Even before the Colorado legislature passed the All-Payer Database law and the Department of Health Care Policy and Financing turned your medical records over to CIVHC, a private 501(c)(3), the Independence Institute warned that allowing states to routinely requisition medical records would compromise medical privacy (see this, this, and this). The problem is that medical records contain so much personal data that individuals can be identified even if names and SSNs are redacted.
Bloomberg is now reporting that states hungry for revenue and flush with the power to requisition individual medical records are moving to capitalize on the value of that information by selling the information in those records to all comers. Unlike private companies, states and their agents are exempt from HIPAA requirements and therefore do not have to take data privacy especially seriously.
In an experiment, researchers were able to match several dozen people with their supposedly de-identified medical records by combining public record searches and the information in a sample group of records purchased for $50 from Washington State. Among other things, “an executive treated for assault was found to have a painkiller addiction,” and a “retiree who crashed his motorcycle was described as arthritic and morbidly obese.”
CIVHC’s “De-Identified” data set for Colorado includes type of insurance, gender, month and year of birth, city of residence, race/ethnicity, month and year of admission, where service was provided, the zip code where service was provided, the DEA code or National Provider Identifier number code for the person providing service, details of the drugs prescribed and how they were delivered, and all payment details for everything. The de-identified data set also includes details of family relationships, such as whether the person receiving services is the spouse or child of the person who owns the family insurance policy.
The attack on medical privacy also represents another front in the legislature’s war on rural Colorado. In rural areas with small populations, there is more than enough data in the “de-identified data set” to link individuals to their medical records.
Consider Montrose hospital. In 2012, it hosted 2,563 surgeries and 469 births. In 2011, the hospital received 77 percent of its patients from an area with a population of about 42,000. It contained about 7,000 females of childbearing age, 4,347 people between 25 and 34, and 127 black people. Its service area includes the town of Naturita, population 635. Census records show that there are 32 Hispanic residents fewer than 10 of whom were between the ages of 15 and 40 in 2010. If the de-identified data set includes a birth by a Hispanic mother from Naturita, it would not be difficult to match her to her medical records.
With the passage of the All-Payer Database, members of the Colorado legislature made it quite clear that protecting your medical privacy was not a priority. Until the law is repealed, along with similar requirements in ObamaCare, your medical records are for sale to the highest bidder.
Every future visit to a doctor or a hospital should be made with this in mind. If you need health care and you have, or have ever had, a health condition that you do not want to make public knowledge, you might be wise to travel to a state or foreign country that takes medical privacy more seriously.
IB-C-2013 (May 2013)
Author: Linda Gorman
Supporters of the Patient Protection and Affordable Care Act claim that it will reduce Colorado health care costs and health insurance premiums. Nonsense. Even economist Jonathan Gruber, an ObamaCare architect, estimated that it would increase premiums in Colorado’s individual market by 19 percent. Don’t be fooled when the businesses, bureaucrats, and non-profits who benefit from increasing your premiums choose to blame your higher costs on everything but the ObamaCare law.
by Linda Gorman
Gov. John Hickenlooper wants yet another expansion of Colorado Medicaid. This one will cover the more than 86,000 college students in Colorado that the Census Bureau estimates have incomes below the federal poverty level. It also will cover the unknown number of otherwise healthy single students above the poverty level who have incomes up to $15,414 a year. (Income figures do not include additional subsidies received for things like housing, child care, energy assistance and food.)
As the Hickenlooper Administration claims the expansion would enroll an additional 160,000 people, it seems that college students will be its primary beneficiaries.
Many Colorado colleges already require students to buy health coverage. But Medicaid enrollment is free and it covers everything from unnecessary emergency room visits and major surgery to over-the-counter drugs with $5 copays and no deductible. Students and their parents know a good deal when they see one.
Under the Hickenlooper plan, rational observers expect droves of students to drop their private coverage in favor of Medicaid. Since Medicaid enrollment is also open to anyone who can produce a driver’s license, photo ID or other proof of residence in Colorado, the expansion offers equal opportunity for the state’s taxpayers to pay for the health care of both in-state and out-of-state students.
The plan will cost taxpayers a bundle. Medicaid medical services premiums for the program’s least expensive adults are $3,000 a year per enrollee, according to the legislature’s Joint Budget Committee. Capitated payments (one flat fee for everyone) to regional organizations that provide mental health care will add another $278 for each adult without dependent children.
Groups that have managed care contracts with the state Medicaid program receive these payments for each person enrolled, whether services are used or not. This arrangement creates a financial incentive to encourage the state to enroll people in Medicaid regardless of need.
This may explain why people hear so little about the Colorado Indigent Care Program, a state program that already underwrites needed medical care for people who cannot afford it and are ineligible for Medicaid. It also may explain why the state continues to try to herd Medicaid recipients into managed care, even though it has admitted that managed care increases Medicaid expenditures. The Robert Wood Johnson Foundation also has concluded that Medicaid managed care does not save money.
In addition to paying for the new costs arising from the Medicaid caseload increase, Colorado taxpayers will have to make up for the tax revenues lost when people stop making payments to private insurers and start receiving benefits from the government.
Assuming that the federal government picks up the entire cost of medical service premiums for the first few years of the expansion, the Hickenlooper Administration estimates that state taxpayers will be on the hook for an additional $1.4 billion over the next 10 years. That assumption may understate the cost, given the state of the federal budget and the fact the Obama Administration has already proposed reducing federal funds.
Since increasing Colorado taxes is likely to trigger an exodus to other states with lower taxes, spending is a zero sum game. An additional $1.4 billion for the healthy college students means $1.4 billion less for expenditures on schools, roads, law enforcement and other core functions of state government.
This article originally appeared in Health Policy Solutions, January 24, 2013.
by Linda Gorman
The federal Patient Protection and Affordable Care Act (Obamacare) has radically restructured federal subsidy programs for medical care. For the first time in decades, Colorado can begin bringing state expenditures in line with tax revenues by using federal money to reverse the excessive growth in its Medicaid and child health insurance programs.
Shrinking Medicaid and CHP could make a lot of people better off. Obamacare makes subsidized commercial health coverage available for a large fraction of the healthy adults and children who make up the bulk of the state’s Medicaid and CHP caseloads. The catch is that people have to be ineligible for Medicaid and CHP in order to be eligible for the federally subsidized coverage.
Compared to Medicaid, commercial policies have historically reimbursed at significantly higher rates, making it easier to find a physician and to arrange for timely care. Low reimbursements generally translate into less care. A number of recent papers in medical literature report that Medicaid coverage is an independent predictor for increased mortality, extended hospital stays and higher costs. In some cases, Medicaid patients even have worse outcomes than uninsured patients.
Obamacare annual premiums for commercial coverage for people at 100 percent of the federal poverty level ($11,170 in money income in 2012) are limited to $217 for a single person. They increase by about $75 for each additional person. Federal poverty level income refers only to cash income.
It does not take into account subsidies from programs like those that provide means-tested assistance for food, housing, transportation, child care or heat. According to the 2010 Consumer Expenditure Survey, people with under $10,000 a year in pretax income spent about $1,000 on entertainment, $1,000 on food away from home, and more than $2,000 on private vehicle transportation.
Because Medicaid puts severe limits on the price that can be charged for care, Medicaid patients often have to wait. This increases the time price of care. Unpredictable waiting times are especially burdensome for hourly workers who aren’t getting paid while they wait.
Many low-income people would rather pay nominally higher prices for care than miss work, but Medicaid rules prevent this. When North Carolina Medicaid reduced the allowable one-stop supply of Medicaid prescription medications from 100 days to 34 days and raised the co-pay from $1 to $3, raising the time price led to a much greater reduction in the needed drugs obtained by chronically ill patients than increasing the price.
Even if Obamacare didn’t offer the opportunity to make many Medicaid clients better off by switching them to private insurance plans, Medicaid expansion makes little fiscal sense. Even though the federal government promises to cover the medical costs of Medicaid expansion through 2019, it does not cover the state share of additional administrative costs, which average an estimated $2.48 for each additional $100 of state Medicaid spending.
Plus, the Obama administration’s FY 2013 budget has already proposed making states pay more.
Even without expanding the program, Colorado Medicaid costs are set by an unknown amount.
Thanks to Obamacare’s individual mandate, some fraction of the one-third of the uninsured who are already Medicaid eligible but simply have not signed up because they don’t need health care will now sign up, swelling caseloads and costs. People who are eligible for Medicaid but who currently have private coverage will add to the rolls as employers respond to Obamacare by cutting hours and dropping employer coverage.
The state budget will also face increased demands for provider subsidies. Medicaid pays most providers less than cost, so increasing Medicaid caseloads can increase uncompensated care costs.
Finally, Obamacare makes deep cuts in Medicare reimbursements, a loss that will lead to calls for more taxpayer subsidies for Colorado’s government-owned hospitals.
This article originally appeared in the Pueblo Chieftan, January 6, 2013.