Health-Care Law Poses a Technology Challenge for the Needy

The Nathan Cummings Foundation


By Helen Brunner

Foundation and nonprofit leaders who joined the fight to make affordable, quality health care a reality for all Americans achieved a true victory last month.
But as grant makers build on the momentum created by the Supreme Court decision to uphold the Affordable Care Act, we must consider how to ensure that in putting the law into effect, everything is done in a practical way that truly makes health care more affordable, accessible, and secure. In particular, that requires grant makers to put their money into projects that expand Internet access and privacy protections.

The health-care law acknowledges the importance of technology in two key ways: by requiring states to create exchanges (including online platforms for consumers to compare insurance policies) and by requiring providers to use electronic medical records.
While these are huge advances, they assume that patients and providers all have reliable and fast Internet access that allows them to take advantage of a modernized health-care system. Unfortunately, that is not the case for millions of people in this country, especially in rural communities. What’s more, as new health-care policies encourage health-care providers to move more and more personal information online, millions of Americans are left vulnerable to privacy violations because the U.S. lacks comprehensive privacy protections.

As foundations make decisions about the role we will play, it is critical that we understand the direct relationship between health care and technology. We must integrate strategies that ensure that the greatest number of people can truly benefit from the health-care law by increasing Internet access and protecting patient privacy as more and more of our personal information is stored online.

According to the Pew Research Center’s Internet & American Life Project, 80 percent of Internet users look online for health information. However, almost 40 percent of American adults with chronic diseases do not have Internet access. Without Internet access, these patients are missing out on online resources that can help them stay healthy, interact with peers, and cope with continuing pain.

Ethnic and racial minorities as well as rural and low-income people are among those who could benefit most from provisions in the health-care law, but they are also among those least connected online. While 72 percent of whites have Internet access at home, only 55 percent of African-American and 57 percent of Hispanic households can access the Internet at home. In addition, only four of every 10 households with incomes below $25,000 and 50 percent of rural Americans have wired home Internet access.
Affordable Internet access is a critical first step to changing the health-care system. As grant makers, we have a responsibility to think about which key health services are moving online, pinpoint who is missing out on these opportunities, and identify the most effective ways to fill these gaps. We have the ability to act as a catalyst for efforts to ensure that small community providers, not just exclusive doctors’ offices and hospitals, can transfer patient records online—so that all Americans can benefit from the health law’s new online services.

It is also unclear how the law will secure patients’ privacy. Since the U.S. currently has no real online-privacy policies, how will we ensure that medical records will be kept secure and that patients won’t be tracked online without their permission?

When medical records go electronic, it will reduce health-care costs, protect patient safety, and give doctors and nurses a more holistic, accurate picture of each patient’s health needs. But what if these records are hacked and go public? Most people have something in their medical history that they want to keep confidential. Do we want them to be accessible for all to read? And those records also contain Social Security numbers, home addresses, and billing or credit-card details. In the wrong hands, this could mean credit-card or identity theft.

Privacy also means protecting patients’ identities when they are searching for health information online. Patients should be able to research treatments and interact with peers confidentially. But today, almost all of our movements online are tracked by corporations and advertisers.

Right now, there is nothing to stop private companies from monitoring personal medical information through our online activity. If a cancer patient is reading about possible treatments, for example, is it acceptable for pharmaceutical companies to advertise the specific products they offer? To ensure that patients can trust and take advantage of the new tools from the health-care law, grant makers need to call for real online privacy protections.

The momentum spurred by the Supreme Court decision has resulted in a renewed commitment from policy makers, health-care providers, nonprofit organizations, and grant makers to keep pushing for new ways to deliver quality, affordable health care. But fulfilling the promise of the new health-care law will take more than changes to the insurance system and the way we deliver medicine and treatment.

We need to ask ourselves and our grantees the question, “How can we ensure that this country’s technology policies help us deliver 21st-century health care?”

This isn’t just a question for grant makers who focus on technology. Any institution working to improve access to quality health care has a stake in policies that expand Internet access and online privacy protections.

Helen Brunner directs the Media Democracy Fund.

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