Table 3. Comparison of Federal Legislation Addressing Genetic Coverage, Limitations, and Protections
| Law | Coverage | Limitations | Protect All Americans |
| Adapted from Leib et al.[31] | |||
| Civil Rights Act of 1964 | Employment only | Does not apply to health insurance | Yes |
| Applies in instances of discrimination based on genetic information if associated with race or ethnic groups | Strong association with a racial or ethnic group for hereditary cancers is rare | ||
| Americans with Disabilities Act of 1990 | Disabilities associated with manifesting genetic information | Does not apply to health insurance | Yes |
| Health Insurance Portability and Accountability Act of 1996 | Group health insurance plans | Does not stop insurers from requiring genetic tests | Yes |
| Genetic information is not defined | |||
| Forbids excluding an individual in a group health plan due to genetic information | Genetic information can be used for plan underwriting | ||
| Forbids premium increases for different group plan members | Disclosure of genetic information is not restricted | ||
| Preexisting conditions can not include predictive genetic information | Does not apply to individual health plans, unless covered by the portability provision | ||
| Executive Order 13145 of 2000 | Forbids Federal employee workplace genetic discrimination | Does not apply to health insurance | No; excludes members of the United States military and anyone who is NOT a federal employee |
| Only applies to Federal employees | |||
| Genetic Information Nondiscrimination Act of 2008 (GINA) (Enacted in 2009) | Forbids genetic discrimination in the workplace and in health insurance | Civil suit is restricted to only those who have had all administrative remedies exhausted | No; excludes members of the United States military, veterans obtaining health care through the Veteran’s Administration, and the Indian Health Service |
| Genetic information broadly defined | |||
| Specific to group and individual insurance plans | |||
| Forbids use of genetic information in underwriting | |||
| Forbids requiring genetic testing by employers and insurers | Does not cover life, disability, and long-term care insurance | ||
References
- Leib JR, Hoodfar E, Haidle JL, et al.: The new genetic privacy law: how GINA will affect patients seeking counseling and testing for inherited cancer risk. Community Oncology 5 (6): 351-4, 2008.
