Mental health professionals, advocates against domestic violence, and family planning providers all agree: confidentiality is critical to ensure that patients can access the health care they need. That’s why Massachusetts, long a leader in promoting universal health insurance coverage, must also lead the way in guaranteeing safe, confidential access to care. Merely having health insurance doesn’t do a person any good if she doesn’t feel safe to use it.

A few years ago, when she was 22 and fresh out of college, Vanessa Calaban received a distressing text message from her mother. A form had just arrived from the family’s health insurance company, displaying a charge for care Calaban received from a doctor her mother didn’t recognize.

It’s hard to feel safe seeking medical care for a sensitive issue if you know someone else is going to find out about it from the insurance company. That’s the problem described in a front-page Boston Globe article that opens with this story:

The doctor was a psychiatrist. And that’s why Calaban, although living on her own in Boston, had to tell her parents that she suffers from an anxiety disorder. “I felt very violated,” she said. “I wasn’t ready to tell them.”

In the wake of the Affordable Care Act, which allows adult children to stay on their parents’ insurance plans until age 26, stories like Vanessa’s are becoming all too common. Whether seeking mental health care, reproductive health care, or a consultation with a transgender health specialist, young adults could be forgiven for not being too jazzed about having that information sent home to their parents by an insurer. But the need for confidential health care long pre-dates the ACA and affects a much wider population than those newly-insured youth – including domestic violence victims and anyone on a spouse’s insurance plan.

Dr. Bruce Black, director of a mental health group practice in Wellesley and treasurer of the Massachusetts Psychiatric Society, said the consequences of privacy breaches can be dire.

He told of a divorced father who, after receiving an insurers’ notices revealing that his ex-wife was seeing a psychiatrist, persuaded authorities that she was unstable. Their child was put in foster care for months, according to Black.

Black had another patient, an adolescent girl, whose mother was in an abusive relationship and didn’t want the father to know their daughter was receiving mental-health treatment. She paid out of pocket and could afford fewer visits than the girl needed.

Thankfully, there’s a simple legislative fix being contemplated by the Massachusetts legislature: An Act to protect confidential health care, filed by champions Sen. Karen Spilka and Rep. Kate Hogan. This bill, supported by the ACLU of Massachusetts in concert with a broad coalition, would establish mechanisms to ensure that when multiple people are on the same insurance plan confidential health care information is not shared with anyone other than the patient against the patient’s wishes.

California, Colorado, Maryland, and Oregon have passed similar measures. This isn’t rocket science.

The fact is, health insurance doesn’t work without confidentiality. It’s time for Massachusetts to make it work.
 
Gavi Wolfe is legislative counsel at the ACLU of Massachusetts.

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