Report on the SB 329 Federal Laws Committee Meeting of 4/8/08

Submitted by Mallen Kear on Sat, 04/12/2008 - 12:32pm.

This week our Federal Laws committee met on Tuesday, April 8th, and heard presentations on HIPAA and EMTALA. As always, these observations are my own and don't represent the views of other committee members or of Archimedes.

At this meeting, I was struck by the enormity of the challenge of staying true to the goals of SB 329, not only because of the intertwine of state and federal law and health policy, but also because the issues themselves are all so interconnected. I'll give some examples from our meeting.

HIPAA, (The Health Insurance Portability and Accountability Act) was passed by Congress in ‘96 and began to be implemented in ‘03. It regulates how health care providers, insurers, and health care clearinghouses can disclose patient health information. States themselves can enact laws that impose more stringent requirements on disclosure. And indeed, Oregon state law imposes restrictions on the way mental health information can be disclosed, which is a possible barrier to the integrated health system that SB 329 wants to create.

Recently Oregon was one of several states to receive a grant to develop policy regarding the use of health information technology. We heard a presentation from Dr. Jody Pettit who is a member of the committee, The Health Information Infrastructure Advisory Committee, formed by Gov. Kulongoski to carry this work forward. Dr. Pettit reminded us of the wording of SB 329's proposal regarding HIT: "Using information technology that is cost-neutral or has a positive return on investment to deliver efficient, safe and quality health care and a voluntary program to provide every Oregonian with a personal electronic health record that is within the individual's control, use and access and that is portable." As Dr. Pettit pointed out, the SB 329 wording represents a complete policy shift, -to begin to see the individual health record not as the domain of the provider or insurer, with the patient having access upon request, but instead that the "home" for the record actually resides with the individual. She pointed out "the current legal framework does not support (SB 329's) goal of a personal health record."

At this meeting we also heard from a panel on EMTALA, (The Emergency Medical Treatment and Labor Act), passed by Congress in ‘86 to ensure public access to emergency services regardless of ability to pay. Several ED physicians not only testified in support of EMTALA, but also gave their views on current ED use. They stressed that changing ED use is not a simple matter of getting health care coverage for the currently uninsured, but instead also depends on increasing the primary care workforce and increasing reimbursement for primary care providers. There is currently a 30% shortage in the primary care workforce, and yet the federal Deficit Reduction Act of 2005 eliminates Medicaid reimbursement for graduate medical education, cutting Medicaid funding to facilities, like OHSU, that train medical residents.

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About Mallen
Before retiring in 2005, Mallen Kear was a staff RN on the medical floor at Providence St.Vincent Hospital in Portland. While there, she was dismayed at the number of severely ill patients who had no health care coverage and who were brought to the medical floor directly from the hospital ER.

After learning about the Archimedes Movement, Mallen became a supporter in early 2006, and started the Eastside Portland chapter in June of that year. When the Healthy Oregon Act was passed in 2007, Mallen followed its progress. She applied and became a member of the OHFB Federal Laws Committee, and attended many of the other committee meetings as well as meetings of the full Oregon Health Fund Board. She has been writing blogs about her observations for the Eastside Portland chapter since January of this year.