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Human Genome News Archive Edition

Human Genome News, July 1993; 5(2)

Insurance Task Force Makes Recommendations

In May 1991 the Joint NIH-DOE Working Group on the Ethical, Legal, and Social Implications (ELSI) of Human Genome Research formed the Task Force on Genetic Information and Insurance to develop recommendations to prevent the negative impact of genetic information on access to insurance. The group was composed of physicians, biologists, geneticists and genetic counselors, lawyers, ethicists, and representatives from the insurance industry, associations of people with disabilities, and an organization of state governments. After meeting periodically for 2 years, the task force, cochaired by Thomas Murray (Case Western Reserve University) and Jonathan Beckwith (Harvard Medical School), presented its report to the working group on May 10 of this year. Following is a synopsis of the report's executive summary and the full text of the recommendations.

Synopsis of Executive Summary

One of the ironies in the current crisis in health care coverage is that developing more-accurate biomedical data could make things worse rather than better for those most in need. Knowledge useful in predicting the individual's likelihood of developing a particular disease opens the door to both the welcome preventive strategies and the unwelcome possibility of genetic discrimination. Injecting considerations about genetic risks into the current health care system could result in more-refined risk rating by insurers and greater difficulty in finding affordable health care coverage for large numbers of people. Access to health care might be denied or "preexisting" conditions excluded from coverage. Individuals might be compelled to provide genetic information as a condition of obtaining health care coverage, and information on genetic health risks may also include children, parents, siblings, and other relatives.

Affording special protection for genetic material and data is unlikely to provide a solution to these challenges. Genetic privacy should be vigorously protected, but other varieties of health-related information are equally sensitive. Because diseases are increasingly seen as having both genetic and nongenetic components, classifying health-related data as wholly genetic or nongenetic is difficult. Furthermore, as a practical matter, genetic and other materials are not segregated in medical records. The standard personal medical history, for example, is a rich source of genetic information. Policies intended to protect genetic privacy will need to address the privacy of health-related knowledge in general. The task force considered these factors carefully in making its recommendations.

Recommendations

In anticipation of fundamental reform in the financing and delivery of health care in the United States, the Task Force on Genetic Information and Insurance offers the following recommendations. The recommendations concern health care coverage and should not be applied uncritically to other forms of insurance, such as life or disability income insurance.

  1. Information about past, present, or future health status, including genetic information, should not be used to deny health care coverage or service to anyone.
  2. The U.S. health care system should ensure universal access to and participation by all in a program of basic health services* that encompasses a continuum of service appropriate for the healthy to the seriously ill.
  3. The program of basic health services should treat genetic services comparably to nongenetic services and should encompass appropriate genetic counseling, testing, and treatment within a program of primary, preventive, and specialty health care services for individuals and families with genetic disorders and those at risk of genetic disease.
  4. The cost of health care coverage borne by individuals and families for the program of basic health services should not be affected by information, including genetic information, about an individual's past, present, or future health status.
  5. Participation in and access to the program of basic health services should not depend on employment.
  6. Participation in and access to the program of basic health services should not be conditioned on disclosure by individuals and families of information, including genetic information, about past, present, or future health status.
  7. Until participation in a program of basic health services is universal, alternative means of reducing the risk of genetic discrimination should be developed. As one step, health insurers should consider a moratorium on the use of genetic tests in underwriting. In addition, insurers could undertake vigorous educational efforts within the industry to improve the understanding of genetic information.

*We use the phrase "program of basic health services" to describe the array of services that would be available to all after implementation of major health policy reforms, such as those being considered by the President's Health Policy Task Force. We explicitly reject all connotations of "basic" as minimal, stingy, or limited to such services as immunization and well-child care. A program of "basic" health services could encompass a broad range of care for those most in need.


Copies of the full report are available from:

ELSI Branch
NCHGR
Bldg. 38A, Room 617
9000 Rockville Pike
Bethesda, MD 20892
301/402-0911
Fax: -1950


HGMIS Staff

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Human Genome Project 1990–2003

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