broad
protections and industry officials looked for greater flexibility.
the rules, patients could sign a one-time consent form on their first visit to
a doctor allowing disclosures for routine matters like billing and treatment.
But they would have to explicitly authorize most other uses of their records,
said administration officials and others who have been briefed on the
Patients also are gaining the right to inspect and request
corrections to their records. And employers will be barred from pursuing
medical information about their workers unless it's directly related to
providing health care.
"This will touch nearly every aspect of health
care," said Janlori Goldman, who directs the Health Privacy Project at
Georgetown University. "We have tried for years to get these protections, and
we have been unsuccessful until now. This is just a huge victory."
the rules, which take effect in two years, violators face civil and criminal
fines and in severe cases, prison.
Until now, patients have had to rely
on state laws, which range from comprehensive to nonexistent.
federal rules cover both electronic and paper records, as well as oral
communications - a major change won by privacy advocates. As originally
proposed last year, the rules would have affected only electronic
And, in a change won by industry, the administration deleted a
provision that could have opened the door for patients to sue if their records
were improperly released.
The administration would have liked to include
an explicit new right to lawsuits, but did have the legislative authority to do
Law enforcement agencies could obtain access to records with an
administrative subpoena or summons, but they would not have to go to court as
advocates would have liked.
The ACLU worries that it will be too easy
for the police to get their hands on private records, said Ronald Weich,
legislative consultant to the civil liberties group. But overall, he said, "we
think it's a significant step forward."
The administration revised its
initial regulation after receiving some 52,000 comments from the public, an
overwhelming number that highlights the intense interest in the
President-elect Bush could undo the rules with a new regulation,
but starting over would be a tremendous task. Likewise, Congress could overturn
them, but lawmakers would be unlikely to agree on specific changes.
health industry supports the notion of improved medical privacy, but worries
because the rule allows states to write even stricter
"Without uniformity, the regulations are going to cause more,
not less, confusion," Chip Kahn, president of the Health insurance Association
of America, complained.
And industry officials argued that requiring
consent might prevent doctors and insurers from trading information needed to
ensure quality health care.
In 1996, Congress gave the Department of
Health and Human Services the power to issue privacy regulations if it failed
to enact legislation within three years. Negotiators in the Senate came close
but couldn't close the deal.
"The administration has done mush of what
Congress should have done," said Sen. Patrick Leahy, D-Vt., a leader in the
Administration officials estimate the rules will cost the
health care industry and employers about $17.6 billion over 10 years, but that
would be offset by an estimated $30 billion in savings from companion rules
that eliminate paperwork, and allow for electronic filing of insurance
The new regulation also:
-Requires health providers and
insurance companies to rewrite contracts with business partners, including
attorneys, auditors and consultants, to ensure they adhere to the privacy
rules. But if the outside businesses violate the rules, there are no federal
-Holds health care providers responsible for the partners'
violations only if they knew about them. The original proposal held them
accountable if they should have known.
-Provides for a range of
Violators who unintentionally disclose information would
face civil fines of $100. Per violation, up to a total of $25,000 per
Those who intentionally disclose information face criminal
sanctions of up to $50,000 and up to a year in prison. And intent to sell the
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