Managed Care - July 2008 - (Page 32) Future Shock for Insurers The Genetic Information Nondiscrimination Act will have a profound effect on insurers, even if we’re not quite sure what it will be By John Carroll Contributing Editor ndividuals shopping for health insurance have traditionally had to deal with an underlying principle that guides their relationship with an insurer. They’re expected to be open about their health status so that insurers and their underwriters can consider the risk they’re taking on and the premiums that need to be charged. Until now, that relationship has allowed underwriters to examine the medical history of the member. But following the passage of the Genetic Information Nondiscrimination Act (GINA), there’s a section of the medical record that will remain blank to the medical underwriters from now on: the results of genetic tests that determine whether an individual is running a heightened risk of an explosively expensive medical condition. By the time lawmakers gave their final approval — fully 13 years after the issue was first raised — insurers were all on board with the final piece of legislation. Karen Ignagni, CEO of America’s Health Insurance Plans, said in a prepared statement that the law “ensures that patients can continue to benefit from health plans’ innovative early detection and care coordination programs that improve the safety and quality of care.” The new privacy guarantees are taking effect, though, just as genetic testing is poised to become a highly promoted predictive health tool. Companies like 23andMe, Navigenics, and DecodeMe have just begun marketing a range of genetic tests that cover breast cancer, heart disease, diabetes, and other serious conditions. And while genetic information has only rarely been a concern for insurers until now, an army of genetic researchers is rapidly adding to the list of conditions and medical signposts that can be genetically identified in each person. As the underwriters’ blank page grows into a volume of genetic insights, some longtime students of health policy say that the shift in risk assessment could fundamentally change the way insurance works in the U.S. — and the wary relationship between consumers and insurers. If a negative (no problems) genetic checkup causes people I 32 Todd Davidson/©Images.com/Corbis MANAGED CARE / JULY 2008
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