title: Access to health insurance: experiences and attitudes of those with genetic versus non-genetic medical conditions.
abstract: While studies reveal that individuals with both genetic and other chronic medical conditions have difficulty obtaining health insurance, no large-scale studies have compared the health insurance experiences of these groups. The goal of this study was to document and compare the health insurance experiences, attitudes, and beliefs of persons with genetic conditions to those of persons with or at risk for other serious medical conditions. We interviewed approximately 100 adults or parents of children with one of each of the following medical conditions: sickle cell disease (SCD), cystic fibrosis (CF), diabetes, and HIV, and 200 adults with or at risk for breast (BC) or colon cancer (CC). The interview included items related to respondents' experiences and attitudes regarding health insurance. Twenty-seven percent of 597 total respondents self-reported having been denied health insurance or offered insurance at a prohibitive rate. Respondents with single-gene disorders (CF and SCD) were twice as likely to report this as those with non-genetic conditions. Legislation that exists to limit genetic discrimination in insurance addresses genetic risks or traits only, however, rather than protecting those with actual disease. Thus, current legislation may not address the challenges faced by individuals like those in this study, who try to maintain access to health insurance when they or their children are symptomatic with a genetic or other serious health condition. More than one-third of all respondents thought there was a high chance they would be denied health insurance in the future or their insurance would become unaffordable. That individuals with all six health conditions expressed concern regarding their ability to obtain future health insurance suggests policy proposals should be broad-based, addressing the needs and concerns of individuals with diverse health conditions.
authors.affiliation: Johns Hopkins Berman Institute of Bioethics, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-1996, USA. nkass@jhsph.edu
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Kass
authors.forename: Amy M
authors.initials: AM
authors.lastname: Medley
authors.forename: Marvin R
authors.initials: MR
authors.lastname: Natowicz
authors.forename: Sara Chandros
authors.initials: SC
authors.lastname: Hull
authors.forename: Ruth R
authors.initials: RR
authors.lastname: Faden
authors.forename: Laura
authors.initials: L
authors.lastname: Plantinga
authors.forename: Lawrence O
authors.initials: LO
authors.lastname: Gostin
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D030342:Genetic Diseases, Inborn; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged