Getting “Hip” With HIPAA

Since we are on a bit of a statutory roll here, we thought we would continue to knock out a few more primers on some of the most important statutes that impact our business. Starting with this “strange animal.” Word to the wise, it has nothing to do with African semi-aquatic mammals of a similar sounding name.

This statute (known formally as the Health Insurance Portability and Accountability Act) was passed in 1996 during the Clinton era discussions about healthcare reform. It covers many areas important to everyone who needs healthcare, but there are some particular aspects of this law that we wanted to highlight, specifically as they interact with both Privacy Act requirements (a topic for a blog post coming soon), and of course our favorite two civil rights bills, the ADA and the Civil Rights Act of 1991.

Title I of HIPAA was the first real attempt to limit the ability of health insurers to exclude individuals for coverage based on pre-existing conditions. It is nowhere near as declarative in this regard as Obama’s current law, which is why we support this critical aspect of healthcare reform. This however, we anticipate will become less of an important piece of this statute as some form of Obamacare comes into practice.

Title II of HIPAA however, still has a lot of teeth, and we anticipate that this segment of the legislation will only grow in importance. Specifically, this section deals with the creation of standards for the dissemination of healthcare related information. Again this is tied into Privacy Act issues we’ll discuss another day, but these provisions are critical in maintaining not only medical privacy for individuals but their basic Constitutional Rights under both the ADA and The Privacy Act which include not only privacy but the right of due process. In the former, for one, it directly addresses the right of a PWD, for example, to better control who knows what about their disability. As the ADA is very clear on the rights of individuals who are “perceived” to have disabilities (whether they have them or not), this statute compliments that legislation for this demographic in very positive ways.

The so-called “Security Rule” deals with electronically transmitted medical information specifically. In other words, one has to be very careful where and how medical records are transmitted and stored on what databases and who should have access to them. This is the part of HIPAA that has proved to be particularly problematic for some of the larger IT players (and indeed some state actors, starting with North Carolina) to comply with.

Our service provision model we believe not only creates an answer for some of those ongoing issues and problems, we also plan to give access to advertisers to a very valuable demographic while protecting our customers’ medical privacy. We believe our model is unique among IT players who are entering this space or have wanted to for some time (such as Google and Facebook). What the specifics are we will decline to elaborate upon further at this time, but we have provided one model we intend to use on this site. Click on the taxi to the left of the blog post and we hope readers will see what we mean.

We as a company will be operating in some very highly regulated waters. We actually think its a very good thing. One of what we believe to be the value adds we bring to the table is a profitable operating model that actually makes its business case BECAUSE of regulation rather than in spite of it. While this may not be the case for every private enterprise out there, we think that some of the ideas and models we have created set new benchmarks and open new doors to profitability and innovation.

A Primer on The Civil Rights Act of 1991

Along with the passage of the ADA, another piece of legislation passed about the same time (The Civil Rights Act of 1991) guarantees PWDs the same Constitutional protections as minorities – specifically that they are worth the full “value” of a white man.

The Act was originally passed in the Reconstruction Era and until 1991 only applied to minorities. Ever afterwards, it also applied to the PWD community, even though legal challenges if not a broad understanding of the statute remains oblique and largely untested.

What the statute also essentially does is address not only the “contractual worth” of PWDs, it also ostensibly creates economic “rights” or an economic “floor” for PWDs. This means that, for example, a PWD may not be hired at less than the minimum wage (for example).

What it also does, however, is create mandates for the government where goods and services vital to maintaining that “contractual” worth are provided to this community.

Starting with, of course, healthcare.

While a great many of the failings of the ADA remain to be addressed thanks to aggressive federal push back in the courts (for example), one of the most instructive things to come out of the last twenty years of litigation under the Act was attempts to “define” a covered disability.

The ADA Restoration Act will address many of these issues, we hope, but taking from that line of reasoning, we contend that in fact, since so many people with disabilities require medication to manage their disabilities so as to not meet the federal standards of being “disabled” that this is actually a very interesting legal space right now. Specifically, using that logic, a person with a disability who can manage their disability with medication (starting with diabetes) is therefore guaranteed a certain “floor” of medical service. Without such service (including access to medication, regardless of the ability to pay), such a person very well may be “disabled.” With it, they will be a PWD, able to take their rightful place in society in every place the “able-bodied” now participate. As such, the state has a vested interest if not obligation (starting with a fiscal one if not a civil rights based one) to insure, if not is forced to require, unimpeded access for every PWD to state provided medication to preserve their “contractual value.”

We realize that for the non legal eagles reading this, this may all sound like complicated legal mumbo jumbo.

However in the middle of budget battles, from the federal to the state level, we think this is an important point to raise.

Particularly as we have a service provision model which not only addresses it but creates a very powerful “fix” that will reverberate both directly on the bottom line and in indirect costs that we anticipate will become increasingly obvious as we begin service provision.