In this edition of The Wired Practice video, originally published for MedPage Today, Vanguard CEO Ron Harman King discusses how healthcare systems and practices often promise a great patient experience but often fall short.
Watch the video on MedPage Today
By Ron Harman King, MS, JD, CEO
Government access to medical records including abortion threatens patient rights
In the novel 1984, author George Orwell wrote: “Always, at every moment, there will be the thrill of victory, the sensation of trampling on an enemy who is helpless.”
In Orwell’s words I can think of no better way to characterize a political movement to trample on approximately half the United States population: women and girls.
Since January of this year, officials have launched a wave of initiatives to track what’s happening inside their reproductive organs. In one of the latest moves, a Texas judge recently overturned a Biden-era rule blocking law enforcement from obtaining medical records of patients seeking legal abortions or gender-affirming care.
Politically favored medical procedures?
A couple of months ago, U.S. District Court Judge Matthew Kacsmaryk of Amarillo, Texas, found that the U.S. Department of Health and Human Services (HHS) exceeded its powers in enacting the rule. In his ruling, Judge Kacsmaryk described the rule as affording “special protection for medical information produced by politically favored medical procedures.”
Yes, he apparently does believe that ending, say, an ectopic or anencephalic pregnancy is an act of political favoritism.
Judge Kacsmaryk gained national attention in 2023 for his opinion invalidating the FDA’s approval of the abortion drug mifepristone [Mifeprex] nearly a quarter-century ago. The next year, the Supreme Court unanimously restored access to the drug under current FDA regulations.
This time around, the judge said the Biden-era HHS exceeded its statutory authority in applying the HIPAA Privacy Rule, which Congress enacted 25 years ago, to impose safeguards for abortion privacy. In essence, the rule allows the sharing of protected health information only among providers, health plans, healthcare clearinghouses, and certain contractually bound business associates.
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The morality of abortion and law enforcement tactics
Whatever your opinion on the morality of abortion, if the judge’s ruling stands, law enforcement officials in states with abortion bans may subpoena reproductive healthcare records of presumably any kind in any state, even those where abortions are largely unrestricted.
Let me emphasize that broad phrase, reproductive healthcare records. That’s right, those would be records of examinations, diagnoses, and treatments on everything from anovulation to endometriosis to Pap smears to uterine ultrasounds and breast exams. Perhaps even records of men’s sperm counts and prostatectomy surgeries would be fair game.
Targeting women, squarely and cruelly
Yet let’s not avoid the obvious. The privacy-invasion trend targets women squarely and cruelly. For example, weeks ago the Illinois secretary of state called for an investigation into a report that a suburban Chicago police department violated state law by sharing data from automatic license-plate readers with a Texas sheriff searching for an abortion patient.
Proposed federal system wants people to upload PHI
There’s more. Recently, the Trump administration announced an initiative for millions of Americans to upload personal health information and medical records to a proposed nationwide private database. Leaders from more than 60 companies met just days ago at the White House to strategize a so-called “digital health ecosystem.”
Attendees included tech giants Google and Amazon, as well as the Cleveland Clinic, UnitedHealth Group, and CVS Health – which have agreed to share patient data in the system. Of course, the stated goal is improved management of diabetes and obesity.
French healthcare system shows possible benefit
To be fair, the scheme could be a great step forward. For example, France – which the Commonwealth Fund ranks as having the world’s fifth-best healthcare system – maintains a national healthcare database that tracks 11 million hospital stays and 500 million healthcare events per year.
The French system contributes to research and advancing technology through epidemiological, health economics, and treatment efficacy evaluations. To protect individual privacy, the data is “pseudonymized” to mask patients’ names, addresses, and Social Security numbers.
In the U.S. plan, individual participation in the system would ostensibly be opt-in. But can we expect adequate privacy protections from the current presidential administration? Or from the U.S. Supreme Court for that matter?
List of 2025 healthcare privacy transgressions
Let us run through the list of privacy transgressions in 2025. First, the youthful techies in the new Department of Governmental Efficiency gained unfettered access to our Social Security data, including physical and mental health records. Eventually the Supreme Court blessed the intrusion in a 6-3 unsigned order, overturning two lower courts.
Further, weeks ago the president signed an executive order legalizing the forced institution of homeless and mentally ill Americans. The order grants expansive powers to federal agencies to gather sensitive health information of the most vulnerable.
ICE (Immigration and Customs Enforcement) gets Medicaid PHI
A month ago, the Trump administration granted access to the personal data of 79 million Medicaid enrollees to Immigration and Customs Enforcement (ICE) officials. More than one media outlet reports that ICE will get login credentials to a database holding sensitive medical information.
Ergo, the current president who steadfastly refuses to release his own medical records publicly is steadily gaining access to the most private of personal information of millions of Americans.
Granted, women and girls are hardly alone in vulnerability to Big Brother surveillance. They are joined by the poor, the homeless, and the mentally ill.
Nevertheless, because they make up a little more than half the population, they constitute the largest at-risk group by far.
Old HIPAA vs. new HIPAA differences
Admittedly, HIPAA has never been a bomb-proof shield. Privacy rule exceptions may allow law enforcement officials to breach the HIPAA wall.
Yet there is a key difference between the old and the new. For example, legal experts say that guardians of protected health information can sometimes successfully resist by insisting on seeing a subpoena or judicial warrant. However, once the information is already in the hands of the government, it’s doubtful any resistance would prevail.
Additionally, how readily would a health insurer subject to an array of state and federal regulations prioritize patient safety in a stare-down with law enforcement? Again, doubtful.
State laws attempt to protect reproductive health info including abortion
Lastly, while 22 states and the District of Columbia have shield laws limiting official accessibility to reproductive health information, data may be held by insurers and healthcare clearinghouses based in the 28 states without such limits. Besides, a federal warrant or subpoena could possibly override any state law.
Hence, it’s not just someone’s abortion records exposed to government hands. It’s anything too personal for a girl or woman to share with any stranger. I say that government capture of their secrets is not merely a violation of the U.S. Constitution Fourth Amendment’s “search and seizure” clause; it’s an Orwellian trampling in the extreme.