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Discussion: Module 1

Topic: Legislative Act: 1996 Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act (HIPPA), passed by U.S. Congress in
1996 (The Henry J. Kaiser foundation, pg. 15, 2011), was enacted to improve efficiency and
effectiveness of health-care delivery by creating a national framework for health privacy
protection which builds on efforts by states, health systems, Individual organizations and
Individuals.

HIPPA, protects the rights of patients by providing access to their health information and
controlling inappropriate use or disclosure of patients information. Portability on the other hand,
deals with protecting healthcare coverage for employees who change jobs allowing them to carry
their existing plans with them. Before HIPAA privacy rule, personal information were shared or
disclosed with other hospitals, doctors offices, insurers or third party payers without the consent
of the patient, while state lines fell under a patch work of federal and state laws. As such,
patients information could be distributed without notice nor authorization for reasons other than
patient medical treatment or health care reimbursement. For example; a presumptive employer
could gain access to a potential employees medical file, and they may unfairly discriminate
based on a medical condition.

Personal privacy is important and a Right but often times indiscriminately abused and violated.
To curb this trend of indiscriminate disclosure and transfer of patients medical records without
consent, HIPAA created the strict provisions to allow an individual control his or her medical
history or other sensitive information. The provision though beneficial, has its own shortfalls.
The benefits which includes providing patients with better support to their healthcare coverage,
safeguarding their medical records, giving greater flexibility and definite rules, while expanding
the coverage base are all a benefit but the shortfalls increase costs and labor that is eventually
passed on to the patients. For instance, in compliance, Medical offices have employed the use of
computer software systems to keep patients data secured and have increased paperwork. Most
significant of the shortfalls is the danger patients face especially in emergency situations where
patients are unable to give consent which cause delays in the much needed treatment to help the
patient whose record is protected by HIPAA provisions.

Using my experience as a Patient Service Representative with Triwest Healthcare Alliance, if a


Veterans spouse calls in on behalf of a spouse without verbal approval or an Authorization to
disclose on file, we are unable to assist that veteran, care is therefore delayed or the referrals
gets returned to the Veterans Administration if no swift action is taken.

Nevertheless, this act was passed by congress for the benefit of consumers. The provisions and
safeguard of this act has been extremely helpful for us all, certain negativity may occur, but the
advantages outweighs its disadvantages. In conclusion, since change is the only constant, the act
will become more useful and stable for everyone.
Hi Oluwaseyi ,

I enjoyed reading your post. You had some very good points regarding the
Health Insurance Portability and Accountability Act (HIPAA). This act was very
important to put into place to protect the confidentiality of patient information. There
are many pros to the Health Insurance Portability and Accountability Act, but there are
also some cons to consider. HIPAA, for the first time, allowed patients the legal right to
see, copy, and correct their personal medical information. It also prevented employers
from accessing and using personal health information to make employment decisions.
And, it enabled patients with pre-existing conditions to change jobs without worrying
that their conditions would not be covered under a new employer's health plan.
However, HIPAA's effects have not all been positive. The regulations increased
the paperwork burden for doctors considerably, according to the American Medical
Association. HIPAA has spawned a mini-industry of companies and consultants who
help medical professionals comply with the law's lengthy provisions. In addition, some
professionals who deal with medical paperwork have become overcautious about
releasing protected information. There was also an increased need in technology such as
computer and software that will be used to keep the data privacy secured (Boyce, 2016).
All of this resulted in an increase of cost and labor.
The American Recovery and Reinvestment Act of 2009 (ARRA) was signed into
law on in 2009. It established a tiered civil penalty structure for HIPAA violations.
HIPAA violations can prove quite costly for healthcare organizations. First, the HIPAA
Breach Notification Rule within the regulations requires covered entities and any
affected business associates to notify patients following a data breach. In addition to the
notification costs, healthcare organizations can encounter fines. Providers could also
face criminal penalties stemming from violations of the HIPAA privacy and security
rules (Harl, 2015).

References

Boyce, B. (2016). Emerging Technology and the Health Insurance Portability and Accountability
Act. Journal of the Academy of Nutrition and Dietetics.

Harl, N. E. (2015). American Recovery and Reinvestment Act of 2009. Ag Decision Maker,
13(6), 1.

HIPAA-Health Insurance Portability and Accountability Act


In 1996 the Health Insurance Portability and Accountability Act (HIPAA)
was established as an Act. The main purpose of HIPAA was to provide
better portability and accountability of health insurance coverage. This
Act protects the confidentiality of patient information. It is illegal to
obtain patients personal health information (PHI) unless the reasons
deal with delivering health care, operations, or reimbursements. HIPAA
was put into affect to help alleviate any concerns patients or providers
might have about confidentiality with PHI.

When it comes to HIPAA, there are many different pros that we are
aware of. Patient privacy obviously being the number one pro that came
out of this Act. This allows that patient to correct or change any of their
information and also who is allows access to their data. HIPAA also avert
any sort of discrimination that could happen on a patient that has pre-
existing health issues. It provides simplification and portability for the
people. This act makes it change easy for the patient. It allows them to
change to plans that may cover their needs better than a prior plan the
patient may have had.

While there are many pros to the Health Insurance Portability and
Accountability Act, there are some cons to consider also. This Act is
anything but cost efficient for facilities. In order to keep this Act in place,
businesses had to be brought in to manage health care and computer
software. This is to ensure that HIPAA is not being violated. This also
creates more paperwork for different health care professionals. HIPAA
comes with many restrictions that will hinder the flow of patient
information. In some cases this can be seen as a pro, but in other cases it
can slow down the providing of care for a patient. It can provide
misinterpretations along the way too.

This Act has a major impact on health care today. HIPAA is a big issue
that is only becoming larger! The more we understand HIPAA and the
history of what brought it into affect, the better we can apply it to our
everyday use!

References

Shi, L., & Singh, D. (2015). Delivering health care in America: A systems approach (6th
ed.). Burlington, MA: Jones & Bartlett.
"HIPAA History". HIPAA Journal. N.p., 2016. Web. 31 Aug. 2016.

"Pros And Cons Of HIPAA - Hrfnd". HRFnd. N.p., 2014. Web. 31 Aug. 2016.

HISTORICAL EVENTS/CIRCUMSTANCES LEADING TO CREATING


THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA).

The Affordable Care Act is also known as the ObamaCare. Its the greatest
overhaul of the US health-care system, providing coverage for over 94%
of Americans. It has reform that gives health coverage for adults with
pre-existing conditions which hasnt be available up until now. It allows
comprehensive health insurance reforms that will extend over four years
and more.According to , The speaker of the House Nancy Pelosi in July
2009 and some Democrats from the House of Representatives revealed
their plan for overhauling the health-care system. It was named H.R.
3962, the Affordable Health Care for America Act. A Massachusetts
senator Ted Kennedy in August 25th of the same year, who was a leading
supporter of health-care reform died and reduced the number of Senate
Democrats who were 60 in number and in majority who s required to
pass an Act almost at jeopardy. Paul Kirk a Democrat appointed an
interim senator from Massachusetts to make up the 60 temporarily. In
November 7, 2009, the House of Representatives voted. 219 Democrats
and one Republican vote for the Affordable Health Care for America Act,
and 39 Democrats and 176 Republicans vote against the Act. In
December 24, 2009, the Senate version of the bill called the Americas
Healthy Future Act was voted for by 60 democrats and voted against by
39 republicans. In January 2010,Scott Brown, a Republican senator
replaced the late democrat Ted Kennedy and campaigned against the
Act. In March 11, 2010, the Senate Democrats used the budget
reconciliation to get it approved by the House and the Senate since they
lacked the 60th vote. The use of budget reconciliation only requires 51
Senators to vote in favor of the bill in order for it to go to the presidents
desk for signature. In March 21, 2010, The Senates version of the health-
care plan was approved in a 219-212 vote. With all Republicans and 34
Democrats vote against it. In March 23, 2010, President Obama signed
the Affordable Care Act into law.
DESCRIPTION AND INFLUENCE OF PPACA ACT ON THE U.S
HEALTH SYSTEM.

On March 23, 2010, President Obama signed the Affordable Care Act.
The following changes occurred.2010: A new Patient's Bill of Rights goes into
effect, protecting consumers from the worst abuses of the insurance industry. Cost-free
preventive services begin for many Americans. 2011: People with Medicare can get key
preventive services for free, and also receive a 50% discount on brand-name drugs in the
Medicare donut hole. 2012: Accountable Care Organizations and other programs help
doctors and health care providers work together to deliver better care. 2013: Open
enrollment in the Health Insurance Marketplace begins on October 1st. 2014: All
Americans will have access to affordable health insurance options. The Marketplace
allows individuals and small businesses to compare health plans on a level playing field.
Middle and low-income families will get tax credits that cover a significant portion of the
cost of coverage. And the Medicaid program will be expanded to cover more low-income
Americans. All together, these reforms mean that millions of people who were
previously uninsured will gain coverage, thanks to the Affordable Care Act.2015: The
Supreme Court is expected to render a decision on King v. Burwell by late June or early
July 2015.2016: The threshold for itemizing medical expenses on taxes increases from
7.5% to 10% for seniors. 2018: All existing health insurance plans must cover
preventive care and checkups without copayments.2020: The Medicare Part D
coverage gap (donut hole) is phased out.

The general influence of the Act were: New consumer protections were putting
Information for Consumers Online, Prohibiting Denying Coverage of Children Based on
Pre-Existing Conditions, Prohibiting Insurance Companies from Rescinding Coverage,
Eliminating Lifetime Limits on Insurance Coverage, Regulating Annual Limits on
Insurance Coverage, Appealing Insurance Company Decisions, Establishing Consumer
Assistance Programs in the States, Prohibiting Discrimination Due to Pre-Existing
Conditions or Gender, Eliminating Annual Limits on Insurance Coverage,Ensuring
Coverage for Individuals Participating in Clinical Trials. Quality of health was
improved and cost lowered by Providing Small Business Health Insurance Tax Credits,
Offering Relief for 4 Million Seniors Who Hit the Medicare Prescription Drug Donut
Hole., Providing Free Preventive Care, Preventing Disease and Illness, Cracking Down
on Health Care Fraud, Improving Preventive Health Coverage. Access to affordable
care was increased by Providing Access to Insurance for Uninsured Americans with Pre-
Existing Conditions, Extending Coverage for Young Adults, Expanding Coverage for
Early Retirees, Rebuilding the Primary Care Workforce, Holding Insurance Companies
Accountable for Unreasonable Rate Hikes, Allowing States to Cover More People on
Medicaid, Increasing Payments for Rural Health Care Providers, Strengthening
Community Health Centers, Increasing Medicaid Payments for Primary Care Doctors,
Open Enrollment in the Health Insurance Marketplace Begins. Insurance companies
are held accountable by Bringing Down Health Care Premiums, Addressing
Overpayments to Big Insurance Companies and Strengthening Medicare Advantage.

CONSEQUENCES OF IMPLEMENTATION OF PPACA ACT.


The consequences are both positive and negative. The positive
consequences include: Uninsured rate drops: For the first time in modern U.S.
history, the uninsurance rate fell precipitouslyfrom 20 percent to 15 percent among
adults ages 19 to 64 by the end of the first open enrollment period for the Affordable
Care Acts health insurance marketplaces. An estimated 10 million fewer Americans
were uninsured. Spending slowdown continues: We learned more in 2014 expenditures
grew more slowly than at any time since Medicare was passed 50 years ago..Delivery
system reform gathers steam: More than 600 public and private accountable care
organizations (ACOs) dot the landscape, covering an estimated 20 million Americans.
The percent of private health insurance payments that are value-based jumped from 11
percent to 40 percent in the past year, according to one study. (Both ACOs and value-
based payments are part of an effort to encourage higher-quality care and lower costs
through increased provider accountability for cost and quality.) Efforts to reduce
hospital-acquired conditions saved 50,000 lives and $12 billion since 2010.

The Negative consequences include:Republicans gained control of the U.S.


Congress and more: Supreme Court took up an ACA challenge in November 2015.

REFERENCES:
Centers for Medicare & Medicaid Services. (2015). History. Retrieved
fromhttp://www.cms.gov/About-CMS/Agency-Information/History/index.html?
redirect=/history/

The Henry J. Kaiser Family Foundation. (2011). Timeline: History of health reform in
the U.S. Retrieved fromhttp://kaiserfamilyfoundation.files.wordpress.com/2011/03/5-
02-13-history-of-health-reform.pdf

U.S. Department of Health & Human Services. (2015). Key features of the Affordable
Care Act by year. Retrieved
fromhttp://www.hhs.gov/healthcare/facts/timeline/timeline-text.html

Brookings Institute / Khan Academy. (2014). Introduction to the U.S. healthcare


system [Media file]. Retrieved fromhttps://www.khanacademy.org/partner-
content/brookings-institution/introduction%20to%20healthcare/v/introduction-to-
health-care

Laureate Education (Producer). (2015d). Historical perspective of the U.S. healthcare


delivery system [Video file]. Baltimore, MD: Author.
https://resources.ehealthinsurance.com/affordable-care-act/history-timeline-
affordable-care-act-aca