The Senate passed genetic testing anti-discrimination legislation by a very non-partisan margin of 95 – 0. The bill will now go to the House, which is expected to approve it next week. HR 493 basically prohibits group and individual health insurance carriers from using information obtained through genetic testing for underwriting or pricing purposes. It also prohibits employers from making hiring and firing decisions based on genetic testing. Supporting it seems on the surface like supporting puppies and small children – how can you not? But InsureBlog made some good points last fall about the bill, and why it’s not really all that helpful. In terms of the small group market, I would agree, since small group plans are guaranteed issue, and in Colorado, the state has restricted insurers from increasing premiums for small groups based on medical history – regardless of how the medical information was obtained. The InsureBlog post also asks the obvious question – how is using genetic testing info for underwriting and pricing of health insurance different from using any other medical information? Like a person’s HIV status or previous cancer diagnosis? It can be argued that our genetic makeup is completely beyond our control, unlike many other factors that are taken into consideration on health insurance applications, like tobacco use and blood pressure. But there are plenty of medical conditions that are beyond our control that are currently subject to underwriting – especially in the individual health insurance market. A person who was born with Type 1 diabetes will never be able to get an individual health insurance policy in Colorado. His illness is just as beyond his control as anything that would be found through genetic testing, and yet underwriting most definitely takes his medical history into consideration. But Section 102 of HR 493 would bar individual health insurance carriers from basing underwriting decisions on information obtained through genetic testing.
Health insurance was designed to spread risk over a large pool of people. It’s difficult for health insurance companies to accurately spread risk when they are unaware of all the facts. As science and technology increase our understanding of health, it makes sense to use as much information as possible when determining future projected health expenses. But individual people should not have to suffer financially because of information obtained through genetic testing. It’s bad enough to find out that you’re carrying a gene for breast cancer – it would be worse still to find out that you’re now ineligible for individual health insurance or at risk of losing your job if your employer finds out.
I like the portion of HR 493 that deals with hiring and firing of employees based on genetic testing. And I like the wording that prohibits health insurance carriers from requiring genetic testing in order for a person to obtain coverage. And I very much like the provision for individual health insurance policies, which are already difficult enough to obtain. But for the overall health care industry, it would seem that utilizing genetic testing information could help insurers and providers more accurately predict future costs. Rather than imposing rate increases on specific groups based on the medical information of each group (some of which may only have a handful of employees), it would make more sense to use the data as a broad tool for looking at overall trends in health care expenses, and setting rates for all groups accordingly – without discriminating against any specific group. The individual health insurance market could use a similar model in theory, but with our current system of looking at each applicant separately and declining coverage to those with unsatisfactory medical histories, using genetic information would seem to only increase the number of people who are unable to obtain health insurance in the individual market. We need to avoid anything that makes health insurance harder to get, so overall I give this bill a thumbs up. There are some redundant and overly-wordy parts to it (when was the last time you saw legislation that was crystal clear and simple though?), but it will provide peace of mind to people who are thinking about getting genetic testing but had been afraid of the ramifications the results might have on their employment, or their health insurance eligibility and premiums.