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The Genetic Information Nondiscrimination Act (GINA) is designed to prevent the use of genetic information in the underwriting or issuing of health insurance in individual, group, or medigap type policies. It affects and modifies federal laws that regulate these products, including ERISA, the Public Health Service Act and Title XVIII. In each of these, issuers of insurance are prohibited from health discrimination on the basis of genetic information or genetic services. Health insurance issuers that are regulated by the federal government are not allowed to use either genetic information or information that a person or a person's relatives have sought genetic services in their underwrting decisions.
In this type of legislation, definitions do matter and GINA's definitions are inclusive, but not overly broad.
Genetic information is defined as 1) an individual's genetic tests; 2) the genetic tests of family members of the individual; or 3) the occurrence of a disease or disorder in famiy members of the individual.
Family members are defined as 1) the spouse of an individual; 2) a dependent child of the indiviudla, including a child who us born to or placed for adoptin with the individual; and 3) all other individuals related by blod to the individual or the spouse or child described above.
A genetic test defined as: an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that detects genotypes, mutaitons, or chromosomal changes. The exceptions to this are: 1) an analysis that does not detect genotypes, mutations or chromosomal changes; or 2) an analysis of proteins or metabolites that is directly related to a manifested disease or disorder, or pathological condition that could reasonably be detected by a health care professional with appropriate training in the field of medicine involved.
This last part hinges on the adjective "manifested". I am not sure exactly what "manifested" might mean and I expect this may be a weakness in the law. Take familial hypercholesterolemia (FH) as an example. The simplest test to screen for FH is serum cholesterol levels and in this case, this test is providing informaton about genotype. However, it is also a manifestation of the pathological conditinon of high cholesterol and, if someone who has this condition, has had a heart attack or some other clinical manifestation of FH, does this mean that they are not protected from discrimination?
I may be overthinking this, but at first glance, this part of the legislation bothers me. If you are reading this differently, I would appreciate your comments. Or, are there any lawyers in the house? I would love to have some thoughts from some sharp legal minds on how this might be interpreted in practice or in the courts.
Comments
I'm so happy my genetic makeup is not used a determining factor for insurance coverage decisions. I have crappy dna ;)
Posted by: Johns | November 27, 2008 7:18 PM