[dsplittgerber]

Is the most obvious question being adressed in any jurisdiction yet? - Do you legally have to disclose your results to any insurance company you already have an existing contract with or prior to any new insurance contract?

By chance, I just read a typical life insurance contract and it already stated that if you have undergone a genetic testing, you do have to disclose your results if you enter into a life insurance contract >300.000€. This was stipulated in the contract and not under general German contract law. If you do not disclose your results, the company can void the contract any time and/or terminate it any time in the future.

This is going to be THE most important issue with genetic testing - the implications for your insurance contracts. Obviously, your test results can have massively positive or negative results.

[apaprocki]

In the US, President Bush signed the Genetic Information Nondiscrimination Act of 2008 which covers these topics. Some relevant parts are available here: http://thomas.loc.gov/cgi-bin/bdquery/z?d110:HR00493:

edit: Specifically, "`(A) IN GENERAL- For purposes of this section, a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not adjust premium or contribution amounts for the group covered under such plan on the basis of genetic information."

[jellicle]

Note that it doesn't prevent discrimination for life insurance, disability insurance or long-term care insurance; if you get a dangerous condition in your DNA testing you'll never get any of those types of insurance again.

Also note the limitations are not very comprehensive. Health insurers could use genetic info and then find ways to deny you coverage on a technicality (didn't disclose tonsilitis at age 4 - DENIED). There's no civil remedy in the law so it would be up to you to petition the Federal government to carry out some sort of enforcement action against insurers, which seems less than likely.

[apaprocki]

The coverage for life/disability/long-term on a state-by-state basis is here:

http://www.ncsl.org/issues-research/health/genetic-nondiscri...

While it isn't covered by law in all states (yet), my state restricts discrimination for life/disability and requires informed consent to use genetic information.

[MichaelSalib]

Health insurers could use genetic info and then find ways to deny you coverage on a technicality

How could that work once the Affordable Care Act goes into effect? It requires Guaranteed Issue, so insurers can't do that. Insurers have to accept anyone who requests their plan and they can only vary premiums based on age, location, and smoking.

[martincmartin]

Gender is determined genetically, and men and woman have different life expectancies. Does this mean you can't charge men and women different rates (all else being equal)?

[apaprocki]

The US bill explicitly excludes gender: "`(C) EXCLUSIONS- The term `genetic information' shall not include information about the sex or age of any individual."

[Joeri]

The european court of justice has already ruled that price discrimination based on gender for insurance premiums is sex discrimination and therefore in violation of fundamental human rights.

http://europa.eu/rapid/press-release_MEMO-11-123_en.htm?loca...

[thwest]

Sex is determined genetically; Gender is determined socially and psychologically.

[g8oz]

That is an ideological position, not a statement of fact.

[thwest]

The claim that ideology is separate from fact is an ideological position, so I don't think you are saying much. Do you care to make a claim about why you feel its acceptable to confuse sex and gender?

[khomenko]

You can. Insurance spreads risk across population pools. You have to carve out those pools somehow, so you use broad variables like age and gender. The problem is genetic information has potential to make the pools too small.

[mikeash]

You don't have to carve out those pools at all. Insurance is workable if everyone is lumped into a single huge pool. The trouble is that a company which is able to break their clientele into smaller pools will outcompete those who aren't, so you get a bit of a race to the bottom.

[khomenko]

Indeed. Singe Payer + Universal Coverage = FTW.

[rscale]

And from a payer perspective, it's problematic if a sizable population secretly learns that they are at meaningfully greater risk of health problems. Those individuals could then adversely select against the payers by buying Cadillac healthcare plans.

[carbocation]

Since these companies don't determine your sex by asking you to submit a DNA sample and then surmising your sex via genetic information, but rather by asking you to indicate 'M' or 'F' on a form, genetic protections would be unlikely to be pertinent in the vast majority of cases. At least, that's my nonlawyer layperson read of things.

[natrius]

The Affordable Care Act prohibits charging based on gender. This provision kicks in on January 1, 2014.

https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...

[hickory]

Tangentially related, I've been wondering if that could affect current gender discrepancies in the entrepreneurial scene (prospect of paying 200-300% more for private health insurance than male counterparts makes it even harder to leave your day job). More female startup founders in 2014, maybe?

[mtgx]

That would be the same as charging women different for being more prone to car accidents.

[mseebach]

It's very common that young male drivers (by virtue of being grossly overrepresented in accident statistics) have very high premiums.

[macey]

Actually car insurance premiums do vary based on gender, at least under a certain age (teenage boys being the most expensive to insure).

[tspiteri]

As far as I know, women in the UK used to pay less for car insurance because they are less accident prone. I don't know if this has changed because of sex discrimination laws. http://www.bbc.co.uk/news/business-12600284

[OverlordXenu]

What? No. Gender isn't determined genetically. It's a psychological phenomenon. Also, sex can't even reliably be determined by chromosomes. There are things like Klinefelter syndrome, or XX male syndrome (exactly like it sounds).

[return0]

Sex can easily be detected from the phenotype in most cases.

[im3w1l]

I think this isnt a good solution. Imagine the following scenario. A disease hits with p=0.001. To cure it is Very Expensive. Everyone gets insurance that covers it.

Now imagine we have a test, that can predict it with certainty. Very soon only those with positive results will want insurance. The insurance against it will become unprofitable and discontinued.

[mahyarm]

This is the reason why single payer healthcare systems based on residency make economic sense, it prevents this exact situation. We already have this problem to an extent, it's called being elderly.

[CamperBob2]

Insurance is a pretty stupid model for health-care financing, in any case. It's not "insurance" if you know that everybody will eventually need to file a claim.

But that's one of those inconvenient truths that American politics refuses to confront.

[ghshephard]

I won't disagree (coming from Canada) that the american "For Profit Medical Insurance" system is pretty cold ("You're poor? You get the cheapest possible health care that keeps you out of the emergency room, which you are more likely to land in because you haven't been getting very good medical care.") - but it is insurance. Some people go fifty years without needing it. Some people make claims multiple times a year for hundreds of thousands of dollars of medical care...

[justincormack]

Indeed true. And it seems to make an extremely expensive system out of it. But it also manages to do much of the worlds medical research so there are right bits amid the wrongs.

[apaprocki]

I'm pretty sure the spirit of the law is to prevent those types of situations from happening. Wouldn't this cover your situation?

"`(1) IN GENERAL- A health insurance issuer offering health insurance coverage in the individual market may not, on the basis of genetic information, impose any preexisting condition exclusion (as defined in section 2701(b)(1)(A)) with respect to such coverage."

[philh]

In insurance, people who get lucky subsidize people who get unlucky. If you can test luck before getting insurance, then lucky people don't get insurance and there's nobody left to subsidize unlucky people.

Forbidding insurance companies to discriminate based on luck does not solve this problem, because the problem is caused by customers selectively buying insurance based on their own luck.

(Clarification: I'm describing reality-as-I-see-it. I'm not trying to make moral judgements on what laws we should or shouldn't pass.)

[PeterBB]

This is the precise reason for the "individual mandate" in Obamacare. The two provisions only work in combination.

[chimeracoder]

> philh 2 hours ago | link | parent

In insurance, people who get lucky subsidize people who get unlucky. If you can test luck before getting insurance, then lucky people don't get insurance and there's nobody left to subsidize unlucky people.

> Forbidding insurance companies to discriminate based on luck does not solve this problem, because the problem is caused by customers selectively buying insurance based on their own luck.

It's a little more nuanced than that. Let's say men are more prone to car crashes than women. Either you charge men more for auto insurance, OR you charge everyone a flat rate, and the market will rapidly clear itself of all women, since that flat rate will be too high to appeal to women. In this case, you end up with a market that's exclusively men, and women are uninsured.

When applied to health insurance, this means that, if you're forcing companies to insure everyone, they will have to insure people predisposed to expensive illnesses at incredibly high rates, because that's the expected cost of their lifetime care.

One implication of this is that the "no discrimination for pre-existing conditions" portion of the ACA is equivalent to "if you have a pre-existing condition, your coverage will be exorbitantly expensive".

There are ways of hiding this extra cost, but at the end of the day, it's like sweeping dust under the rug: it all has to sum to zero.

[xugle]

There's an easy way to weed out unlucky people. Just randomly throw out half the applicants. (You can substitute any proportion for "half" based on business needs)

[ef4]

> Now imagine we have a test, that can predict it with certainty. Very soon only those with positive results will want insurance. The insurance against it will become unprofitable and discontinued.

That does leave a time when the risk is still insurable: before the test is conducted.

One can imagine it evolving as an additional service that the testing provider may partner with insurance companies to provide. At the time you buy the test, they say "if you pay an extra $X now, you get insurance against us finding anything catastrophic."

(Just idly speculating here, who knows how these things will play out in a combination of regulatory, market, and technology changes.)

[carbocation]

But since your parents had the test, and they know your parents' results, your probability of having the (genetic) disease is not exactly unknowable by the insurance company.

[mikeash]

You'd have to prove that you didn't already have the test performed, which sounds tough. For example, maybe you flew to Elbonia to get an illicit test done in some dark alley, then came back to the US and retook the test while buying the insurance.

[mikeash]

Does the law even matter here? If it's illegal to discriminate, then the insurance becomes unprofitable and is no longer available. If it's not illegal to discriminate, then the insurance can remain profitable by jacking up the price, but then is no longer available to the vast majority of those who suffer from it.

Insurance really only works when either 1) what it covers is truly unpredictable or 2) everybody is required to participate regardless of whether they really need it.

[khomenko]

Also, California has put a more stringent law on the books in 2011: http://www.privacylives.com/california-passes-bill-to-prohib...

[hippich]

This covers only lucky ones, who are employed and have access to group insurance plans, isn't it? In this case entrepreneurs who just starting will be screwed.

[apaprocki]

If you read the bill, it covers individuals as well. I just didn't go copy-pasting the entire gazillion page document :)

[fluidcruft]

Right. But the parent used life insurance as an example, not health insurance.

[apaprocki]

You're right, life insurance is less regulated and is handled by the individual states in the US. Both New York and California prevent genetic discrimination in life insurance, though.

[jeremyarussell]

Not sure if you noticed this on their website. Covers a bit of what has been discussed already but I figured while we are talking about the insurance implications involved we should include the answer 23andme already gives the public.

https://customercare.23andme.com/entries/21262356-could-my-g...