The Health Insurance Portability and Accountability Act, which began life as an insurance reform bill, had a second section grafted onto it on "administrative simplification." That became the foundation for today's federal health information technology initiatives, according to its co-sponsor, former U.S. Sen. Nancy Landon Kassebaum Baker.
Kassebaum Baker on HIPAA, health IT and a changed lawmaking environment
I spoke with Kassebaum last week, a few days after the 15th anniversary of President Clinton signing the bill into law. (See Part 1 of our discussion.)
Kassebaum said she had nothing to do with the technical details of the IT portions of HIPAA, "because I don't even do e-mail." She continued: "We would talk about the cost of healthcare. This was in 1980 and '90, and people were concerned about the cost even then. I know some doctors who worked in teaching hospitals. They really railed against paperwork."
The idea was to cut costs by computerizing paper-based healthcare transactions. What resulted in HIPAA, she said, "was the forerunner for IT development, and that was really important for having electronic health records" and will lead to better collaboration within healthcare. "That is going to be a big help" with costs and quality, she said.
The issue of privacy in electronic health records remains an unresolved "bugaboo," Kassebaum said. She recalled how federal privacy and security protections became last-minute additions to HIPAA.
"It came to the floor and we were ready to pass it, and I think it was Senator Bond from Missouri who raised the privacy issue," Kassebaum recalled. "Everybody got all excited about it. We didn't know what to do about it, so we kicked the can and let HHS do it" through rulemaking.
HIPAA passed both houses of Congress by a combined vote of 519-2, but even with overwhelming bipartisan support, a broader bill—one that might have extended protections against discrimination for pre-existing conditions to workers at smaller employers or to individual and family policyholders—probably would not have passed, Kassebaum said. Such were the times and the careful compromises made to arrive at consensus.
Kassebaum said she doubted HIPAA could pass today, when emotions about pending legislation are amplified by high-speed Internet-based communications.
"If it had been today, you would have had groups either for it or against it, blogging," Kassebaum said. "For my part, it hasn't been helpful, because it's so immediate. You wouldn't get the perspective. We spent a lot of time in committees and in hearings going over (HIPAA) and it was there that the work was done.
"Look at the major healthcare reform (legislation), the death panels that flashed up on the screen. You tried to explain, but you can't."
She added that she supports wage-based Medicare. "You can't have universal coverage if you don't mandate it," she said. "And look at what Congress didn't pay for, Part D.”
Washington needs to address healthcare financing, but congressional leaders and the president could benefit from some better messaging, Kassebaum said, citing the marketing of a Reagan-era tax increase. "President Reagan called them revenue enhancements," she noted.
Follow Joseph Conn on Twitter: @MHJConn.
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