Preservation of Confidential Health Care for Young Adults

An interesting article titled “Health Reform and the Preservation of Confidential Health Care for Young Adults” written by Lauren Slive and Ryan Cramer appears in the Summer 2012 issue of the The Journal of Law, Medicine & Ethics (vol. 40, issue 2, pages 383-390).

A discussion is made regarding how sometimes when getting health care services confidential information can be inadvertently disclosed. If a breach of confidentiality can occur then a minor or young adult may not seek the health care services.

The authors state

“Of primary concern is that young adults, not just minors, who remain on their parents health insurance plans often forgo sensitive services with the concern that explanation of benefits (EOBs) from such services will inform their parents, the policyholders.”

In addition, of note and some may not be aware of, with the passage of the Affordable Care Act (ACA) in the U.S. adult children can remain on their parents’ health insurance plans until they are 26. However, the parent remains the policy holder here.

The authors discuss in five parts of the article confidential care as it relates to young adults. In part 1 the article addresses how young adult most choose between utilizing private health insurance coverage or maintaining their privacy. Part 2 discusses how a large number of adult children will remain on their parents’ health plans until age 26 now. A discussion is made in Part 3 about how state Medicaid programs are not required to send EOBs unlike private insurance companies.

In part 4 a discussion is made about competing disclosure and privacy considerations. The authors state

“While it may be asserted that EOBs are necessary to combat fraud, it seems difficult to argue that EOBs from adult childrens’ medical services must be sent to parent policyholders, instead of the young adult patient, where no liability for payment exists on the part of the policyholder. As such, this situation is outside the HIPAA exception that allows for PHI disclosure when necessary for payment, and likely constitutes a HIPAA violation when it occurs.”

Part 5 of the article addresses potential solutions.

I am not going to go into all of the details and discussion in this article but the important take home message is that the new ACA and extension of health insurance coverage from parents to children up to age 26 has many potential confidentiality issues that are not yet settled.

As I have discussed on this blog before the American Health Care system is in a dismal state and needs to be changed. See http://blog.teethremoval.com/american-health-care-system/.

A simple solution to all of the issues addressed in the article above would be to have a single-payer national health insurance such as that proposed by the Physicians for a National Health Program. http://www.pnhp.org/.