Affordable Care Act

A major provision of The Affordable Care Act of 2010 (ACA) is to establish ‘guaranteed issue’; issuers offering insurance in either the group or individual market must provide coverage for all individuals who request it. The law therefore prohibits issuers of health insurance from discriminating against patients with genetic diseases by refusing coverage because of ‘pre-existing conditions’. ACA further provides additional protections for patients with genetic diseases by establishing that certain health insurance issuers may only vary premiums based on a few specified factors such as age or geographic area, thereby prohibiting the adjustment of premiums because of medical conditions.

Note: Under GINA, health insurance issuers are prohibited from using a person’s genetic information for underwriting, but GINA provides no such protections for individuals with a “manifest disease.” Therefore, a provider of health insurance is not restricted by GINA in decisions on whether to issue coverage for an individual with a genetic disease.

For more information on the Affordable Care Act, see: http://www.healthcare.gov.

For information on the intersection between ACA and GINA, see this Congressional Research Service report The Genetic Information Nondiscrimination Act of 2008 and the Patient Protection and Affordable Care Act of 2010: Overview and Legal Analysis of Potential Interactions