In August of 1996 congress passed the Health Insurance Portability and Accountability Act (HIPAA) patients began to see an improvement in the access and consistency of the health insurance coverage. It was not until April 14, 2003 that the privacy portion was passed protection personal health information. Many states have individual laws that were already in place to protect the health information of patients. HIPAA was not intended to eliminate the state law but to cover that which was not addressed by state laws. The state law will prevail providing it is more stringent than the HIPAA policy. In general, the passing of the HIPAA gave patients additional information and greater access to personal medical information while protecting that same information from inappropriate disclosure. Some of the protected information that has raised controversial concerns is regarding a minor’s right to privacy and parental access.
Minor’s Rights versus Parental Rights
HIPAA rules regulate the authorized individuals that legally can obtain a person’s private health information. HIPAA recognizes parents and guardians as “personal representatives,” which permits authorization and access as appropriate with the regulations. The guidelines provide that person that has legal authority over another adult or emancipated minor shall be considered the personal representative and afforded such authority as relevant to the law. The second part addresses unemancipated minors and parents or guardians, shall be regarded as personal representation and give the appropriate authority for decisions regarding a patients PHI (Mary Beth Kirven & Daniel J. Hall, 2003). There are exceptions as with any rules and those exceptions are as follows:
1. The minor consents to such health care service; no other consent to such health care service is required by law, regardless of whether the consent of another person has also been obtained; and the minor has not requested that such person be treated as the personal representative. 2. The minor may lawfully obtain such health care service without the consent of a parent, guardian or other person acting in loco parentis, and the minor, a court, or another person authorized by law consents to such health care service. 3. A parent, guardian, or other person acting in loco parentis assents to an agreement of confidentiality between a covered health care provider and the minor with respect to such health care service (Mary Beth Kirven & Daniel J. Hall, 2003).
These exceptions provide for a minor, the ability to keep only specific health information as confidential from any individual which the minor chooses. In the state of Michigan, this information is protected only if for treatment of pregnancy, HIV or venereal disease and substance abuse (FindLaw, 2011). Benefits could be made by adding contraception to the protected information in the HIPAA policy as well in an effort to protect minors that reside in states that have no laws or public policy that address such issues. Teens have a right to conceal medical information only regarding pregnancy or infection of a sexually transmitted disease or actively addicted to drugs, which will then allow the privilege of privacy. This teaches teenagers that poor decision making will be rewarded with the opportunity to make more decisions.
Promiscuous Adolescent Behavior
Since the early 1970’s adolescent sexual activity has been in the public eye, the actual rate of activity had not changed, it only become more obvious. The average age of marriage was increasing along with the estimated life expectancy. The population was simply waiting longer to get married but not waiting to have sex. The media have placed these topics to the front of this nation with the various stories that seem to glamorize both sex and teen pregnancy. The United States is a nation that has sex everywhere, most entertainment media and many marketing tools use sexuality to attract the consumer and sell the products.
Society needs education and accessibility to counter balance the exposure that is forced upon them from marketers in an effort to keep the sexual content to a minimum and to have the ability to see beyond the sexual nature of the actual products’ uses and its benefits’. Speculation is that the awareness created through these controversial television series (Teen Mom, 16 and pregnant) has contributed to the decrease in teen pregnancy. According to Women’s Health and Health Care Reform, “The United States continues to have the highest teen pregnancy rate of developed countries (Chavkin, Rosenbaum, Jones & Rosenfield, 2010).” The alternative is that adolescents may feel more comfortable with the ability to obtain appropriate supplies and education, both of which have become more accessible because of state and federal laws.
Unfortunately, a recent attempt was made by Indiana Republican Representative Mike Pence, offering an amendment to eliminate the Title X program. This “Pence Bill” is an attempt to prevent programs such as Planned Parenthood from obtaining federal funds for any reason (Miller, LaVaute & Heritage Media, 2011). The primary focus of this amendment was the use of pro-life tax-payers money to fund and promote abortion. A debate over this is still ongoing now at the national level, yet here locally there are still health clinics providing the necessary services to many adolescents, including prenatal care when needed (Miller, LaVaute & Heritage Media, 2011). The controversy over the abortion service is the main factor in the attempt to remove the funding. “According to Planned Parenthood, abortions that are performed in its clinics make up less than 3 percent of its services. There were 332,278 abortion procedures performed in 2009. There were also 830,000 breast exams, and nearly 4 million were tested and/or treated for sexually transmitted diseases (Miller, LaVaute & Heritage Media, 2011).”
Public policy is the only protections that adolescents have to depend on. It will allow protection from both diseases and unwanted pregnancy, and this is limited to only specific minors in the State of Michigan. HIPAA does not pre-empt this policy as it is more stringent in some states than the HIPAA law, this is one limitation to the policy. An excerpt in the Guttmacher Institute report on public policy indicates, “Although the public remains ambivalent, professional organizations familiar with the scientific evidence uniformly support the provision of reproductive health care to minors on a confidential basis. Public policy developments at the state and federal level, however, suggest that teenagers’ access to confidential services will remain under attack in the months and years to come (2005).”
History has proven that children will continue to have sex and contract disease and become pregnant; therefore laws protecting the privacy of reproductive health can actually diminish the barriers and increase access to protection for many patients. Planned Parenthood has played an intricate role in providing access to education and protection for millions of adolescents. Removing the funding for programs such as this also reduces access to education, treatment and supplies, resulting in increased diseases and increases in unwanted pregnancies that subsequently lead to a higher poverty rate. Ideally abstinence is the preferred method to prevent unwanted pregnancy and disease, however, reality shows that this is generally not the practiced method. Protection for adolescents is needed in all societies to promote responsibility and growth for every individual. It is a mature and responsible decision to pursue the protection and education that is needed even when access is limited. Laws are passed to protect mankind, not adults or parents or any one population; laws are created to protect any person that needs protecting, including minors.
Chavkin, W., Rosenbaum, S., Jones, J., & Rosenfield, A. (2010). Women’s health and health care reform [The key role of comprehensive reproductive health care]. Retrieved from
http://www.mailmanschool.org/facultypubs/womenshealthcarereform.pdf FindLaw. (2011). Michigan medical records law. Retrieved from http://law.findlaw.com/state-laws/minors-and-the-law/michigan/, http://law.findlaw.com/state-laws/minors-and-the-law/michigan/ Guttmacher Institute. (2005, November). Teenagers’ access to confidential reproductive health services [The Guttmacher report on public policy]. Retrieved from http://www.guttmacher.org/pubs/tgr/08/4/gr080406.html Mary Beth Kirven, E., & Daniel J. Hall. (2003, June). Health insurance portability and accountability act of 1996 [Applicability to the courts: an initial assessment]. Retrieved from http://www.ncsconline.org/WC/Publications/CS_PriPubHIPPA96Pub.pdf Miller, J., LaVaute, G., & Heritage Media. (2011, March). Washtenaw county: Young and pregnant [Part 1: Prevention]. Retrieved from http://www.heritage.com/articles/2011/03/01/life/doc4d6d5ec57105e610360187.txt?viewmode=fullstory