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Insurers walk fine line on DNA tests

National Underwriter; Life & health/financial serv February 04, 2002 00:00
Linda Koco
National Underwriter

For most insurance companies, the message on genetic testing is: Don't order genetic tests, even if you know they're available."

That is the trend today, said Charlotte A. Lee, M.D., of Osborn Laboratories, Olathe, Kansas, in a seminar here on genetic testing in the insurance industry.

There is no official document saying that insurers voluntarily agree not to test, the doctor stressed, explaining that anti-trust issues may prohibit such agreements.

Still, she said, most do avoid asking for the tests.

However, she added, if an applicant's attending physician's statement indicates a genetic test has been run on the person, insurance companies do want to see those test results. Insurers need to have access to all information applicants have, in order to avoid anti-selection, she said.

Her remarks came during a packed session at the annual meeting of the National Association of Independent Life Brokerage Agencies.

The public today dislikes the process of risk classification in general, Lee said, and one reason for this dislike may be the public doesn't understand what it is that actuaries do. This may prompt some to wonder, "are the rate classes based on sound studies?"'

Furthermore, some people believe underwriters make mistakes. "They don't know that underwriters have manuals they consult, and that the companies have medical directors and registered nurses on staff," Lee said.

Some also believe applicants are being set up by "purposely misleading" application questions, and/or they feel the risk classification process violates privacy, she said.

Others complain the risk classification process discourages good medical care, she said. "They contend people won't go to the doctor, due to worries the information will go to the insurance company."

Some even say it's "unfair" for insurers to charge some people more than others or to deny coverage, Lee noted. "They think it's a basic human right to be able to get insurance. They don't want the companies to differentiate." Some contend some under-writing practices are illegal, too, she added.

Genetic testing raises different concerns, she noted. For one thing, one's DNA information is seen as being "more personal" than any other types of information.

It's also viewed as being predictive, she said, because genetic test results may give information about future risks-"information that could determine a person's outcome.

However, genetic information also has the power to change lives, she said. If one learns, for instance, of the presence of a gene for a dread disease, "that knowledge could change how the person patterns his or her whole life."

Genetic testing also raises other issues, Lee said. Who will have access to the genetic records? Since this testing is "pedigree-sensitive," what is the effect on one's relatives? Are the results "here to stay," in the records of the physicians? Will the data be used prejudicially, to discriminate?

As far back as the late 1980s, the life insurance industry was looking at these issues and how insurers can respond, Lee noted. In 1989, for instance, the Medical Section of American Council of Life Insurers put out a monograph on the subject. The messages contained in that document-regarding the need for education, bioethical focus, public dialogue, and much more-hold true today, she indicated.

She reviewed the messages, and the implications for insurers.

In sum, genetic testing has both advantages and potential disadvantages for people, she said, but they continue to be concerned about the accuracy, cost, and related issues.

The pros and cons-and the concerns-are not likely to go away, she suggested. For instance, gene therapy and stem cell therapy are both on the horizon, and each holds the promise of helping people heal from certain diseases and medical ailments.

"But there's a downside, too. That's the possibility of bio-terrorism and stealth viruses...These are the negative things that can happen when people can alter genes."

Genetic discrimination cuts two ways
National Underwriter;
Life & health/financial serv
February 04, 2002 00:00
Mark Ameigh
National Underwriter



When the race to identify the entire length of the human genetic code finally ended, the media hailed the project's value for advances in scientific and medical research.

In the midst of the celebration, a long simmering controversy also erupted.

Concerned scientists and policymakers have weighed in on how genetic information might be used to discriminate against individuals in areas of health care and employment. And privacy advocates have had success in getting their concerns about genetic testing cited frequently.

Congress has been considering legislation that would restrict or deny the use of genetic test results by employers and insurers for almost six years. And now, some members of Congress are predicting legislation will be signed into law by the end of 2002.

Central to this discussion is an issue of prime importance to insurance people: how to keep the playing field level for applicants and insurers.

Many genetic testing opponents seem to assume that, lacking ironclad controls, information derived from personal genetic testing has a high probability of being used against people who have had such tests. Privacy advocates argue that stingy employers will deny employment, and greedy life and health insurers will deny coverage.

Unfortunately, such arguments take the narrow and deceptive view that discrim-ination and self-interest are limited to employers and insurers.

Isn't it also possible that individuals might use their own genetic information as a tool of anti-selection against employers, and life and health insurance companies?

For instance, a person who has undergone genetic testing and found he or she is carry ing a gene for a debilitating or terminal disease could search out an employer with the most comprehensive employer-paid benefit programs. This person might then take a job at this employer, based solely on the rich benefit package, fully expecting to utilize the health and disability insurance benefits within a relatively short period after starting employment.

As a result of this premeditated act, the employer will sustain real financial losses. That can hit the business in a least three ways:

- Benefit costs increase as a result of utilization that was based on antiselection.

-The productivity of the business falls as a result of the employee's absence.

- T h e employer incurs additional hiring and benefit costs in order to secure a replacement employee.

Insurers, of course, suffer a similar threat. Using personal and private knowledge of genetic tests results, the people most likely to contract serious illnesses will become the people most likely to purchase life, disability or long term care insurance, while failing to disclose what they know about their health.

Should the privacy of personal genetic information be protected? Absolutely!

However, the fact that employers and insurers are equally at risk of being targets of misused genetic testing information should be a key consideration in developing the regulations surrounding this information.

Insurers could be prohibited, for instance, from requiring that new tests be performed to secure coverage. However, I believe they should be able to ask if genetic testing has been done prior to application. If it is determined testing was done, insurers should be able to see the results, as with any other medical procedure today.

Some people may question whether this is an issue, since cheap and reliable genetic testing is not available to individual consumers today. However, the nature of our economic system bears witness to an indisputable factif a market develops for such tests in the future, they will become available.

Privacy is a key issue in this discussion, no question about it. But fairness to all parties is equally important. The playing field must be kept level for individuals and employers and insurers.

Source: Insurance Newsnet