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."
About Me
- ...
- Business, Free Enterprise and Constitutional Issues; Pro-Life and Pro Second Amendment. Susan Lynn is a member of the Tennessee General Assembly. She serves as Chairman of the Consumer and Human Resources subcommittee, a member of the Finance Ways and Means Committee and the Ethics Committee. She holds a BS in economics and a minor in history.
Thursday, June 25, 2009
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
Wednesday, June 24, 2009
Monday, June 22, 2009
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
http://www.npr.org/templates/story/story.php?storyId=105285865&ft=1&f=94427042
Monday, June 08, 2009
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.
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.
Friday, June 05, 2009
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?
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?
Tuesday, June 02, 2009
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.
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.
Saturday, May 30, 2009
State Wants Medical Records Database WSMV
Opponents: Gov't Shouldn't Get Involved In Individuals' Health
Reported By Cara Kumari
"The purpose here is to build as broad a set of population health data as possible so that we can really improve quality of care and efof care in Tennessee," said Finance Commissioner Dave Goetz.
http://www.wsmv.com/health/19593168/detail.html
Reported By Cara Kumari
"The purpose here is to build as broad a set of population health data as possible so that we can really improve quality of care and efof care in Tennessee," said Finance Commissioner Dave Goetz.
http://www.wsmv.com/health/19593168/detail.html
Cap-and-Trade article in the Tennessean
Please see my article in the Tennessean on cap-and-trade -
http://www.tennessean.com/apps/pbcs.dll/article?AID=2009905280319
"This energy policy to reduce carbon emissions is neither upfront nor affordable. Cap and trade is a complex and confusing scheme that will do little to help the environment."
http://www.tennessean.com/apps/pbcs.dll/article?AID=2009905280319
"This energy policy to reduce carbon emissions is neither upfront nor affordable. Cap and trade is a complex and confusing scheme that will do little to help the environment."
Tuesday, May 26, 2009
Tennessee Center for Policy Research on Claims Database
The Tennessee Center for Policy Research has issued a fascinating analysis of the All Payer Claims Database and issued their analysis for review.
State Wants to Collect Private Healthcare Data
"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."
State Wants to Collect Private Healthcare Data
"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."
All Claims Payer Database Commentary
Blue Collar Muse doesn't like All Claims Payer Database either -
"Of all the Orwellian nightmares people have suggested you be concerned about, it would be difficult to find one more universally despised than the idea one’s medical records are available to the state. "
See full article here http://conservablogs.com/bluecollarmuse/2009/05/26/tn-hb2289-gives-goverment-access-to-private-medical-information/
"Of all the Orwellian nightmares people have suggested you be concerned about, it would be difficult to find one more universally despised than the idea one’s medical records are available to the state. "
See full article here http://conservablogs.com/bluecollarmuse/2009/05/26/tn-hb2289-gives-goverment-access-to-private-medical-information/
HJR108 PASSES HOUSE
HJR 108 passed the Tennessee House tonight!
Thank you for your support.
The Resolution now moves to the Senate where Senator Jamie Woodson will carry the bill.
The vote was 85 Ayes, 2 Noes, 3 present not voting and 9 not voting.
Rep. Susan Lynn
Thank you for your support.
The Resolution now moves to the Senate where Senator Jamie Woodson will carry the bill.
The vote was 85 Ayes, 2 Noes, 3 present not voting and 9 not voting.
Rep. Susan Lynn
Monday, May 25, 2009
All Payer Claims Database - Update 2
The All Payer Claims Database seeks to establish a comprehensive database for the private healthcare transactions of every Tennessean by forcing insurance companies to turn their claims data over to the state through the passage of HB2289.
But wait, this is your privately paid for information! The state is not entitled to this information. Yet, the Administration hopes to convince state legislators that the state has a rational state interest to review your private healthcare data.
The bill lists several reasons but truly each are items you should, and do, privately determine for yourself.
As the Administration tries to comfort state legislators with assuring words stating that your identity will not be disclosed. An important question remains, disclosed by whom? All though the bill it sounds as if the state will know your identity. But the state protests that it will comply with all HIPAA Privacy Rules concerning your Private Health Information (PHI).
So are we to assume that the insurance companies cannot turn your identity or PHI over to the state? No we should not. That is because while HIPAA’s privacy rules protect your PHI from disclosure for private use, HIPAA rules allow disclosure without authorization for several other purposes.
That’s right; your private health information can be disclosed without your consent to public health authorities and health oversight agencies for the prevention or control of disease, injury, or disability, and for oversight activities authorized by law.
So when the state says it will comply with HIPAA Privacy Rules you should answer back - Big Deal!
Please remember, you have the right to self determination, and that is largely why our founding fathers broke away from Great Britain and formed our great nation. The peoples' natural rights - their right to self determination was being abridged by an overbearing government.
Be jealous of your privacy and defend it. Our forefathers and many more since died for your right to life, liberty and pursuit of happiness. Do not give up so easily that for which they paid so dear a price.
I know I will never stop defending your rights but your voice will help make a difference - http://www.capitol.tn.gov/.
But wait, this is your privately paid for information! The state is not entitled to this information. Yet, the Administration hopes to convince state legislators that the state has a rational state interest to review your private healthcare data.
The bill lists several reasons but truly each are items you should, and do, privately determine for yourself.
As the Administration tries to comfort state legislators with assuring words stating that your identity will not be disclosed. An important question remains, disclosed by whom? All though the bill it sounds as if the state will know your identity. But the state protests that it will comply with all HIPAA Privacy Rules concerning your Private Health Information (PHI).
So are we to assume that the insurance companies cannot turn your identity or PHI over to the state? No we should not. That is because while HIPAA’s privacy rules protect your PHI from disclosure for private use, HIPAA rules allow disclosure without authorization for several other purposes.
That’s right; your private health information can be disclosed without your consent to public health authorities and health oversight agencies for the prevention or control of disease, injury, or disability, and for oversight activities authorized by law.
So when the state says it will comply with HIPAA Privacy Rules you should answer back - Big Deal!
Please remember, you have the right to self determination, and that is largely why our founding fathers broke away from Great Britain and formed our great nation. The peoples' natural rights - their right to self determination was being abridged by an overbearing government.
Be jealous of your privacy and defend it. Our forefathers and many more since died for your right to life, liberty and pursuit of happiness. Do not give up so easily that for which they paid so dear a price.
I know I will never stop defending your rights but your voice will help make a difference - http://www.capitol.tn.gov/.
Thousands of records 'lost' by NHS
Thousands of personal medical records have been lost by the NHS in the UK.
An article published yesterday tells how "A total of 140 security breaches were reported within the NHS between January and April this year."
Additional related articles can be found here.
An article published yesterday tells how "A total of 140 security breaches were reported within the NHS between January and April this year."
Additional related articles can be found here.
Friday, May 22, 2009
ALEC: Cap & Trade - A New Tax on Energy
...For example, a recent study by CRA International for the National Black Chamber of Commerce concluded the legislation would cost the U.S. economy $350 billion and 2.3 million to 2.7 million jobs each year from now to 2030. This is a net loss meaning they took into account all the “green” jobs the bill promises to create. To read that study, click here.
Read ALEC brief.
Read ALEC brief.
Thursday, May 21, 2009
All Payer Claims Database update
Tennessee state government wants to get into the healthcare business big time! There is pending legislation to collect all of the data on your privately paid for healthcare transactions.
The Governor’s administration is pushing HB2289. As amended the bill claims that the state government needs your information to;
“Improve the accessibility and affordability of patient health care and health care coverage”
“Identify health and health care needs and inform on health and health care policy”
“Determine the capacity and distribution of existing health care resources”
“Evaluate the effectiveness of intervention programs on improving patient outcomes”
“Review costs among various treatment settings, providers, and approaches”
“Provide publicly available information on health care providers’ quality of care”
The plan is to mandate that your insurance company transmit all of your healthcare transactions to the state. You will be assigned a unique encrypted patient identifier by your insurance company. This identifier will be used by the state to track all of your healthcare transactions so that they can evaluate you according to the criteria listed above. Your doctor will also receive a unique healthcare provider identifier; but he or she will be fully identifiable.
What if you should want to opt-out? Well, you can’t. We tried very hard in the House Government Operations Committee this week to make that possible for you and your doctor but we were defeated on a party line vote. Should your insurance company refuse to comply with handing over your information it will receive a $100.00 per day fine from the state.
I want you to understand the breadth and the enormity of this plan. I asked just one of the major health insurance companies in Tennessee how many claims they process. 32,000 per hour; or 256,000 per day was the answer.
So I ask you to consider; why does the state of Tennessee need that much data, and that much detail about your healthcare transactions?
I asked a few public policy groups to take a look at the legislation. They responded with alarm. Some of their comments are that “…this is an avenue to centralized control over medical decisions...and the building of a brand new expensive bureaucracy that will use the data to issue reports to further secure their control over medical decision-making.” And, “Whoa. This bill is very scary. Not only is there no opt-out provision, but looking at claims data is the way to implement price controls.”
From what I’ve been able to learn several states have recently instituted similar databases and several more are considering bills at this time. Most all use a company called the Maine Health Information Center which is affiliated with the National Claims Data Management System. These are non-profit organizations set up to accept and analyze massive amounts of healthcare data.
Recently a similar plan was instituted in Minnesota. The cost was $1.2 million for the databasing of claims data on all Minnesotans for just the first 18 months. Additional costs for analyzing the data are $3.0 million dollars per year.
Yet the state of Tennessee claims that this bill will cost Tennessee little more than $200,000 per year. Perhaps that is because the bulk of the cost is borne by your insurance company.
I fail to see how legislators mandating insurance companies to turn over your healthcare transactions to the state cannot violate the Fourth Amendment to the US Constitution; unreasonable searches and seizures. Surely, passage of this legislation would constitute a seizure by the state of Tennessee of private, and privately paid for detailed information for which the state has no business having and for which they have no compelling, rational or legitimate use.
Outgoing administrations often start thinking of their next job early. Perhaps the Governor and some of his cabinet members have big plans in the ever growing healthcare information field.
I hope that you are concerned about this bill because your voice does make a difference. This is one bill that should go away. Please take the time to contact your legislator to learn more and to express your feelings about this legislation; http://www.capitol.tn.gov/.
The Governor’s administration is pushing HB2289. As amended the bill claims that the state government needs your information to;
“Improve the accessibility and affordability of patient health care and health care coverage”
“Identify health and health care needs and inform on health and health care policy”
“Determine the capacity and distribution of existing health care resources”
“Evaluate the effectiveness of intervention programs on improving patient outcomes”
“Review costs among various treatment settings, providers, and approaches”
“Provide publicly available information on health care providers’ quality of care”
The plan is to mandate that your insurance company transmit all of your healthcare transactions to the state. You will be assigned a unique encrypted patient identifier by your insurance company. This identifier will be used by the state to track all of your healthcare transactions so that they can evaluate you according to the criteria listed above. Your doctor will also receive a unique healthcare provider identifier; but he or she will be fully identifiable.
What if you should want to opt-out? Well, you can’t. We tried very hard in the House Government Operations Committee this week to make that possible for you and your doctor but we were defeated on a party line vote. Should your insurance company refuse to comply with handing over your information it will receive a $100.00 per day fine from the state.
I want you to understand the breadth and the enormity of this plan. I asked just one of the major health insurance companies in Tennessee how many claims they process. 32,000 per hour; or 256,000 per day was the answer.
So I ask you to consider; why does the state of Tennessee need that much data, and that much detail about your healthcare transactions?
I asked a few public policy groups to take a look at the legislation. They responded with alarm. Some of their comments are that “…this is an avenue to centralized control over medical decisions...and the building of a brand new expensive bureaucracy that will use the data to issue reports to further secure their control over medical decision-making.” And, “Whoa. This bill is very scary. Not only is there no opt-out provision, but looking at claims data is the way to implement price controls.”
From what I’ve been able to learn several states have recently instituted similar databases and several more are considering bills at this time. Most all use a company called the Maine Health Information Center which is affiliated with the National Claims Data Management System. These are non-profit organizations set up to accept and analyze massive amounts of healthcare data.
Recently a similar plan was instituted in Minnesota. The cost was $1.2 million for the databasing of claims data on all Minnesotans for just the first 18 months. Additional costs for analyzing the data are $3.0 million dollars per year.
Yet the state of Tennessee claims that this bill will cost Tennessee little more than $200,000 per year. Perhaps that is because the bulk of the cost is borne by your insurance company.
I fail to see how legislators mandating insurance companies to turn over your healthcare transactions to the state cannot violate the Fourth Amendment to the US Constitution; unreasonable searches and seizures. Surely, passage of this legislation would constitute a seizure by the state of Tennessee of private, and privately paid for detailed information for which the state has no business having and for which they have no compelling, rational or legitimate use.
Outgoing administrations often start thinking of their next job early. Perhaps the Governor and some of his cabinet members have big plans in the ever growing healthcare information field.
I hope that you are concerned about this bill because your voice does make a difference. This is one bill that should go away. Please take the time to contact your legislator to learn more and to express your feelings about this legislation; http://www.capitol.tn.gov/.
Monday, May 18, 2009
Word of the day
Sunday, May 17, 2009
All Payer Claims Database
What is the All Payer Claims Database? That is the name of the system the Governor’s administration wants to put in place to collect all of the data on your healthcare transactions - whether you are private pay, insurance pay, Medicare or Medicaid.
The government claims it needs your information to;
“Improve the accessibility and affordability of patient health care and health care coverage”
“Identify health and health care needs and inform on health and health care policy”
“Determine the capacity and distribution of existing health care resources”
“Evaluate the effectiveness of intervention programs on improving patient outcomes”
“Review costs among various treatment settings, providers, and approaches”
“Provide publicly available information on health care providers’ quality of care”
I asked a few public policy groups to take a look at the legislation. They responded with alarm. Some of their comments are that “…this is an avenue to centralized control over medical decisions...and the building of a brand new expensive bureaucracy that will use the data to issue reports to further secure their control over medical decision-making.” And, “Whoa. This bill is very scary. Not only is there no opt-out provision, but looking at claims data is the way to implement price controls.”
The administration claims through all of this your identity will be safe because the government will give you a unique encrypted patient identifier. Your doctor will receive a unique health care provider identifier as well. But wait, if the government is giving you the identifier wouldn’t that mean they know who you are or else how can they give it to you…and why?
What if you should want to opt-out? Well, you can’t. And should your doctor refuse to comply with giving over your information he or she will receive a $100.00 per day fine from the state.
Recently a similar plan was instituted in Minnesota. The cost was $1.2 million for the databasing of claims data on all Minnesotans for just the first 18 months. Additional costs for analyzing the data are $3.0 million dollars per year. The next phase of educating physicians was another $100,000+, and about $45,000 per year in expenses for the state’s health dept. Of course the cost to the doctors for sending the data has never been calculated.
But the state claims that this bill will cost little more than $10,000 per year.
I hope that you are concerned about this bill because your voice does make a difference. This is one bill that should go away. We do not need to collect such data, and some believe that such collection may violate the Fourth Amendment.
The government claims it needs your information to;
“Improve the accessibility and affordability of patient health care and health care coverage”
“Identify health and health care needs and inform on health and health care policy”
“Determine the capacity and distribution of existing health care resources”
“Evaluate the effectiveness of intervention programs on improving patient outcomes”
“Review costs among various treatment settings, providers, and approaches”
“Provide publicly available information on health care providers’ quality of care”
I asked a few public policy groups to take a look at the legislation. They responded with alarm. Some of their comments are that “…this is an avenue to centralized control over medical decisions...and the building of a brand new expensive bureaucracy that will use the data to issue reports to further secure their control over medical decision-making.” And, “Whoa. This bill is very scary. Not only is there no opt-out provision, but looking at claims data is the way to implement price controls.”
The administration claims through all of this your identity will be safe because the government will give you a unique encrypted patient identifier. Your doctor will receive a unique health care provider identifier as well. But wait, if the government is giving you the identifier wouldn’t that mean they know who you are or else how can they give it to you…and why?
What if you should want to opt-out? Well, you can’t. And should your doctor refuse to comply with giving over your information he or she will receive a $100.00 per day fine from the state.
Recently a similar plan was instituted in Minnesota. The cost was $1.2 million for the databasing of claims data on all Minnesotans for just the first 18 months. Additional costs for analyzing the data are $3.0 million dollars per year. The next phase of educating physicians was another $100,000+, and about $45,000 per year in expenses for the state’s health dept. Of course the cost to the doctors for sending the data has never been calculated.
But the state claims that this bill will cost little more than $10,000 per year.
I hope that you are concerned about this bill because your voice does make a difference. This is one bill that should go away. We do not need to collect such data, and some believe that such collection may violate the Fourth Amendment.
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