The Bush administration proposed on Thursday to drop a requirement at the heart of federal rules protecting the privacy of medical records.
The administration said that doctors and hospitals should not have to get consent from patients before using or disclosing medical information for the purpose of treatment or reimbursement.
The proposal, favored by the health care industry, was announced by Tommy Thompson, secretary of health and human services, who said the process of getting consent could have "serious unintended consequences" and could impair access to quality health care.
The sweeping privacy rules were issued by President Bill Clinton in December 2000. When Bush allowed them to take effect in April, consumer advocates cheered while much of the health care industry expressed dismay.
Thursday's proposal would repeal a provision widely viewed as the core of the Clinton rules: a requirement that doctors, hospitals and other health care providers get written consent from patients before using or disclosing medical information for treatment, for the payment of claims or for any of a long list of "health care operations," like setting insurance premiums and measuring the competence of doctors.
The proposal is to be published in the Federal Register next week, with 30 days for public comment. The government will consider the comments and issue a final rule with the force of law.
Thompson said he wanted to "remove the consent requirements" because he believed they could delay care.
Pharmacists and hospitals had expressed the same concern. Drugstores said they could not fill prescriptions phoned in by a doctor for pickup by a patient's relative or neighbor. Hospitals said they could not schedule medical procedures until the patient had read a privacy notice and signed a consent form.
Hospitals and insurance companies praised Thursday's proposal as a victory for common sense, but consumer advocates and Democratic members of Congress denounced it as a threat to privacy.
"In general, this is great for the health care industry," said Elisabeth Belmont, corporate counsel for Maine Health, which operates seven hospitals, a nursing home and a home health agency in Maine.
Mary Grealy, president of the Health Care Leadership Council, which represents drugmakers, drugstores, insurers and hospitals, said: "The new proposal strikes an appropriate balance. It's a workable compromise."
But Janlori Goldman, coordinator of the Consumer Coalition for Health Privacy, a coalition of more than 100 groups favoring patients' rights, said the administration was proposing "a destructive change."
Rep. Edward Markey, D-Mass., said: "By stripping the consent requirement from the health privacy rule, the Bush administration strips patients of the fundamental right to give their consent before their health information is used or disclosed. The administration's proposal throws the baby away with the bath water."
Sen. Edward Kennedy, D-Mass., chairman of a Senate committee on health care legislation, said he was "very concerned" because he believed that "an individual should have to give permission before medical information is disclosed."
The Bush administration denied that it was eviscerating privacy protections.
"The president believes strongly in the need for federal protections to ensure patient privacy, and the changes we are proposing today will allow us to deliver strong protections for personal medical information while improving access to care," Thompson said.
Under the rules, doctors and other health care providers would have to notify patients of the patients' rights and the providers' disclosure policies. Patients would be asked to acknowledge in writing that they had got such notice, but they could get care without providing the acknowledgment.