ALEC Waxman Markey Opposition Letter

Dear Representative:

On behalf of the undersigned 186 state and national leaders, Legislators, heads of think-tanks, activist groups, business owners and organizations representing millions of American families, taxpayers and energy consumers, we urge you to oppose H.R. 2454, “The American Clean Energy and Security Act,” also known as the Waxman-Markey plan (or Cap-and-Trade/Capand-Tax).

This bill was recently passed out of the U.S. House Energy and Commerce Committee and we are urging all members of Congress to oppose consideration of this bill. This bill raises taxes on American families, increases the cost of energy, and eliminates American jobs. These are not proposals we can support.

The Waxman-Markey bill you are asked to consider will increase energy costs by $1,500 annually for the typical family of four. Further, the Heritage Foundation estimates that even with the estimated 26 percent reduction in electricity use, electric bills will increase $754 with the Waxman-Markey plan.

Additionally, from 2012 to 2035, a typical family will spend $12,200 more on its electric bill than in the absence of Waxman-Markey.

Despite the attempts in Waxman-Markey to decrease gas consumption by 15 percent, gas prices will still increase. As a result of the Waxman-Markey plan, an average American family of four will pay an additional $596 for gas usage in 2035. From 2012 to 2035, the Waxman-Markey plan will cost them an additional $7,500 in gas costs.

Before all the damage is done from Waxman-Markey, a family of four will see its direct energy costs rise by $22,800 from 2012 to 2035.

The Waxman-Markey plan does not just raise taxes and increase energy costs; it is expected to end 1,105,000 American jobs annually. The proposed Cap-and-Trade scheme will result in a loss of nearly 2,500,000 million American jobs. America needs economic policies that lead to job creation, not job destruction. This proposal is not something we are prepared to accept.

Table I - Percentage of Electricity that Meets Congress’ Definition of ‘Carbon-Free Renewable’ Energy for Each State

AL 2.5 HI 5.4 MA 0.7 NM 4.5 SD 1.9
AK 0.2 ID 5.5 MI 2.0 NY 1.6 TN 1.0
AZ 0.1 IL 1.4 MN 9.2 NC 1.5 TX 3.9
AR 2.9 IN 0.3 MS 3.1 ND 4.7 UT 0.6
CA 12.6 IA 7.3 MO 0.2 OH 0.3 VT 7.1
CO 5.9 KS 3.8 MT 2.3 OK 3.4 VA 2.9
CT 0.1 KY 0.5 NE 0.8 OR 5.8 WA 4.4
DE 2.1 LA 3.1 NV 3.8 PA 0.9 WV 0.4
FL 1.3 ME 23.8 NH 5.0 RI 2.1 WI 2.6
GA 2.3 MD 0.5 NJ 0.4 SC 1.7 WY 2.0

As indicated in Table I, the Waxman-Markey-mandated Federal Renewable Electricity Standard (RES) (which requires the nation to derive 10 percent of electricity from renewable sources by 2012 and 25 percent by 2025) is simply unrealistic given our current situation. Fourteen states (in bold boxes) are currently receiving less than one percent of their electricity from “renewable” sources.

Forcing this unrealistic mandate without an opt-in option or state-defining renewable option will do nothing more than increase the cost of electricity on rate paying consumers.

States that cannot meet with RES will be face monetary penalties from the federal government. These penalties will be passed onto consumers in the form of higher fees and taxes which they simply cannot afford. Further, by not allowing states to define what is “renewable” in their region, the bill inaccurately assumes that Maine has the same resources available as California. This illconceived logic should not be part of any national energy strategy.

Further, the bill calls for the 2050 CO2 emissions rate to be 83 percent lower than the 2005 emissions rate. However, as seen in Table II, 36 states (in bold boxes) produce their energy using over 80 percent carbon-based fuels. This proposal will cripple state economies, as energy is overwhelmingly derived from carbon-based fuels. Sadly, consumers will experience negative effects from unrealistic goals when they result in higher taxes, increased fees, and higher prices.
Table II - State Percentage of Energy Supplied by Carbon-Based Fuels

AL 76.3 HI 94.9 MA 90.8 NM 97.8 SD 84.1
AK 97.8 ID 64.6 MI 86.8 NY 77.5 TN 81.8
AZ 80.9 IL 46.6 MN 85.4 NC 78.1 TX 95.0
AR 77.5 IN 98.6 MS 85.1 ND 95.9 UT 98.3
CA 82.7 IA 90.4 MO 93.6 OH 94.0 VT 52.9
CO 97.6 KS 89.5 MT 79.9 OK 97.0 VA 81.1
CT 75.1 KY 97.4 NE 83.5 OR 59.3 WA 53.1
DE 99.4 LA 91.1 NV 92.1 PA 80.4 WV 98.5
FL 87.4 ME 64.5 NH 68.0 RI 97.0 WI 86.2
GA 81.8 MD 84.6 NJ 84.3 SC 65.8 WY 97.8

A recent poll indicated that 52 percent of registered American voters oppose the cap-and-trade
policy contained in the Waxman-Markey plan. Fifty-eight percent said they were unwilling to pay additional money for electricity to combat climate change. Sixty-eight percent disagreed with the notion that Congress should enact a carbon tax to encourage consumers to decrease their electricity usage. In addition, more than 50 percent opposed any carbon tax used to fund energy research.

Moreover, 73 percent of respondents placed the economy first among issue priorities. Based on the evidence above and many other detrimental effects of this disastrous bill, we urge you to oppose the Waxman-Markey Cap-and-Trade/Cap-and-Tax bill as a tax increase that American families simply cannot afford, and energy policy that we cannot accept.

For more information, contact Brian Johnson at Americans for Tax Reform at bjohnson@atr.org or 202-785-0266.

Sincerely,

Alabama Policy Institute, Gary Palmer
Alabama State Representative Greg Wren
Alabama State Senator Steve French
Alliance for Worker Freedom, Brian M Johnson
American Civil Rights Union
American Conservative Union, David Keene
American Council for Health Care Reform, William Shaker
American Shareholders Association, Ryan Ellis
American Solutions, Dan Varroney
Americans for Prosperity, Tim Phillips
Americans for Tax Reform, Grover Norquist
Americans for the Preservation of Liberty, David Ridenour
Arizona State Representative Cecil Ash
Arizona State Representative Debbie Lesko
Arizona State Representative John McComish
Arizona State Representative Nancy Barto
Arizona State Senate Majority Whip Pamela Gorman
Arizona State Senator Jack Harper
Arizona State Senator John Nelson
Arizona State Senator Johnny Key
Arizona State Senator Ron Gould
Arizona State Senator Russell Pearce
Arizona State Senator Sylvia Allen
Center for Fiscal Accountability, Sandra Fabry
Center for Individual Freedom, Jeffrey Mazzella
Charles W. Baird, Ph.D., Professor of Economics, Emeritus, CSU East Bay
Citizen Outreach Project, Doug Bandow
Citizens for Responsible Government, Joseph Andrews
Citizens United, Chuck Muth
Clean Oceans Technology Coalition, Joel C. Mandelman
Club for Growth, Andy Roth
College Republican National Committee
Colorado State Senator Scott Renfroe
Connecticut Center-Right Coalition, D. Dowd Muska
Connecticut State Representative Bill Hamzy
Connecticut State Representative John Piscopo
Council for Citizens Against Government Waste, Erica Gordon
Eagle Forum, Phyllis Schlafly
Ethan Allen Institute, John McCalughry
Evergreen Freedom Foundation, Amber Gunn
Florida Center-Right Coalition, Rick Watson
Florida State Representative Alan Hays, DMD
Florida State Representative Sandra Adams
FRCAction, Tom McClusky
FreedomWorks, Matt Kibbe
Frontiers of Freedom, George Landrith
Georgia Eagle Forum, Nancy Schaefer
Georgia State Representative Ed Setzler
Georgia State Representative Melvin Everson
Georgia State Representative Randy Nix
Georgia State Representative Tom Rice
Georgia State Representative Wendell Willard
Georgia State Senate Majority Leader Chip Rogers
Georgia State Senator Chip Rogers
Grassroots Institute of Hawaii, Dick Rowland
Hawaii State Senator Sam Slom
Hispanic Leadership Fund, Mario Lopez
Illinois Policy Institute, John Tillman
Illinois State Representative Dave Winters
Independence Institute, Jon Caldara
Indiana Eagle Forum, Pat Schneider
Indiana State Representative Cindy Noe
Indiana State Representative Eric Koch
Indiana State Representative Jeff Thompson
Indiana State Representative William Ruppel
Indiana State Senator Brandt Hershman
Institute for Liberty, Andrew Langer
Kansas State Senator Mary Pilcher-Cook
Kansas State Representative Don Meyers
Kansas State Representative Marc Rhoades
Kansas State Representative Sharon Schwartz
Kansas State Senator Tim Huelskamp
Kentucky State Representative Mike Harmon
Let Freedom Ring, Colin Hanna
Louisiana Republican National Committeeman, W. Ross Little, Jr.
Louisiana State Representative Nickie Monica
Louisiana State Representative Scott Simon
Maryland Center-Right Coalition, Richard Falknor
Maryland State Delegate Nic Kipke
Maryland State Representative Richard Sossi
Maryland State Delegate Gail Bates
Michigan Eagle Forum, Violet Vestevich
Minnesota Eagle Forum, Bonnie Nugent
Minnesota State Senator Mike Jungbauer
Mississippi Center for Public Policy, Forest Thigpen
Mississippi State Representative Becky Currie
Missouri State Representative Bob Nance
Missouri State Representative Cynthia Davis
Missouri State Representative Dwight Scharnhost
Missouri State Representative Shane Schoeller
Missouri State Representative Stanley Cox
Missouri State Representative Tim Flook
Missouri State Representative Walter Bivins
Missouri State Senator Jim Lembke
Montana State Representative Bob Lake
Montana State Representative Cary Smith
Montana State Representative Chas Vincent
Montana State Representative Gary MacLaren
Montana State Representative Mike Miller
National Center for Public Policy Research, Amy Ridenour
National Taxpayers Union, Duane Pardee
Nevada Eagle Forum, Janine Hansen
New Hampshire State Representative Betsey McKinney
New Hampshire State Representative Beverly Rodeschin
New Hampshire State Representative Jennifer Coffey
New Hampshire State Representative John Reagan
New Jersey State Assemblyman Michael J. Doherty
New Mexico Former State Representative Frank Bird
New Mexico Former State Representative Justine Fox-Young
New Mexico Former State Representative, Senator & Lieutenant Governor Jack Stahl
New Mexico Former State Senator Mickey D. Barnett
New Mexico Republican Party, John E. Rockwell
New Mexico Shooting Sports Association, Paul Lisle
New Mexico State Senator Steve Neville
New Mexico, Bernalillo County Sheriff, Darren P. White
New York Assemblyman Greg Ball
North Carolina Deputy Republican Senate Leader Neal Hunt
North Carolina State Representative George Cleveland
North Carolina State Representative Mitch Gillespie
North Carolina State Representative Pat McElraft
North Dakota State Representative Chuck Damschen
North Dakota State Representative Ken Svedjan
Ohio State House Assistant Minority Whip Sean Chichelli,
Ohio State House Minority Whip John Adamns,
Ohio State Senator Bob Gibbs
Ohio State Senator Kevin Coughlin
Oklahoma Council of Public Affairs, Inc., Brandon Dutcher
Oklahoma State Representative Colby Schwartz
Oklahoma State Representative Leslie Osborn
Oklahoma State Representative Mike Sanders
Oregon State Representative Matt Wingard
Oregon State Representative George Gilman
Oregon State Representative John Huffman
Pelican Institute for Public Policy, Kevin Kane
Pennsylvania Eagle Forum, Fran Bevan
Pennsylvania State Representative Daryl Metcalfe
Pennsylvania State Representative Jeff Pyle
Pennsylvania State Representative Kathy Rapp
Pennsylvania State Representative Matthew Baker
Project 21, Deneen Borelli
Property Rights Alliance, Kelsey Zahourek
Quantum Communications, Charlie Gerow
RightMarch.com, Dr. William Greene
Samuel Properties, Ltd., Patty Terrell
Small Business & Entrepreneurship Council, Karen Karrigan
Smart Business Hawaii, Sam Slom
Society of American Florists, Jeanne Ramsay
South Carolina State Senator David Thomas
South Dakota State Representative Val Rausch
Talbott Advisors, Inc., Fenton R. Talbott
Tennessee Eagle Forum, Bobbie Patray
Tennessee State Representative Ben West, Jr.
Tennessee State Representative Susan Lynn
Texas Eagle Forum, Cathie Adams
Texas State Representative Joe Driver
The Harbour League, Eli Gold
The Rule of Law Committee, Bill Shaker
Utah State Representative Bradley Daw
Utah State Representative Lorie Fowlke
Utah State Senator Ralph Okerlund
Virginia House of Delegates Member Kathy Byron
Washington State Minority Whip Bill Hinkle
Washington State Representative Jan Angel
Washington State Representative Shelly Short
Washington State Senator Val Stevens
West Virginia House of Delegates Member Troy Andes
West Virginia State Delegate Jonathan Miller
West Virginia State Delegate Ronald Walters, Sr.
West Virginia State Representative Troy Andes
Wisconsin State Representative John Nygren
Wisconsin State Representative Leah Vukmir
Wisconsin State Representative Mike Huebsch
Wisconsin State Representative Robin Vos
Wyoming State Representative Allen Jaggi
Wyoming State Representative Amy Edmonds
Wyoming State Representative David Miller
Wyoming State Representative Peter S. “Pete” Illoway
Wyoming State Representative Sue Wallis

ALEC on Cap and Trade

Click here: http://www.alec.org/AM/Template.cfm?Section=Cap_and_Trade

In 2008, ALEC adopted the following position on climate change:

"Climate change is a historical phenomenon and the debate will continue on the significance of natural and anthropogenic contributions. ALEC will continue to monitor the issue and support the use of sound science.

Regardless, the economy is becoming more energy efficient. Each year we emit less carbon dioxide per dollar of economic output. In fact, carbon dioxide emissions per dollar of GDP declined 41.3 percent between 1981 and 2005. This impressive improvement has taken place without greenhouse gas emissions regulations or taxes."

Oppose the Cap and Trade 'Tax' Increase Bill, H.R. 2454

Click the link below to take action on this issue.:http://www.votervoice.net/link/forward/jbs223753.aspx

Stimulus reason for All Payer Claims Database?

Ruin Your Health With the Obama Stimulus Plan
Betsy McCaughey

Understanding Cap-and-trade

Don't understand cap-and-trade? Listen to this...

http://www.npr.org/templates/story/story.php?storyId=105285865&ft=1&f=94427042

HB2318 - Governor's Energy Bill

Mandating Politics

The traditional police powers of government are health, safety, welfare and morals.

This means that the state might see fit to intercede through laws by limiting your activity if there is an unseen danger in what you do that could have a significant effect on another individual; thus jeopardizing that individual's right to life, liberty or the pursuit of happiness in a tangible way.

For instance; health inspections have increased cleanliness, cutting down on diseases that could severely impact your health. Safety inspections ensure that unseen dangers, like in electrical wiring or gas hook-ups, are minimized. Welfare typically refers to some sort of fraud - it is why we inspect bank records. Morals normally refer to activity, perhaps that concerning drugs or alcohol.

Strangely, the state is wanting to add energy efficiency to it's police powers. HB2318 changes Tennessee code 68-120-101, the law on statewide building construction safety standards, to include energy efficiency.

It is one thing for the state to take precautions because something may seriously jeopardize your health, or safety, or all that you have worked to earn, or to keep you from being a danger to others when you are under the influence of drugs or alcohol, but to police energy efficiency?

People already have an incentive to build energy efficient homes or to purchase energy efficient appliances - its called a utility bill.

For the state to get involved and create mandates is for the state to become involved in political decisions that favor some parts and supplies over others; certain businesses over other businesses; certain policies and political philosophies other others.

People naturally balance what they can afford with what they will save and examine the margins to see how far they want to go. Mandating politics is not good policy - and it moves us further still from freedom.

Economic Liberty and the Constitution, Part 1

by Jacob G. Hornberger, June 2002

Police powers and mercantilism

...The courts, however, had not limited the concept of “police powers” to laws proscribing violent crimes, such as murder, rape, theft, and burglary. Instead, the concept had been vaguely defined as the power to enact laws relating to the “safety, health, morals, and general welfare” of the public, a definition that opened up a Pandora’s box that harkened back to the era of mercantilism, an economic system that characterized European life during the 1600s and 1700s.

Under the old mercantilist system, the government had the power to regulate the most minute aspects of people’s economic affairs. Consider, for example, the cloak industry. The government prescribed how many cloaks should be produced in the nation, as well as sizes and colors. Regulations even outlined exactly how the nation’s weavers were to do their weaving.

Why were these extensive regulations necessary? Because if the government did not regulate the production of cloaks, it was believed, there existed the distinct possibility that people might end up with no cloaks to wear, which would mean that they might very well freeze to death. After all, what if everyone forgot to make cloaks one year? Or what if they didn’t make them in sizes that would fit the people?

Section by Section Analysis - All Payer Claims Database

Title: Bill Number: HB2289/SB2239


This brief document summarizes some of the major components to HB2289 (SB2239) which is currently being considered by the Tennessee General Assembly.


Summary

The bill creates a government database of Tennesseans’ private healthcare claims. Each Tennessean that has private health insurance would be listed in the database, and all claims for care that they receive would be transmitted to the state by private health insurance companies for compilation in the database.

For example, if you went to the doctor today with a cold, and again on Friday with bronchitis, then by Monday you were admitted to the hospital with pneumonia all of that data would be submitted to the state so that the department of finance and administration can follow the progress of your illness and treatment.

The enormity of this database cannot be overstated. For instance, Blue Cross / Blue Shield processes 38,000 insurance claims per hour. Each of the claims would become part of the database.

Several New England states and Minnesota have already instituted similar databases. Minnesota’s health dept has recently begun dictating health protocols to doctors and insurance companies - what business the state has interfering in private healthcare transactions is yet unanswered.

As outlined in the bill, the government wants the private healthcare data of her citizens’ so that the Commissioner of the TN Department of Finance and Administration (presently Dave Goetz) can carry out several stated objectives including:

Improve health care accessibility and affordability,

Identify health care needs,

Determine the capacity and distribution of existing health care resources,

Evaluate the effectiveness of programs on patient outcomes,

Review costs,

Provide publicly available information on providers’ quality of care.

REMEMBER! This data is privately paid for information on private individuals who are making claims to private insurance companies. Frankly, the government has no business having such private information or performing any of the above duties when you privately pay for your healthcare.



Section by Section Analysis

Section 1; Adds the National Committee for Quality Assurance (NCQA) to the Tennessee Code under insurance company utilization review agents in 56-6-704.

NCQA is a non-profit organization that “promotes the adoption of strategies that we believe will improve care, enhance service and reduce costs, such as paying providers based on performance, leveraging the Web to give consumers more information, disease management and physician-level measurement.”

In a letter dated March 6, 2009 to President Obama from this non-profit organization praised the president for his White House Healthcare Summit and for moving us toward “comprehensive health care reform we need.”

Their criteria for which insurance companies must comply contains 6011 data fields on patients for evaluating cost and quality. Some large insurance companies already belong to this organization and comply with the 6011 data sets - however, others do not already comply.

Amendment 1

Section 3 - Definitions;

Bill contains no definition for;

· All Payer Claims Database
· National Standards in Section 3 (c)(2)(A) or Section 3 (f)(1)(C).
· HEDIS information in Section 3 (f)(2)(A). Some HEDIS information is based solely on surveys.
· National multi-collaborative stakeholders found in Section 3 (c).


Section 3 (c); Tennessee Health Information Committee

· No requirements for meetings of the committee or for the call of meetings or for the format.
· There is no sunrise date for the committee.
· Under the proposed law, the Commissioner of Finance and Administration would take recommendations from the newly established “Tennessee Health Information Committee.” The committee is to be comprised of 19 members, only one of whom “represent[s] health care consumers”; all of whom may view all of the information on the database. It is unclear why oversight of the database and the functions is housed within the Department of Finance and Administration, as opposed to the TN Department of Health.

Section 3 (c)(2)(A); Calls for the committee to develop a description of data sets based on “national standards” - National standards is not defined.

Protected Health Information; Not any specific part of the bill restricts the submission of “Protected Health Information” (PHI) to the state of Tennessee - “Protected Health Information” is a dataset of 18 fields of personal information identified by HIPAA’s Privacy Rules. The bill does not preclude the state from getting your PHI; only three of the 18 fields of the PHI may not be included in the Database. In fact, HIPAA expressly allows the government to receive your Personal Health Information - http://privacyruleandresearch.nih.gov/pr_08.asp.

All through the bill it implies that the state will have Protected Health Information.
See:

Section 3 (c)(3)(A) & (B)
Section 3 (c)(5)
Section 3 (d)(1) - one of the most obvious spots
Section 3 (f)(2) - another very obvious spot
Section 3 (d)(2)(A) asserts that “source” or “draft” information used to construct or populate the database will exist.

Nowhere does it state that the data set will be fully de-identified before the state receives the information from the insurance companies.

Section 3 (c)(2)(B); Requires the Committee to develop a method for the submission of data. NO METHOD IS DESCRIBED IN THE BILL.

Once an all payer claims database is established health insurance issuers must submit data in a standardized, electronic form, for inclusion in the database. The data submitted will include information on patients, their claims, the quality of care received, pricing rates, costs of care, and possibly other information in conformity with the National Committee for Quality Assurance (NCQA).

Section 3 (d)(2)(b); The information will be made available to virtually any branch of state government.

Section 3 (e); Excludes only three pieces of personal information from the All Claims Database; name, address, and social security number. This is startling to anyone that knows anything about datasets and privacy. HIPAA identifies 18 fields of protected health information that must be excluded in order for complete privacy to be assured. The inclusion of any of the remaining 18 fields puts patient privacy at risk.

This section should expressly state that none of the 18 fields of Protected Health Information will ever be received by the government.

Section 3 (f)(1)(A); States that all group health plans and health insurance issuers shall provide electronic health insurance claims and eligibility data in accordance with the committee and state rule. Why is eligibility data included if we do not know the persons identity? Again, there is no statement that Protected Health Information will be omitted.

Section 3 (f)(1)(B); Allows the committee and the commissioner to request any additional information from insurance companies that they deem.

Section 3 (f)(1)(C); States the committee and commissioner shall strive for standards and procedures that reflect “national standards”. No definition of national standards exists in the bill.

Section 3 (f)(2)(B); This unfunded mandate forces insurance companies to change the way they receive claims from providers to the very same format that the Centers for Medicare and Medicaid Services requires claims to be submitted.

Section 3 (f)(3); Insurance companies that fail to submit patient information to the state shall be fined up to $100 each day of delay. It is unclear whether this fine applies to the failure to file all records, or whether it is assessed per record.

Fiscal note: The TN General Assembly Fiscal Review Committee notes that the legislation will increase State expenditures by more than $200,000. That is an improbable amount for such an expansive database with continuing analysis. In Minnesota the compilation of the data base cost $1.2 million for just the first 18 months and the analysis was $3 million.



Additional Analysis
By TCPR

Vagueness – The bill’s language is extremely vague when describing the “duties” of the Commissioner of Finance and Administration with regards to his utilization of this database. For instance, one duty is “evaluating the effectiveness of intervention programs on improving patient outcomes.” It is unclear by what standards the commissioner is to use when making such evaluations.

Effectiveness – It is unlikely that a database, while comprehensive in nature, will allow members of the newly created TN Health Information Committee (THIC) to develop meaningful and effective recommendations that increase public health without years of extensive analysis. Billions of dollars are spent each year in the U.S. to improve public health yet the fiscal note for this legislation is just over $200,000. The likelihood of success with such a meager expenditure, especially among a myriad of other, more sophisticated research, is weak at best.

Access to Data – The proposed legislation gives access to otherwise private and confidential health care data to any “departments of state government” if the information is disclosed with the purpose of achieving the duties (of the Commissioner of Finance and Administration). Given the vagueness of the “duties” as noted supra, access to this sensitive information is given to nearly any governmental agency in the state of Tennessee.

As with all public databases, there is a significant chance the information could become compromised. This could occur from a computer “hacker” or from someone within state government (as was the case in the State Trooper’s office last year). Exposure to liability should this sensitive data become publically available is virtually infinite and could open the state to decades of litigation from around the country. Also troubling is the potential to cross-reference health care data with other databases such as school records, criminal records, and travel logs.

It should also be noted that numerous public websites already exist that allow consumers to “shop” for a health care provider that meets their needs. These websites exist without sharing identifiable or sensitive information. Thus the state already has data from which to study health care from a public policy perspective.

Privacy – As the proposed law is written, patients and health care providers are unable to exempt themselves from this database. Similarly, there is no “opt-in” provision that would apply the new law to only those choosing to be a part of the government maintained database. The law states that it will comport with all applicable Health Insurance Portability and Accountability Act (HIPAA) regulations, however this is misleading. HIPAA, by its own terms, does allow for private health care information to be shared with state agencies in certain instances and this law seems to fall within those rules. HIPAA does, however, seem to establish a reasonable expectation of privacy (between patient, provider, and insurer) and this law may unconstitutionally violate that constitutional right.

TN Residents Only? – The bill, by inference only, seems to apply only to Tennessee residents however, it is not clear that lawmakers have contemplated how to the law should apply to part-time residents, those that visit TN-based health care providers, those that work for a TN-based company though they live out of state, Tennesseans with out of state dependents, etc. Requiring insurance companies to submit data without a way to meaningfully limit the law to Tennesseans subjects both insurance companies and the state to great litigation exposure.

Costs to Consumers & Insurers – The legislation’s current fiscal note is less than $200,000 but this only takes the cost to the state government into account. Furthermore, even the 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. These costs are likely to be passed along, eventually, to consumers. Thus the stated goal of “improving…affordability of patient health care and health care coverage” is thwarted from the start.

Finally, insurance companies will have to disclose otherwise proprietary information which, according to the proposed law, is subject to “public release” via report. While this could lead to greater price transparency, it could also lead to forcing insurance companies to exit the state in favor of states that allow them to retain some competitive advantage. Again, the stated goal of “improving accessibility” could be drastically harmed if this legislation becomes a law.