Today, the House of Representatives passed the Genetic Information Nondiscrimination Act (GINA) by a vote of 414-1, joining the Senate, which passed the bill last week 95-0. In addition to prohibiting discrimination in employment on the basis of genetic conditions, GINA prohibits health insurerance companies from denying coverage or determining premiums based on a customer's gentic information, which is defined broadly to include family history of health conditions.
The Act provides important protections, not only for customers in the individual health insurance market, but also for small employment groups with one or more individuals who have a high likelihood of suffering a genetically-linked illness. (Federal law prohibits health insurers from discriminating against any individual in the group insurance market, but the expected costs of covering the individual can be spread equally across all members of that group). The Act also will remove a disincentive for healthy individuals to take genetic tests because of fear that knowing the results will cause insurability problems.
In an op-ed piece in last Saturday's Los Angeles Times (here), I argue, however, that the law does not go far enough, because it still allows discrimination in coverage and pricing of insurance based on any conditions the individual customer has or has had in the past. Hopefully, GINA will be the initial step toward a legal regime in which health insurance premiums are community rated within age bands, with differential pricing allowed for risky behaviors that are individually controllable (such as smoking) in order to minimize moral hazard.