WASHINGTON — The American Medical Association is opposing a change to patient privacy laws that would allow doctors to more freely share information about a patient’s history of substance use, a proposal that has divided the health care community and highlighted some of the challenges of addressing the opioid epidemic.
In a letter to lawmakers obtained by STAT, the AMA said it believed there was a “fundamental misunderstanding” among groups working to incorporate the proposal into a sprawling opioids bill. Relaxing restrictions on patient privacy, the AMA wrote, could prevent individuals with addiction from seeking medical treatment in the first place.
The letter to Reps. Greg Walden (R-Ore.) and Frank Pallone (D-N.J.), the leaders of the House Energy and Commerce Committee, is a potentially fatal blow to the proposal, which has long enjoyed Walden’s support and that of a wide array of other lawmakers, including the House’s 12 physicians.
The powerful AMA, in entering the fray, is also pitting itself against a similarly strong coalition of groups, including the American Hospital Association, the American Society of Addiction Medicine, and insurers including Aetna, Cigna, Anthem, and Blue Cross Blue Shield.
“We do have concerns that [the proposal] could have unintended consequences and will not be as helpful in addressing the opioid abuse crisis as some people think,” an AMA spokesman wrote in an email to STAT.
The provision would allow doctors to much more freely share a patient’s full medical history, including addiction treatment, with other health care professionals and even insurers, sometimes without a patient’s consent. Patients with substance use disorders must currently provide a one-time consent for information about addiction to be used in their electronic health record, or elect to consent to a single hospital or health system using that information.
The groups pushing the measure say that the current restrictions inhibit providers from accessing information critical to providing quality treatment — giving a common example in which a doctor, not knowing a patient has a history of addiction, unknowingly prescribing opioids for pain treatment.
Opponents of the proposed change, however, argue that Americans with substance use disorders face such severe discrimination that removing some confidentiality protections could discourage them from seeking medical treatment entirely.
“We applaud the AMA for opposing changes to Part 2, the law protecting confidentiality of substance use disorder patients, which would weaken essential patient privacy protections and likely lead to fewer people seeking life-saving care,” Paul Samuels, the president of the Legal Action Center, said in a statement.
Buoyed by a large coalition of mental health and addiction treatment organizations, Walden and the bipartisan duo of Reps. Markwayne Mullin (R-Okla.) and Earl Blumenauer (D-Ore.) nonetheless worked in the past year to push legislation on the change through a controversial committee vote and then a vote before the full House.
While the measure has been contentious from the start, the proposed change has proven abnormally apolitical. Voting yes on the measure, along with most Republicans: House Minority Leader Nancy Pelosi (D-Calif.) and the House’s two Democratic doctors: Ami Bera (Calif.) and Raul Ruiz (N.M.).
The legislation was never wrapped into a broader House bill to address the opioid crisis. The Senate, itself, passed a bill requiring the Department of Health and Human Services to issue guidelines promoting better access to patient information.
Walden and House leadership, as a result, were left to negotiate the provision’s inclusion in the opioids bill as the chambers work to craft a single, final version that can be sent to President Trump’s desk.
Some Democrats — namely Pallone and Sen. Patty Murray (D-Wash.) — have long opposed the House measure as written.
Though the Senate was unlikely to fully concede the provision to Walden, the AMA weighed in this week just as the House and Senate went to work reconciling their bills.
“Ranking Member Pallone continues to have serious concerns with the … proposal,” a Democratic aide to the Energy and Commerce Committee wrote. “Any action that could potentially prevent people from seeking treatment in the midst of a substance use disorder epidemic like the one were currently facing must be avoided.”
The move is also seen as a nod to Pallone, the top Democrat on the committee who would likely become its chairman if his party, as is expected, wins control of the House in November.
Even in light of the AMA’s opposition, a Walden spokesman said the committee majority would continue to push for the provision.
“With more than 350 members of the House and bipartisan support in the Senate, this commonsense policy should be a part of our efforts to combat the opioid crisis,” a committee aide told STAT in an email.