The legislation that impacts reproductive health information

When reproductive health information is protected, individuals have greater control over their healthcare decisions. A wide variety of legislation sets the standard for how reproductive health is handled, with the specific impact of protecting reproductive health information that can vary across different states and healthcare settings in the United States. 

Title X of the Public Health Service Act 

Purpose 

Title X ensures that individuals can access a broad range of family planning methods and services. It aims to ensure that individuals can access these services without fear of judgment, stigma, or breach of confidentiality. It also attempts to improve access to family planning services for underserved populations, including low-income individuals, uninsured or underinsured individuals. 

Impact on individuals 

Title X ensures that individuals can receive contraception, pregnancy testing, STI screenings, and other related services at reduced or no cost, based on their ability to pay. The title emphasizes how healthcare organizations should hold patient privacy in high regard allowing patients to share data without concerns about a breach of confidentiality. Training programs and counseling programs are also supported under the title to inform individuals about family planning, contraceptive options, and reproductive health. 

Effects on healthcare organizations

It provides funding to healthcare organizations, such as family planning clinics, community health centers, and nonprofit organizations, to deliver comprehensive family planning and reproductive health services. Title X also establishes certain program requirements and standards that healthcare organizations must meet to receive funding, including ensuring that organizations offer a range of contraceptive methods and maintain the privacy of patient data when providing services. Beyond this, it fosters collaboration and networking among healthcare organizations and encourages them to participate in various research programs.  

Case Law 

Rust v. Sullivan (1991): This Supreme Court case involved a challenge to the Reagan Administration's Title X regulations. The regulations prohibited Title X funds from being used to provide counseling or referrals for abortion. The Court upheld the regulations, stating that the government has the right to favor childbirth over abortion and can allocate funds accordingly.

Planned Parenthood Federation of America, Inc. v. Agency for International Development (1995): In this case, the Supreme Court considered whether the government could impose restrictions on international family planning organizations receiving federal funds. The Court held that the government could require foreign organizations to adopt policies that prohibit the use of non-federal funds for abortion-related activities, even if those activities are conducted with separate funds.

Affordable Care Act (ACA)

Purpose 

Enacted in 2010, the ACA addressed several issues in the healthcare system, such as the high number of uninsured individuals, rising healthcare costs, and inadequate consumer protections. The law sought to achieve these goals through various provisions, including the establishment of health insurance marketplaces, the expansion of Medicaid eligibility, the requirement for most individuals to have health insurance or face penalties, and the implementation of health benefits.  

Impact on individuals

While not the primary goal of the ACA, it does include provisions relating to the protection of individual data. It establishes guidelines and safeguards to ensure personal health information is handled securely and confidentially. The ACA also prohibits discrimination based on gender or pregnancy status, ensuring that individuals receive equal access to reproductive healthcare services without fear of privacy breaches or discriminatory practices. 

Additionally, the ACA provides certain preventive services related to reproductive health, such as contraceptives and screenings, at no additional cost, further promoting access to reproductive healthcare while maintaining the privacy of patient data.

Effects on reproductive health services and access

The ACA expanded coverage options, extending access to healthcare services to millions of previously uninsured individuals. Additionally, the ACA implemented changes in reimbursement models, emphasizing quality and value-based care over the traditional fee-for-service approach. introduced various regulations and reporting requirements to enhance transparency, patient privacy, and data security. Healthcare organizations must now comply with stricter guidelines regarding the collection, storage, and sharing of patient information to protect patient privacy and maintain data security. 

Case law

King v. Burwell (2015): This case involved the interpretation of a provision in the ACA related to the availability of premium subsidies on the federal health insurance marketplace. The Supreme Court ruled that the subsidies were available to eligible individuals regardless of whether they purchased insurance on the state or federal exchanges.

Zubik v. Burwell (2016): This case addressed the accommodation process for religious nonprofit organizations that objected to the contraceptive coverage requirement in the ACA. The Supreme Court sent the case back to lower courts, encouraging the parties to find a mutually agreeable solution.

Related: How HIPAA applies to reproductive health information

Health Insurance Portability and Accountability Act (HIPAA)

Purpose 

The purpose of the Health Insurance Portability and Accountability Act (HIPAA) is to safeguard the privacy and security of individuals' health information. HIPAA was enacted in 1996 to address concerns about the electronic transmission and storage of healthcare data, as well as the need for standardized privacy practices across the healthcare industry.

Impact on individuals 

It gives individuals greater control over their health information, ensuring that it is not improperly disclosed or used without their consent. HIPAA requires healthcare organizations and organizations to maintain the privacy and security of PHI, reducing the risk of unauthorized access, identity theft, and medical fraud. Individuals have the right to access and request amendments to their medical records, and they can file complaints if they believe their privacy rights have been violated.

Effect on healthcare organizations 

Healthcare organizations must adhere to the Security and Privacy Rules requirements for safeguarding patient privacy. When using third-party vendors, they should have a signed business associate agreement (BAA) in place to remain HIPAA compliant. A last requirement is set by the Breach notification rule. Organizations must ensure that they have effective breach policies and procedures in place in the event of a data breach. 

Case law

Shinnick v. United States: In this 2014 case, the court ruled that a healthcare organization could be held liable under HIPAA for the unauthorized disclosure of a patient's PHI. The case involved the wrongful release of a patient's reproductive health information, leading to emotional distress and damages.

CVS Pharmacy, Inc. v. Mistretta: This 2012 case involved a lawsuit against CVS Pharmacy for allegedly violating HIPAA by revealing a patient's prescription history, including medications related to reproductive health, to her husband without her consent. The court allowed the case to proceed, emphasizing the necessity for protecting patient privacy under HIPAA.

Related: Understanding and implementing HIPAA rules

A brief view of state law

California's Reproductive FACT act

California passed the Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act. This law requires certain licensed pregnancy-related centers to provide specific disclosures to clients, including information about available reproductive health services, such as contraception and abortion.

Illinois' reproductive health act

The Reproductive Health Act in Illinois is a comprehensive law that affirms and protects individuals' reproductive rights. It includes provisions to ensure the confidentiality of reproductive health information. It prohibits the disclosure of such information without proper authorization.

New York's comprehensive contraception coverage act

This act requires health insurance plans in New York to provide coverage for all FDA-approved contraceptive methods and related services without cost-sharing. It helps individuals access and afford various forms of contraception and related reproductive health services while ensuring the privacy of their PHI.

Massachusetts' pregnancy privacy act

The Pregnancy Privacy Act in Massachusetts prohibits the unauthorized disclosure of an individual's pregnancy-related PHI. It ensures that healthcare organizations, insurers, and others involved in the provision of pregnancy-related care maintain the confidentiality of sensitive health information.

Related: HIPAA Compliant Email: The Definitive Guide