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Young people need the right to access the full range of reproductive, sexual, and other sensitive health services they need to take personal responsibility for their own health. Most young people seek these health services with their parents’ knowledge and involvement. And any young person who needs to access health care services should be able to seek the advice of those who care for them. But for those who can’t or who face the threat of violence in their homes—it is better for them to be able to access the services of a trained medical professional than to face the situation alone and afraid, possibly delaying or foregoing the health care they need. Advocates must push policymakers on the local, state, and federal levels to guarantee that young people can independently consent to the care they need and to receive that care confidentially.

Independent access to confidential health care is key for young people’s health

The right to take responsibility for important decisions is a vital part of young people’s health. Why? Because developing responsibility for healthcare is part of building a healthy adulthood. The vast majority of young people exercise this responsibility in consultation with their parents about their healthcare decisions. [ i. ] Nonetheless, there are a variety of reasons they do not always feel it is safe or possible to involve their parents. For example, thirty percent of teens who do not tell their parents about their abortions feared violence or being forced to leave home. [ ii. ] If young people cannot consent to their own health care or feel secure in that care being confidential, they may delay, forgo, or even be denied needed care by parents, guardians, or others. That’s why the American Medical Association, [ iii. ] the Society of Adolescent Medicine [ iv. ], and the American Academy of Family Physicians have stated it is essential that adolescents have independent access to confidential health care [ v. ], and the Centers for Disease Control has made the clear guarantee of independent access and confidentiality protections key in developing teen-friendly reproductive health care. [ vi. ]

Pullout Stat: A 2007 study found that guaranteeing young people access to confidential health services did not discourage them from discussing their healthcare decisions with their parents and was not a barrier to parental involvement. [ vii. ]

State and federal law often prevent young people from accessing health care independently

Current policies limit youth rights to independently consent to a range of necessary health services. Legal doctrine historically required parental consent for the medical treatment of almost all minors. Thirty-eight states currently enforce laws that require a young person to notify or obtain consent from one or both parents before they can receive abortion care. Just sixteen provide exceptions for minors who are victims of sexual and physical assault, incest or neglect. [ viii. ] Twenty-nine states have some limitations on minors’ right to consent to contraceptive services [ ix. ], and eighteen states do not even allow all minors to consent to their own prenatal care. [ x. ] The legal barriers extend beyond sexual and reproductive health care: Half of the states do not permit minors to independently consent to mental health care. [ xi. ] Ten states do not permit minors to independently consent to substance abuse treatment. [ xii. ] And as few as five states permit minors to consent to medical treatment for sexual assault independently.

But there has been progress: over the last several decades some policymakers have begun to recognize the importance of young people’s right to consent to their own care in some circumstances. For example, the federal government requires that minors be able to independently consent to contraception and STI services at federally funded Title X clinics and for services provided through Medicaid and to receive those services confidentially, [ xvi. ]

Even with independent access to some care, young people’s confidentiality is often compromised

Young people cannot always count on information about the health care they receive to be kept confidential. Some states allow providers to inform parents of certain types of care received even when they allow minors to consent to their own services. For example, while every state allows minors to obtain STI screening and treatment without parental consent, eighteen states allow providers to notify parents of those services. [ xv. ] And if a minor is insured on a parent’s health plan, the federal Health Insurance Portability and Accountability Act (HIPAA) does not usually protect their personal health information from parental access. [ xvi. ]

Even for young people over eighteen, widespread insurance billing and claims practices routinely risk compromising confidential access to health care: when teenagers or young adults access care through their parents’ health plans, explanations of benefits and other insurance communications may disclose sensitive medical information to their parents, inadvertently breaching patient confidentiality. [ xvii. ] This contributes to serious negative health risks for teens and young adults and counteracts the promise of efforts, such as those of the Affordable Care Act, to expand youth access to health care.

Pullout Stat: In a 2002 study, 59% of young women under 18 indicated they would stop using some or all sexual health care services, or delay testing or treatment for HIV or other STDs if their parents were informed.

Failing to guarantee young people independent access to health care causes real harm, especially to those from communities that are already marginalized

The failure to guarantee young people independent access to care can lead to a range of troubling health outcomes: When young people fail to seek timely STI/HIV screening and treatment, they put themselves and their sexual partners at risk of a variety of serious health problems. [ xix. ] For young people with the capacity for pregnancy, delaying or forgoing contraceptive care increases their risk for unintended pregnancy and related health concerns, and delaying prenatal care when they are pregnant has negative effects for both the young person and their child. [ xx. ] For young people seeking abortion care, parental involvement requirements can delay access, leading to more expensive, invasive, and harder to obtain later-term abortion procedures. [ xxi. ]

The harm of these policies falls more heavily on young people from marginalized communities: young people in the foster care system or whose parents are unavailable may be forced to leave the state they live in to access care they need, or denied access entirely. [ xxii. ] Similarly, homeless minors may be denied a range of sensitive health care services due to a lack of parental consent in many states. Finally, consent restrictions allow parents and the state to deny LGBTQ youth treatment they need, and to subject them to harmful treatment against their will. [ xxiv. ]

We can ensure young people have the right to independently access confidential health services

Advocates and policymakers on the local, state, and federal levels must support young people rights to access the full range of reproductive, sexual, and other sensitive health services they need to take personal responsibility for their own health.

• State legislatures should recognize young people’s right to independently consent to sensitive health services. State legislatures have the power to grant young people the right to independently consent to health services, and to require communications about those services be confidential. Some states have crafted inventive approaches to do just that, [ xxv. ] and Advocates for Youth has drafted the MY Access (Minors & Youth Access to Sensitive Health Services) Act; [ xxvi. ] model legislation that allows advocates can replicate effective measures in their own states.
• The federal government should work towards a national solution. The U.S. Department of Health and Human Services (DHHS) should be encouraged to interpret HIPAA to grant young people the option of requesting that insurance communications be sent directly to them when they reference sensitive health care services.
• State agencies should guarantee the protection of young people’s confidentiality. Advocates should urge their state Insurance Commissioners and Departments of Health to enact strong, comprehensive confidentiality protections for young people and all individuals insured as dependents.
• Advocates should ensure that young people know their rights. Unless young people are adequately informed of their rights, protections will fail to meaningfully improve their access to needed health care services. That is why advocates should support state-wide efforts to educate patients and providers on the right to confidential health care.

When they need health care, young people should able to access the services of a trained medical professional rather than face the situation alone and afraid. Advocates must push policymakers on the local, state, and federal levels to fully recognize that young people need the right to access the full range of reproductive, sexual, and other sensitive health services they need to take personal responsibility for their own health.

For more information on young people’s consent and confidentiality laws, please contact Abbey Marr, State Policy Analyst, abbey@advocatesforyouth.org.

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REFERENCES

i. Warren Richey, “In Texas, A Side of the Abortion Debate Few Ever See.” Christian Science Monitor, February 28, 2016. Available at: http://www.csmonitor.com/USA/Justice/2016/0228/In-Texas-a-side-of-abortion-debate-few-ever-see. Accessed on March 7,2016. Dailard C and Richardson CT. “Teenagers’ Access to Confidential Reproductive Health Care Services.” The Guttmacher Report on Public Policy, 2005: 8(4); Gans JE, McManus MA, Newacheck PW. Adolescent Health Care: Use, Costs and Problems of Access. [Profiles of Adolescent Health Series, v. 2]. Chicago, IL: American Medical Association, 1991 

ii. Martin Donohoe, Parental Notification and Consent Laws for Teen Abortions: Overview and 2006 Ballot Measures MEDSCAPE Ob/Gyn & Women’s Health, February 9, 2007.

iii. American Medical Association. “Opinion 5.055 – Confidential Care for Minors.” November 2013. Available at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion5055.page? Accessed on March 7, 2016.

iv. Society of Adolescent Medicine. “Confidential Healthcare for Adolescents: Position of the Society of Adolescent Medicine.” Journal of Adolescent, 2004. Available at: https://www.adolescenthealth.org/SAHM_Main/media/Advocacy/Positions/Aug-04-Confidential_Health_Care_for_Adolescents.pdf. Accessed on March 7, 2016.

v. American Academy of Family Physicians, “Adolescents, Protecting: Ensuring Access to Care and Reporting Sexual Activity and Abuse (Position Paper).” 2004. Available at: http://www.aafp.org/about/policies/all/adolescent-protecting.html Accessed on March 7, 2016.

vi. Centers for Disease Control and Protection, “Reproductive Health: Teen Pregnancy, Health Care Providers.” Available at http://www.cdc.gov/teenpregnancy/health-care-providers/teen-friendly-health-visit.htm. Accessed on April 7, 2016.

vii. Lerand, Sarah J. et al, “Communication with Our Teens: Associations between Confidential Service and Parent-Teen Communication.”20:3 J. Pediatric and Adolescent Gynecology 173 – 178 (2007).

viii. Guttmacher Institute. “State Policies in Brief: Parental Involvement in Minors’ Abortions.” Available at http:// http://www.guttmacher.org/statecenter/spibs/spib_PIMA.pdf. Accessed on February 26, 2016.

ix. Guttmacher Institute. “State Policies in Brief: Minors’ Access to Contraceptive Services.” Available at http:// www.guttmacher.org/statecenter/spibs/spib_MACS.pdf. Accessed on on February 26, 2016.

x. Guttmacher Institute. “State Policies in Brief: An Overview of Minors’ Consent Law.” Available at https://www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf. Accessed on March 7, 2016.

xi. Amy L. McGuire, J.D., Ph.D., Courtenay R. Bruce, J.D., Keeping Children’s Secrets: Confidentiality in the Physician-Patient Relationship, 8 Hous. J. Health L. & Pol’y 315, 323-24 (2008).

xii. Ibid.

xiii. National District Attorneys Association, “Minor Consent to Medical Treatment Laws.” 2013. Available at http://www.ndaa.org/pdf/Minor%20Consent%20to%20Medical%20Treatment%20(2).pdf. Accessed on March 7, 2016.

xiv. Rachel Benson Gold. “Unintended Consequences: How Insurance Processes Inadvertently Abrogate Patient Confidentiality.” The Guttmacher Policy Review, 2009: 12(4).

xv. Ibid.

xvi. 45 C.F.R. § 164.502.

xvii. Rachel Benson Gold. “A New Frontier in the Era of Health Reform: Protecting Confidentiality for Individuals Insured as Dependents.” Guttmacher Policy Review, 2013: 16(4).

xviii. D.M. Reddy, et al. “Effect of mandatory parental notification on adolescent girls’ use of sexual health care services.” Journal of the American Medical Association 288:6 (2002). Available at http://www.ncbi.nlm.nih.gov/pubmed/12169074. Accessed on April 7, 2016.

xix. National Institute for Health Care Management Foundation. Protecting Confidential Health Services for Adolescents & Young Adults: Strategies & Considerations for Health Plans. May 2011. Available at: http://www.nihcm.org/images/stories/NIHCM-Confidentiality-Final.pdf. Accessed February 26, 2016.

xx. Ibid.

xxi. Dennis A et al., The Impact of Laws Requiring Parental Involvement for Abortion: A Literature Review, New York: Guttmacher Institute, 2009.

xxii. Katherine Moore, Pregnant in Foster Care: Prenatal Care, Abortion, and the Consequences for Foster Families, 23 Colum. J. Gender & L. 29, 57 (2012); Rachel Rebouche, Parental Involvement Laws and New Governance, 34 Harv. J. L. & Gender 175, 195 (2011).

xxii. U.S. Dept of Health & Human Services, “Understanding the Health Care Needs of Homeless Youth.” HRSE Program Assistance Letter 2001-10. Jan. 21, 2001. Available at. http://bphc.hrsa.gov/archive/policiesregulations/policies/pal200110.html. Accessed on March 7 ,2016.

xxiv. Sonja Shield, The Doctor Won’t See You Now: Rights of Transgender Adolescents to Sex Reassignment Treatment, 31 N.Y.U. Rev. L. & Soc. Change 361 (2007); Maureen Carroll, Transgender Youth, Adolescent Decisionmaking, and Roper v. Simmons, 56 UCLA Law Review 725 (2009).

xxv. Julie Lewis, et al. Proactive Policies to Protect Patients in the Health Insurance Claims Process. National Family Planning and Reproductive Health Association. 2015. Available at http://www.confidentialandcovered.com/file/ConfidentialandCovered_PolicyGuide.pdf . Accessed on March 7, 2016; Kashif Syed, “Youth confidentiality in the affordable care act: approaches for ensuring greater privacy protections for vital health care.” Advocates for Youth. 2014. Available at https://www.advocatesforyouth.org/component/content/article/2324-youth-confidentiality-in-the-affordable-care-act. Accessed on March 7, 2016.

xxvi. The text and summary of the MY Access Act are available at: http://www.publicleadershipinstitute.org/my_access_act_minors_youth_access_to_sensitive.