Government Access to your Private Medical Information

SB 2239 by *Kyle ( *HB 2289 by *Cobb C)

This bill was heavily amended prior to passage to provide addditional protection to Tennesseans. Information HERE.

Companion bill has been assigned Public Chapter Number 611 by the Secretary of State.


If you ask the average person if the government already knows far too much about each of us, they will readily agree. Well, the State of Tennessee will know far more about you and your PRIVATE medical information is we don’t stop SB 2239 by *Kyle ( *HB 2289 by *Cobb C), as amended, in its tracks.

When HB 2289 was in the House Government Operations committee, they spent over an hour debating the proposal with Republicans trying mightily to amend some of the more egregious provisions out, but were unsuccessful in those efforts.
This bill creates an “All Payer Claims Database”, a comprehensive database for the private healthcare transactions of every Tennessean by requiring insurance companies to turn their claims data over to the state. There are over 6,000 details about your heath history that would be made available through this legislation.
To view the categories, click HERE.
This new database will give to the Commissioner of the TN Department of Finance and Administration (presently Dave Goetz) your medical information in order to:
“Improve the accessibility and affordability of patient health care and health care coverage”
“Identify health and health care needs and inform on health and health care policy”
“Determine the capacity and distribution of existing health care resources”
“Evaluate the effectiveness of intervention programs on improving patient outcomes”
“Review costs among various treatment settings, providers, and approaches”
“Provide publicly available information on health care providers’ quality of care”
The Administration continues to assure legislators that this information will be protected by compliance with federal HIPAA requirements and other applicable privacy laws and policies. However, HIPPA clearly states that disclosure of Public Health Information is permitted to public heath authorities and they are authorized by law to collect or receive the information for purposes of preventing or controlling disease, injury or disability.  
In fact, here is what one expert on HIPPA had this to say:

“We call HIPAA the "NO-privacy" rule. It authorizes 600,000 entities, plus their business associates (estimated total of a million entities), to access private medical records for multiple (often patient-unfriendly) purposes without informed or written consent.”  

Although claimed that the insurance company will strip all identifiable information the bill does not state that. If that were the intent, the bill should contain a provision that insurances companies will only submit de-identified information in accordance with the ‘safe harbor’ method of requiring 18 specified identifiers to be removed from the database. See  National Institutes of Health HIPAA Privacy Rule.   

Suppose you or your physician do not want to participate? Well, neither of you have that choice. Insurance companies that fail to submit the required information will be fined up to $100 per day.
Other problems with this bill include the use of undefined terms. There is no definition for the “All Payer Claims Database”, “National Standards”, “national multi-collaborative stakeholders”, etc. It establishes a Tennessee Health Information Committee but does require meetings or outline a format.
What will something like this cost? Good question. The legislation’s current fiscal note is less than $200,000 but this only takes the cost to the state government into account.

It appears that this fiscal note is a gross under-estimate. In Minnesota, where similar legislation passed, the cost of the program exceeded $4 million in less than 4 years. Insurance companies are likely to incur great costs when forced to conform to an electronic form as prepared by the NCQA.
There is also evidence that passing this kind of legislation is being pursued in other states. Is there some sort of national implication here?
There are far to many ‘unknowns’ and potentially privacy invading provisions in this comprehensive legislation for it to passed by our lawmakers. This bill needs to be defeated.
Special thanks to Rep. Susan Lynn (R-Lebanon) who picked up on the problems with this legislation and has tirelessly researched this issue. Because of her diligence and tireless efforts, Rep. Lynn was successful in amending this legislation to prohibit the use of some identifying information thus adding an additional layer of protection for patient privacy.