The Defense Department’s policy of informing parents about the health of teenagers angers some Republicans in Congress

Ten Republicans in the House of Representatives have opposed new restrictions on military parents’ access to their teenagers’ medical records, calling the measures “reprehensible” and saying they limit parents’ ability to make decisions about their children’s health.

An update to the federal Health Insurance Portability and Accountability Act (HIPAA) privacy rules in April changed the circumstances under which an individual’s health information can be disclosed, particularly with respect to reproductive health care.

The change followed the Supreme Court’s 2022 decision to overturn Roe v. Wade and prohibits doctors, insurance companies and other health care organizations from sharing patient information with government authorities for investigations or civil or criminal proceedings.

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Shortly before the change, the Defense Health Agency issued a policy stating that in the military health system, parents of minors under 12 would have full access to their children’s health records in MHS Genesis, the Department of Defense’s electronic health record system. However, parents of dependent children ages 13 to 17 would only have access to appointment information, messages, immunization records and allergy care.

Although HIPAA privacy rules allow parents to access the medical records of their minor children, there are exceptions under individual state laws that protect teens seeking medical care for mental health or sexual health concerns, including contraception and pregnancy, or for other reasons.

The Department of Defense memorandum on parental access to protected health information of underage minors, released last year, said the department would comply with federal and state privacy laws in the U.S. A March 2023 Department of Defense memo allows minor dependents to receive treatment for contraception, treatment of reproductive health conditions, and treatment of sexually transmitted diseases at military hospitals and clinics overseas without parental consent.

The new Defense Department restrictions have angered some Republican lawmakers, who say the guidelines would allow health care providers to determine whether teens are capable of making their own health care decisions, violating parents’ rights.

According to the group, led by Republican Rep. Mark Alford of Missouri, the lack of access is “problematic” and “places an undue burden on these parents.”

“Young children or teenagers under the age of 18 are prohibited from voting, using alcohol and tobacco, and many other things that are regulated differently under federal and state law because they are not mature enough to make appropriate decisions about their own well-being. Health care decisions should be no different,” the lawmakers wrote in an Aug. 5 letter to Assistant Secretary of Defense for Health Affairs Dr. Lester Martinez-Lopez.

The group also claims that the changes would make it impossible for parents to “find out if their child ‘identifies’ with a different gender.”

According to the letter, a minor can also be considered mature and request treatment such as “removal of his or her reproductive organs” without the need for parental notification.

The Department of Defense guidelines specifically state that there are situations in which a provider “may be required to notify” a parent or legal sponsor, including life-threatening conditions, those requiring removal of reproductive organs, or behavior that involves potential harm to the provider or others.

However, lawmakers said the language in the privacy policy meant there could be situations where parents of soldiers overseas would not have a chance to talk to their child about a life-changing decision before the loved one undergoes a procedure.

“Even then, the provider may not determine that it is necessary to notify the child’s parents. This practice is reprehensible,” they wrote.

Lawmakers urged Martinez-Lopez to reconsider the policy.

Adam Greene, a former regulator at the Department of Health and Human Services and a partner at the Washington, DC-based law firm Davis Wright Tremaine, said the military policy was “actually quite typical.”

“We have this complicated relationship where HIPAA defers to state law as to whether the minor … needs parental consent, but then HIPAA essentially decides based on the outcome whether the parents have access,” Greene said in an interview with Military.com on Thursday.

State laws vary widely when it comes to allowing teens to make their own health decisions, but many allow young people to act on their own behalf when it comes to reproductive care, mental health and substance abuse, or conditions such as sexually transmitted diseases that teens may not want their parents to know about or whose disclosure could harm the patient.

The creation of patient portals – the interface between providers, electronic health records and patients with access to electronic health records – has complicated privacy issues related to health care, according to Greene.

In a perfect world, the portals would have an option where providers could check a box so that patients under 18 are not tied to protected medical care, but at the same time allow parents to learn about non-private treatments for acute or chronic conditions, Greene said.

However, that is not how the technology is designed.

“This is a bipartisan concern – on the conservative side and on the liberal side, not giving parents immediate access to the patient portal, for example to their child’s oncology information, potentially hinders care. I think the key is improved technological solutions,” Greene said.

A 2022 study published in the Journal of Pediatrics found that the variability of state laws “makes their interpretation difficult” when considering HIPAA regulations and healthcare standards.

According to lead author Dr. Marianne Sharko of the Departments of Population Health Sciences and Pediatrics at Weill Cornell Medicine, the findings show “that adolescents are more likely to seek medical help for potentially sensitive topics such as sexuality, mental health, and substance use when they can give their own consent and can be assured that their health information will be kept confidential.”

“However, parents and guardians also have responsibilities related to the care of minor patients,” she wrote.

Defense Health Agency officials did not respond to a request for comment on the letter.

In a statement accompanying the March press release about the rule, Dr. Anmarie Widener, director of the Defense Health Agency’s Office of Privacy and Civil Rights, said the new HIPAA privacy rule provides “clear guidelines” to protect Americans’ health information and that minors would be included in the rule.

Authorities also urged patients to learn about their state’s laws that allow teenagers to consent to medical treatment without parental notification.

“Each of the 50 states, each U.S. territory, and the District of Columbia has its own rules regarding when a minor can consent to care. DHA follows these federal rules in all circumstances,” DHA officials wrote.

In addition to Alford, Republican Representatives Elise Stefanik of New York, Michael Waltz and Cory Mills of Florida, Doug Lamborn of Colorado, Rich McCormick of Georgia, Ben Cline of Virginia, Harriet Hageman of Wyoming, Pat Fallon of Texas and James Moylan of Guam signed the letter.

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