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IRS role in health care law troubling

About Luis Fábregas
Picture Luis Fábregas 412-320-7998
Medical Editor
Pittsburgh Tribune-Review

Luis Fábregas is an award-winning reporter who specializes in medical and healthcare issues as a member of the Tribune-Review’s investigations team.

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By Luis Fábregas

Published: Saturday, May 25, 2013, 12:01 a.m.

Quick — Which government agency will be responsible for enforcing a penalty on people who don't carry health insurance starting next year?

If your answer is the Internal Revenue Service, give yourself a pat on the back.

If you cringed upon learning this, I don't blame you.

It's exceedingly ironic that after years of debate, enforcement of the federal health care law will wind up in the hands of the IRS, the agency giving President Obama one of the biggest headaches of his second term.

The IRS, which doesn't exactly get a lot of love, faces a slew of hearings and investigations upon disclosures that it gave additional scrutiny to conservative groups applying for tax-exempt status.

The president vowed to hold someone accountable, amid calls from Republicans that someone needs to be prosecuted and go to jail.

The IRS-Obamacare link sticks out because when we think about health insurance, we start thinking about medical care and, inevitably, medical records.

At least on paper, the Affordable Care Act does not give the IRS access to an individual's medical records. The law specifies the IRS would collect penalties from individuals who fail to carry a minimum level of insurance. An agency spokeswoman has said the agency will not have access to personal health information.

Critics aren't buying that.

“I'm quite worried that your medical records will be evaluated by the IRS,” Sen. Rand Paul, R-Ky., said recently. Some members of the Tea Party movement, who apparently were under special IRS scrutiny, have expressed similar views.

On any other day, such comments would have implied some sort of far-fetched conspiracy theory. But we live in strange times.

The Associated Press reported this month that investigators from the Department of Justice secretly obtained months of phone records for several AP reporters and editors. The records included calls placed from more than 20 lines in homes and offices and on cellphones.

If there's disregard for constitutional rights, either by the IRS or the Justice Department, it is not entirely far-fetched to surmise the government could someday go after your blood work or biopsy results.

Sadly, it's nothing new to worry about protecting the privacy of medical information. Some of us always have suspected that insurers share private medical information with employers.

Now, if you ever thought your medical matters are truly private, you need to work in a hospital for a day. (I worked in one for eight years before becoming a reporter.) Some hospitals had to install special software to prevent workers from accessing certain records because someone was caught snooping in records of neighbors or co-workers.

If you've ever been in a waiting room at a doctor's office or a hospital, you've likely heard your name called out. Suddenly you're in a rerun of “Cheers,” where everybody knows your name.

Most of us can probably live with the fact that a nosy neighbor talked to someone else about our bypass surgery. But that's far from intimating that we want the IRS going through our private medical records.

The fact that people are talking about it shows that the tiny bit of trust we have in the IRS is on life support.

Luis Fábregas is a Trib Total Media staff writer. Reach him at 412-320-7998 or




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