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Young Adults and the Affordable Care Act

posted on Mon, Sep 24 2012 2:37 pm by Roybn Rontal

In a prior blog, I discussed the issues created when young adults up to age 26 take advantage of the Affordable Care Act (ACA) provision that allows them to remain on their parents’ health insurance plans. Young adults can gain needed health care coverage, only to face loss of confidentiality when they seek access to sensitive services that are disclosed to their parents as policyholders through the insurance company’s explanation of benefits (EOB). As a parent of three young adults who remain on my plan, I am familiar with the competing policy issues that EOBs present. Since I am the policyholder I am granted electronic access to EOBs itemizing health care services provided to all my dependents. My son pays his own health bills and to maintain confidentiality, he should be the primary recipient of his EOBs, especially if he receives any sensitive services. For my college-age daughters, I maintain financial liability and want to review their EOBs to determine the accuracy of my payments to their providers. On the other hand, if either of them need services for a sexually transmitted infection (STI), family planning, mental health, substance abuse or another sensitive service, I would not want to learn about their health issues by receiving an EOB; I would prefer to hear from them directly when they are emotionally ready. Moreover, I want them to be able to access these services with assurances that their medical records and EOBs would be kept confidential, even from me, if it means they would get the care they need and avoid costly health complications.

Two recent articles provide new insights into this dilemma. In Health Reform and the Preservation of Confidential Health Care for Young Adults, Lauren Slive and Ryan Cramer present potential solutions. In particular, they maintain that young adults who remain on their parents’ insurance plans are protected from disclosure of protected health information (PHI) under the federal Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. They argue that the “minimum necessary” standard governing the use or disclosure of protected health information should be applied to restrict the release of EOBs to parents of young adults when parents do not have any remaining liability for payment. Furthermore, they contend that the federal HIPAA law should pre-empt state laws that mandate sending EOBs to prevent fraud and abuse. They also suggest state laws that could serve as a blueprint for national or state-by-state reform.

A recent Guttmacher report, Confidentiality for Individuals Insured as Dependents: A Review of State Laws and Policies, provides a comprehensive review of patient confidentiality laws in all states. Eight states have adopted statutes or regulations that may provide approaches that could be extended to provide greater confidentiality protection for dependents in other states. The table below from the Guttmacher report summarizes the range of protections for both young adults and minors.

Protection afforded


EOB not sent when no balance is due

New York, Wisconsin

EOB may be sent to patient

New York, Wisconsin

Confidential STI treatment for minors, including in billing process

Connecticut, Delaware, Florida

General confidentiality provisions


Health care providers must inform insurer when “minors without support” request confidentiality


Dependent children may refuse parent's request for EOB or explanation of claim denial for sensitive services


Insurer may not disclose private health information, including by mailing an EOB, without authorization of minor or adult patient


Confidentiality is a very real issue for young adults needing sensitive services. The various solutions described in these articles offer guidance to promote viable change at the state or federal level. 

This blog was written by Robyn Rontal, J.D., M.H.S.A, a collaborator on health information data sharing for the Network for Public Health Law – Mid-States Region.

The views expressed in this post are the authors and do not necessarily reflect those of the Network for Public Health Law or Robert Wood Johnson Foundation.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.


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