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Life Health > Health Insurance > Health Insurance

Republican Lawmaker Questions Risk Adjustment Database

By Allison Bell

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Rep. Denny Rehberg is demanding more information about U.S. Department of Health and Human Services (HHS) plans to build a patient health record database that would be used in reinsurance and risk adjustment programs.

Rehberg, R-Mont. – the chairman of the Labor, Health & Human Services and Education subcommittee at the House Appropriations Committee – has expressed those concerns in a letter sent to HHS Secretary Kathleen Sebelius.

If the Patient Protection and Affordable Care Act of 2010 (PPACA) takes effect as written and works as drafters expect, it will require health insurers to sell individual and small group coverage on a guaranteed-issue, mostly community-rated basis starting in 2014.

PPACA also is supposed to create a new system of health insurance exchanges that will help individuals buy health coverage using a new, tax-credit-based subsidy.

HHS officials are trying to develop reinsurance programs and risk adjustment programs to protect health insurers against the possibility that they might attract sicker-than-expected enrollees as a result of the changes.

To support the reinsurance and risk adjustment programs, HHS would develop a patient information database.

Health insurers and researchers have argued that they need large patient information databases to analyze health care and health care billing trends.

Rehberg says in the letter to Sebelius that he has heard that HHS officials already have hired a contractor to build the database and gather data from a large claims database.

“I would like to know if these reports are, in fact, true,” Rehberg says in the letter. “If so, it would represent an egregious violation of the privacy rights that the American public rightfully demands.”

Rehberg notes in the letter that he has been working to cancel funding for the Center for Consumer Information and Insurance Oversight (CCIIO), the HHS arm in charge of implementing much of PPACA.

It is irresponsible for HHS to move ahead with creating the database while the CCIIO appropriations process is incomplete, Rehberg says.

Rehberg is asking how HHS plans to protect the data in the database and how HHS plans to gather public input on “an effort to determine whether or not Americans support having their private medical records assessed by government bureaucrats.”

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