Monday, October 26, 2009

Unintended Consequences: Wellness, Genetics and GINA

Last year, Congress passed, and the President signed into law, the Genetic Information Nondiscrimination Act of 2008 (GINA). This was a far-reaching bill that sought to address some issues regarding genetic testing and the results of such testing. As we've noted before, insurance carriers aren't generally allowed to use genetic predispositions in underwriting and pricing; GINA sought to clarify and tighten this restriction.

Unfortunately, the law's definition of "underwriting" was overly broad, and has led to some presumably unforeseen problems:

"However, DMAA believes the definition of “underwriting” included in the interim final regulations far exceeds Congressional intent and will have dramatic and unintended consequences on programs designed to support at-risk and chronically ill individuals."


Although there's no persuasive evidence showing that wellness programs actually reduce health insurance costs, a lot of employers offer, and carriers encourage, their use. One of the factors in designing such programs is a tool called an HRA, a Health Risk Assessment. These are essentially questionnaires which help identify employees' problem areas, and can help providers design programs targeting them. Until now, one of the areas often included in HRA's were genetic factors. The problem now is that GINA effectively prohibits an HRA from asking about one's genetic "background," or from using that information if it is disclosed. This means that providers may not be able to design an appropriate wellness plan.

So, the aforementioned DMAA Care Continuum Alliance is requesting that these new rules be put put on hold, and that the definitions be revisited.

For those readers who are interested, the interim regulations are here.

[Thanks to Dan Vorhaus for his help]
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