ObamaCare to undermine financial, home privacy?

Will ObamaCare force Americans to reveal their banking data?  At National Review, Diana Furchtgott-Roth points out an interesting section of HR3200 dealing with health-care identity cards and what data will be required for them.  In Section 163, HR3200 envisions a national health-service card that handles electronic transactions for financial responsibility, including apparently patient-responsible payments:

Buried in the 1,017 pages of the House Democrats’ health-care bill is a little-noticed provision that for the first time could give the government access to the checking or credit-card information of every American. Under section 163, which is entitled “Administrative Simplification,” the bill sets new “standards” for electronic transactions between individuals and their health-care providers.

According to section 163, the standards will “enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service . . . ” In addition, they will “enable electronic funds transfers, in order to allow automated reconciliation with related health care payment and remittance advice.”

What is envisioned is a “machine-readable health plan beneficiary card” that, in addition to information about a person’s medical history, will contain checking-account or credit-card information, so as to allow electronic payments and, if a person is lucky, occasional remittances. Since under the proposed legislation everyone would be required to have health insurance, all Americans would have to provide this information.

The required collection of such data is unprecedented. At no other time has the government sought to collect this type of financial information from everyone in America.

My reading of Section 163 is somewhat more ambiguous than NR’s.  Here is the complete text of the section:

SEC. 163. ADMINISTRATIVE SIMPLIFICATION.

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(1) IN GENERAL- Part C of title XI of the Social Security Act (42 U.S.C. 1320d et seq.) is amended by inserting after section 1173 the following new section:CommentsClose CommentsPermalink

(a) Standardizing Electronic Administrative Transactions-CommentsClose CommentsPermalink

‘SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE TRANSACTIONS.
‘(a) Standards for Financial and Administrative Transactions-CommentsClose CommentsPermalink

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‘(A) be unique with no conflicting or redundant standards;CommentsClose CommentsPermalink

‘(B) be authoritative, permitting no additions or constraints for electronic transactions, including companion guides;CommentsClose CommentsPermalink

‘(C) be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications;CommentsClose CommentsPermalink

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‘(D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;CommentsClose CommentsPermalink

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‘(E) enable, where feasible, near real-time adjudication of claims;CommentsClose CommentsPermalink

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‘(F) provide for timely acknowledgment, response, and status reporting applicable to any electronic transaction deemed appropriate by the Secretary;CommentsClose CommentsPermalink

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‘(G) describe all data elements (such as reason and remark codes) in unambiguous terms, not permit optional fields, require that data elements be either required or conditioned upon set values in other fields, and prohibit additional conditions; andCommentsClose CommentsPermalink

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‘(H) harmonize all common data elements across administrative and clinical transaction standards.CommentsClose CommentsPermalink

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‘(A) clarify, refine, complete, and expand, as needed, the standards required under section 1173;CommentsClose CommentsPermalink

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‘(B) require paper versions of standardized transactions to comply with the same standards as to data content such that a fully compliant, equivalent electronic transaction can be populated from the data from a paper version;CommentsClose CommentsPermalink

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‘(C) enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice;CommentsClose CommentsPermalink

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‘(D) require timely and transparent claim and denial management processes, including tracking, adjudication, and appeal processing;CommentsClose CommentsPermalink

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‘(E) require the use of a standard electronic transaction with which health care providers may quickly and efficiently enroll with a health plan to conduct the other electronic transactions provided for in this part; andCommentsClose CommentsPermalink

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‘(F) provide for other requirements relating to administrative simplification as identified by the Secretary, in consultation with stakeholders.CommentsClose CommentsPermalink

‘(A) a process and timeframe with milestones for developing the complete set of standards;CommentsClose CommentsPermalink

‘(B) an expedited upgrade program for continually developing and approving additions and modifications to the standards as often as annually to improve their quality and extend their functionality to meet evolving requirements in health care;CommentsClose CommentsPermalink

‘(C) programs to provide incentives for, and ease the burden of, implementation for certain health care providers, with special consideration given to such providers serving rural or underserved areas and ensure coordination with standards, implementation specifications, and certification criteria being adopted under the HITECH Act;CommentsClose CommentsPermalink

‘(D) programs to provide incentives for, and ease the burden of, health care providers who volunteer to participate in the process of setting standards for electronic transactions;CommentsClose CommentsPermalink

‘(E) an estimate of total funds needed to ensure timely completion of the implementation plan; andCommentsClose CommentsPermalink

‘(F) an enforcement process that includes timely investigation of complaints, random audits to ensure compliance, civil monetary and programmatic penalties for non-compliance consistent with existing laws and regulations, and a fair and reasonable appeals process building off of enforcement provisions under this part.CommentsClose CommentsPermalink

‘(1) IN GENERAL- The Secretary shall adopt and regularly update standards consistent with the goals described in paragraph (2).CommentsClose CommentsPermalink

‘(2) GOALS FOR FINANCIAL AND ADMINISTRATIVE TRANSACTIONS- The goals for standards under paragraph (1) are that such standards shall–CommentsClose CommentsPermalink

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‘(3) TIME FOR ADOPTION- Not later than 2 years after the date of implementation of the X12 Version 5010 transaction standards implemented under this part, the Secretary shall adopt standards under this section.CommentsClose CommentsPermalink

‘(4) REQUIREMENTS FOR SPECIFIC STANDARDS- The standards under this section shall be developed, adopted and enforced so as to–CommentsClose CommentsPermalink

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‘(5) BUILDING ON EXISTING STANDARDS- In developing the standards under this section, the Secretary shall build upon existing and planned standards.CommentsClose CommentsPermalink

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‘(6) IMPLEMENTATION AND ENFORCEMENT- Not later than 6 months after the date of the enactment of this section, the Secretary shall submit to the appropriate committees of Congress a plan for the implementation and enforcement, by not later than 5 years after such date of enactment, of the standards under this section. Such plan shall include–CommentsClose CommentsPermalink

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‘(b) Limitations on Use of Data- Nothing in this section shall be construed to permit the use of information collected under this section in a manner that would adversely affect any individual.CommentsClose CommentsPermalink

‘(c) Protection of Data- The Secretary shall ensure (through the promulgation of regulations or otherwise) that all data collected pursuant to subsection (a) are–CommentsClose CommentsPermalink

(A) in paragraph (7), by striking ‘with reference to’ and all that follows and inserting ‘with reference to a transaction or data element of health information in section 1173 means implementation specifications, certification criteria, operating rules, messaging formats, codes, and code sets adopted or established by the Secretary for the electronic exchange and use of information’; andCommentsClose CommentsPermalink

(B) by adding at the end the following new paragraph:CommentsClose CommentsPermalink

‘(A) Requirements for data content using available and established national standards.CommentsClose CommentsPermalink

‘(B) Infrastructure requirements that establish best practices for streamlining data flow to yield timely execution of transactions.CommentsClose CommentsPermalink

‘(C) Policies defining the transaction related rights and responsibilities for entities that are transmitting or receiving data.’.CommentsClose CommentsPermalink

(A) by inserting ‘on behalf of an individual’ after ‘1978)’; andCommentsClose CommentsPermalink

(B) by inserting ‘on behalf of an individual’ after ‘for a financial institution.’CommentsClose CommentsPermalink

‘(1) used and disclosed in a manner that meets the HIPAA privacy and security law (as defined in section 3009(a)(2) of the Public Health Service Act), including any privacy or security standard adopted under section 3004 of such Act; andCommentsClose CommentsPermalink

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‘(2) protected from all inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses, as defined by the Secretary.’.CommentsClose CommentsPermalink

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(2) DEFINITIONS- Section 1171 of such Act (42 U.S.C. 1320d) is amended–CommentsClose CommentsPermalink

‘(9) OPERATING RULES- The term ‘operating rules’ means business rules for using and processing transactions. Operating rules should address the following:CommentsClose CommentsPermalink

(3) CONFORMING AMENDMENT- Section 1179(a) of such Act (42 U.S.C. 1320d-8(a)) is amended, in the matter before paragraph (1)–CommentsClose CommentsPermalink

(b) Standards for Claims Attachments and Coordination of Benefits -CommentsClose CommentsPermalink

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(1) STANDARD FOR HEALTH CLAIMS ATTACHMENTS- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall promulgate a final rule to establish a standard for health claims attachment transaction described in section 1173(a)(2)(B) of the Social Security Act (42 U.S.C. 1320d-2(a)(2)(B)) and coordination of benefits.CommentsClose CommentsPermalink

(2) REVISION IN PROCESSING PAYMENT TRANSACTIONS BY FINANCIAL INSTITUTIONS-CommentsClose CommentsPermalink

(A) IN GENERAL- Section 1179 of the Social Security Act (42 U.S.C. 1320d-8) is amended, in the matter before paragraph (1)–CommentsClose CommentsPermalink

(i) by striking ‘or is engaged’ and inserting ‘and is engaged’; andCommentsClose CommentsPermalink

(ii) by inserting ‘(other than as a business associate for a covered entity)’ after ‘for a financial institution’.CommentsClose CommentsPermalink

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(B) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply to transactions occurring on or after such date (not later than 6 months after the date of the enactment of this Act) as the Secretary of Health and Human Services shall specify.

This pertains more to being prepared for electronic transactions rather than requiring them, at least as far as the patient-provider transaction is concerned.  The point salient to the “individual” have to do with eligibility rather than payment, which already happens, especially in Medicare.  In fact, one of our providers has recently gotten very particular about calling for verification on every visit.  Section 1173A (4) covers payments and remittances, but only as regards to providers, not patients, and electronic payments and remittances from the insurers to the providers, at least as far as my reading goes.

This section does note that the establishment of electronic verification may include a machine-readable identity/insurance card, but it doesn’t mandate it.  The verification process is more on the backs of providers and insurers, not on the patient.  Some plans already have such cards, although most don’t.  The last two insurers I’ve had use simple plastic with text, and my wife’s Medicare Advantage plan uses a laminated paper card.

The same is true about the issue of home visitations.  People have construed Section 440 as mandating home visitations for implementing wellness programs aimed at children, but they’re missing a key word here:

SEC. 440. HOME VISITATION PROGRAMS FOR FAMILIES WITH YOUNG CHILDREN AND FAMILIES EXPECTING CHILDREN.
‘(a) Purpose- The purpose of this section is to improve the well-being, health, and development of children by enabling the establishment and expansion of high quality programs providing voluntary home visitation for families with young children and families expecting children.

That word, of course, is voluntary.  This section provides more funding in the form of block grants to existing state programs that already provide home visitation for families who are unable to get regular clinic visits for financial or other reasons.  It doesn’t provide any new federal mandate for such programs, although it does require states to prove the effectiveness of the programs they fund with the block grants.

There is a legitimate argument to make that any government program that is voluntary can be made compulsory at some time, especially once government becomes completely responsible for our health care.  That’s one good reason to oppose ObamaCare, among many, and certainly these sections make for good “what-ifs” along those lines.  As currently constructed, though, the evidence doesn’t support the conjecture for the specific arguments above.

We have plenty of good arguments against HR3200, especially on cost, government intrusiveness, efficiency, and much more.  Let’s not get too lost in the weaker arguments.

Update: Sorry about the formatting; the OpenCongress site isn’t terribly conducive to cut & paste.  Mea culpa.

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