Dr. Katherine Fullerton, a pediatric emergency physician, makes a nice point over at Doctors for America’s Progress Notes. (I am an advisor to DFA.) When insurers practice medical underwriting, physicians are correspondingly wary about writing things down that might come back to harm their patients. As Fullerton notes,
Our EMR and record of past medical problems is a wonderful asset when Iâ€™m treating a sick child…. But could this same EMR be a barrier for these children when they become young adults and are trying to obtain their own insurance? Could the adorable 3 year old who is wheezing in room three, have been denied insurance as an adult because I wrote in the medical record that she has asthma? Will the six-year old hemophiliac in room five who is bleeding from a minor abrasion after wrestling with his cousin be denied insurance when heâ€™s reached adulthood?… With the new law, I do not have to worry that my careful history taking will harm their future.
Similar stories could be told in other areas, most obviously in stigmatized matters such as substance use and psychiatric disorders. If we want complete and candid medical records, we must protect patients from discrimination based upon these records. The Affordable Care Act provides these protections, highlighting another good reason not to repeal the new law.