Thursday, January 18, 2018
Politics

Obamacare doesn't require doctors to ask about sex

"Obamacare will question your sex life," said a New York Post headline this week.

The opinion piece underneath, written by the former lieutenant governor of New York, Betsy McCaughey, begins:

" 'Are you sexually active? If so, with one partner, multiple partners or same-sex partners?'

"Be ready to answer those questions and more the next time you go to the doctor, whether it's the dermatologist or the cardiologist and no matter if the questions are unrelated to why you're seeking medical help. And you can thank the Obama health law."

McCaughey then claims that the law offers incentive payments, and eventually penalties, to pressure doctors and hospitals to convert to electronic health records. She quotes a cardiologist saying that sex questions are "insensitive, stupid and very intrusive" and a nephrologist declaring that the new requirements turn your medical record "into an interrogation, and the data will not be confidential."

So does Obamacare require your dermatologist to ask you about your sex life?

We talked with the Centers for Medicare & Medicaid Services, two members of a federal committee on health information technology and the president of a national physicians group.

The federal government did create incentives and eventually penalties to encourage doctors and hospitals to make "meaningful use" of electronic health records. The government says the switch from paper will offer easier access to health records and data, provide reminders and alerts for doctors and patients, and reduce medical errors.

The change wasn't part of Obamacare, though. And it doesn't require any "sex questions" — except for whether you're male or female. You might hear the words, "Are you sexually active?" from your doctor, but it wouldn't have anything to do with the health care law.

In other words, McCaughey's claim is utterly at odds with the evidence.

"Arrgghhh — now I have heard it all!" said Molly Cooke, president of the American College of Physicians.

Cooke, an internist, told PolitiFact that when she was in medical school in the 1970s, she was taught to ask:

• Are you sexually active (with other people)?

• If yes, are your partners men, women or both?

• If no, is that out of choice, because you don't currently have an appealing partner, because you have no privacy, or some other reason?

• Are you happy with your sex life, however it is?

"My classmates and I were taught to ask all patients all four questions," she said. "I am not saying that we always did it, but these questions are as old as the hills."

The rationale is that patients' answers may reveal important information about their health, safety and well-being, she said. Her medical practice happens to focus on patients with HIV and other complex chronic illnesses.

But let's say some doctors, such as the cardiologist quoted by McCaughey, find such questions "insensitive, stupid and very intrusive."

McCaughey wrote that the president's "reforms" aim to "turn doctors into government agents, pressuring them financially to ask questions they consider inappropriate and unnecessary."

Yet that cardiologist could earn government incentives for meaningful use of electronic health records whether he asked "sex questions" or not.

The financial push toward electronic records came not from the Patient Protection and Affordable Care Act of 2010, commonly called Obamacare, but from the federal stimulus bill the year before — the American Recovery and Reinvestment Act.

In the first stage of the incentives program, paid through the Centers for Medicare & Medicaid Services, doctors must use electronic records to keep up with basics on their patients.

They need to check for drug interactions, keep an up-to-date list of diagnoses, transmit prescriptions, keep medication and allergy lists, and record demographics and vital signs. They need to note a patient's gender, race, ethnicity, date of birth, height, weight and other data.

The demographic information helps doctors catch disparities in care, said Paul Tang, an internist who chairs the workgroup on "meaningful use" for the health information technology committee created by the recovery act.

Just as with paper records, that information is protected by federal health privacy laws, such as HIPAA, and in some cases additional state law.

In the second stage, the requirements for doctors get more sophisticated, with provisions for electronic access for patients to their health information, the ability to transmit data to immunization registries, and more. Some optional steps include entering electronic notes for at least 30 percent of the patients they see and recording family health history as structured data.

There's a requirement to protect electronic health information. But there aren't any requirements to ask questions about sexual history.

McCaughey frames her concern for patient privacy with an evidence-free attack on Obamacare that veers toward the ridiculous. We call it Pants on Fire.

Edited for print. Read the full version at PolitiFact.com.

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