what does gina mean? - genetic fairness · the genetic information nondiscrimination act (gina)...
TRANSCRIPT
What does GINA Mean? A Guide to the Genetic Information
Nondiscrimination Act
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TableofContents
GINA:AnOverview ............................................................................................ 3TheHistoryofGINA ........................................................................................... 4WhyGINA? .............................................................................................................................4TheLongRoadtoPassage .......................................................................................................5GINAVictoryCelebration ........................................................................................................5
HowdoesGINAimpactME?............................................................................... 7TitleI:GeneticNondiscriminationinHealthInsurance ............................................................7Whataboutsubmittingclaimstomyhealthinsurancecompany?............................................ 7WhatdoesGINAnotdo? ........................................................................................................... 8
TitleII:ProhibitingEmploymentDiscriminationontheBasisofGeneticInformation ..............9Underwhatcircumstancescananemployer,employmentagency,laborunion,ortrainingprogramhaveaccesstomygeneticinformation?..................................................................... 9Ifanemployer,employmentagency,labororganization,orjointlabor‐managementcommitteedoespossessmygeneticinformation,whateffortsmustbemadetoensuremyinformationiskeptconfidential? ............................................................................................. 10WhatdoesGINAnotdo? ......................................................................................................... 10
HypotheticalExamplesofGeneticDiscrimination .................................................................12InHealthInsurance .................................................................................................................. 12InEmployment ......................................................................................................................... 12
ForHealthInsurers .......................................................................................... 14Whatinformationcaninsurersrequestinmakingcoveragedeterminationsforspecificclaims? ..................................................................................................................................... 14
ForEmployers .................................................................................................. 15Whenmayanemployerrequestoruseanemployee’sgeneticinformation?......................... 15Whateffortsmustemployersmaketoensurethegeneticinformationofemployeesiskeptconfidential? ............................................................................................................................ 16
ForCliniciansandHealthcareProviders............................................................ 17ForResearchers ............................................................................................... 17ForStates......................................................................................................... 17ImportantGINADefinitionsandExamples ....................................................... 18AdditionalResources ....................................................................................... 19
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GINA:AnOverviewPresidentBushsignedtheGeneticInformationNondiscriminationAct(GINA)intolawonMay21,2008.Wecontinuetocelebratethismonumentaleventastheculminationofthirteenyearsofdedicationandperseverancefromtheentiregeneticscommunity,ledbytheCoalitionforGeneticFairness,andmorethan500CongressionalofficesonCapitolHill.BeforeGINA,manyindividualsforwentgenetictestingservices,importanttoolsformanaginghealth,duetofearsofmisuseoftheinformationwereittobeobtainedbyemployersorhealthinsurers;researchandindustrysufferedfromdecreasedenrollmentinclinicaltrials,dueinparttothesefears;andclinicianshadtoinformpatientsaboutthepotentialfordiscrimination.Asthefirstmajorcivilrightsbillofthenewcentury,GINAprovidesindividualswithfederalprotectionsagainstgeneticdiscriminationinhealthinsuranceandemployment.Thehealthinsuranceprovisionsofthebill,TitleI,willtakeeffect12monthsafterthedateofsigning,onMay21,2009.Theprotectionsinemployment,TitleII,willtakeeffect18monthsafterthedateofsigning,onNovember21,2009.Allindividualsresidingwithinthe50StatesandUSterritoriesbenefitfromtheseprotections.NoweveryAmericancanfeelsafefromgeneticdiscriminationinhealthinsuranceandemployment.
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TheHistoryofGINA
WhyGINA?Geneticscontinuestotransformhowwelookathumanhealth.Familyhealthhistoryhelpsustounderstandthehereditarybasisofdisease.Furthermore,geneticsresearchhascontributedtoourknowledgeoftheoccurrenceandprogressionofdiseaseandtheeffectivenessofmedicationsandtherapies—theresultinggenetictechnologiesandservicesarenowutilizedinpersonalhealthmanagement.Theadvancesingenetictestingaloneprovideamodelforthisgrowth:since1995,thenumberofgenetictestsavailablehasincreasedfive‐fold.Whileinthepast,genetictestswereusuallylimitedtorarediseases,newtestsarenowbeingdevelopedthatwillallowfortheidentificationofgeneticpredispositionstomanycommonhealthconditions.Thebenefitsofintegratinggeneticinformationintohealthmanagementaretremendous,andincludeenablinganindividualtomakeproactiveandinformeddecisions.Knowledgeaboutone’sgenescanbeinvaluabletohealthcaredelivery.However,thatknowledgeisalsosusceptibletomisuse.Becausenooneisexemptfromthisharm—eachofuscarriesanumberofmutatedgenes—geneticdiscriminationanditsrelatedprivacyconcernsshouldbeprofoundlyimportanttoeachofus.Concernsofgeneticdiscrimination,moststronglyidentifiedinhealthinsuranceandemployment,promptedtheneedforfederalantidiscriminationlegislation.Onthestatelevel,legislaturesbegantorespondtoconcernsbyprovidingvariouslevelsofprotection,howeverthispatchworkofstatelawsleftmanyindividualsvulnerable.CasesofgeneticdiscriminationinemploymentbegantoemergeintheUS.Inhealthinsurance,individualsrealizedtheprivacyprotectionsaffordedbyHIPAAdidnotprohibitinsurersfromrequiringgenetictestingorfromdenyingcoveragebasedongeneticinformation.Wewerealllosingundertheoldguidelines:individualswouldoftenforegogenetictestingservices,thushinderingtheirownaccesstothehighestqualityhealthcareavailable.Thisalsoimpactedhealthcareproviders,researchers,andindustry.Largenumbersofindividualsoptedoutofclinicaltrials,andinturnslowedthetranslationofresearchintotreatmentsanddiagnostics.TheGeneticInformationNondiscriminationAct(GINA)answersconcernsofgeneticdiscriminationinhealthinsuranceandemploymentbyprovidingafederalbaselineforprotections.Thelegislationcomesatatimewhenhealthcarecostsremainanationaldilemma,andindividualscontinuetoexpressworriesthathealthinsurersandemployers,lookingforwaystosavemoney,willusegeneticinformationasatooltocutcosts.WhenGINAbecomesfullyactiveinNovember2009,allAmericanswillbefreetoputtheirhealthconcernsfirst.
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TheLongRoadtoPassageLegislationregardinggeneticnondiscriminationwasfirstintroducedintheHouseofRepresentativesin1995byRepresentativeLouiseSlaughter(D‐NY).In1996,Sen.OlympiaSnowe(R‐ME)introducedsimilarlegislationintheSenate.Bothbillsspecificallyaddresseddiscriminationinhealthinsurance.Neitherbillpassedinthat104thCongress.SimilarlegislationwasintroducedinbothchambersofCongressinthe105thand106thCongresses,howevernotoneofthesebillsmadeittothePresident’sdesk.
In1997,theCoalitionforGeneticFairnesswasfoundedwiththeobjectivetourgeCongresstopasscomprehensivefederallegislationoutlawinggeneticdiscriminationandtoeducatethepublicabouttheseprotections.Initially,theCoalitionconsistedofcivilrights,disease‐specific,andhealthcareorganizations.In2005,itwasexpandedtoincludeindustrygroupsandemployers.FromitsfoundingthroughthedayGINApassed,theCoalitionunitedasonevoicethehundredsoforganizationsandthousandsofindividualswhostoodinsupportofgeneticantidiscriminationlegislation.
Sen.OlympiaSnowe(R‐ME)firstintroducedtheGeneticInformationNondiscriminationAct(GINA)in2002duringthe107thCongress.Thebilladdresseddiscriminationinbothhealthinsuranceandemploymentdecisions.Thebilldidnotpass.
Similarlegislationwasintroducedonceagaininthe108thCongress.IntheHouseofRepresentatives,thebill(H.R.1910)wasintroducedbyRep.LouiseSlaughter(D‐NY)andgained242cosponsors.IntheSenate,thebill(S.1053)wasintroducedbySen.OlympiaSnowe(R‐ME)andgained23cosponsors.TheSenatebillpassed95‐0,howevertheHousebilldidnotpass.
Inthe109thCongress,Rep.JudyBiggert(R‐IL)introducedthebill(H.R.1227)intheHouseofRepresentatives.Itgained244cosponsors,butagaindidnotpass.IntheSenate,Sen.OlympiaSnowe(R‐ME)introducedthebill(S.306)anditpassed98‐0.
GINAVictoryCelebrationOnMay21,2008,afterpassingintheUSHouseofRepresentatives414‐1andtheUSSenate95‐0inthe110thCongress,PresidentGeorgeW.BushsignedGINAintolaw.Incelebrationofthisvictoryforeveryindividualinthenation,thegeneticscommunitycametogetherattheGeneticAllianceAnnualConferenceonFriday,July11,2008,toreflectuponthelongjourney,recognizeourGINAchampions,andshareintheexcitementforthefutureofgeneticsandhealth.Guestsrepresentingacross‐sectionofthegeneticsandhealthcommunitieswereencouragedtodressinfestiveattire,whichbroughtanairoflightnessandfuntotheevent.Theevening
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beganwiththeGINAHistoryVideo—acelebrationofthehistoricalmoments,movingstories,andunwaveringvoicescontributingtothepassageofthelegislation.Attheconclusionofthevideo,SharonTerry,PresidentandCEOofGeneticAlliance,presentedatoastinhonoroftheMembersoftheHouseandSenatewhocarvedthepathforGINA.Shethenpresentedasecondtoasttousall—wehaveallbeentouchedbythissignificantpieceoflegislation.
DiversemembersofthegeneticsandhealthcommunitywerethenaskedtosayafewwordsabouteachofourCongressionalheroesandtheirkeystaffmembers,whowerepresentedwithawardsfortheirtirelesssupportofGINAthroughoutitslongjourneytopassage.Dr.FrancisCollins,whohadrecentlyresignedfromhispostasDirectoroftheNationalHumanGenomeResearchInstitute(NHGRI),NIH,recognizedSharonTerryforhervisionaryleadershipandpassionthenledtheguestsinacelebratorysong,“G‐I‐N‐A”,whichhewrotefortheoccasion.Afterabriefdemonstrationofthedancestepscorrespondingtothe“G‐I‐N‐A”song—anadaptationofYMCA—themusicalnumberkickedoffmanyhoursofentertainmentanddelight,asthecrowddancedthenightawayincelebrationofthisincrediblevictoryforeveryindividualinthenation.Congratulationstousall.
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HowdoesGINAimpactME?
TitleI:GeneticNondiscriminationinHealthInsuranceTheGeneticInformationNondiscriminationAct(GINA)outlinesunlawfulpracticesforhealthinsurersintheuseofgeneticinformation.Morespecifically,GINAstrictlyprohibitsthefollowing:
• Healthinsurersmaynotrequireindividualstoprovidetheirgeneticinformationorthegeneticinformationofafamilymembertotheinsurerforeligibility,coverage,underwriting,orpremium‐settingdecisions;
• Healthinsurersmaynotusegeneticinformationeithercollectedwithintent,orincidentally,tomakeenrollmentorcoveragedecisions;
• Healthinsurersmaynotrequestorrequirethatanindividualoranindividual’sfamily
memberundergoagenetictest;and
• IntheMedicaresupplementalpolicyandindividualhealthinsurancemarkets,geneticinformationcannotbeusedasapreexistingcondition.
Researchexception:Forjointresearchactivitiesconductedbyhealthinsurersincollaborationwithexternalresearchentities,ahealthinsurerineitherthegrouporindividualmarketmayrequest,butnotrequire,inwritingthatanindividualundergoagenetictest.Theindividualmayvoluntarilychoosetoundergosuchgenetictesting,butnon‐compliancewillnothaveanegativeeffectonthepremiumorenrollmentstatusoftheindividual.Geneticinformationmayonlybeusedforresearchandnotforunderwritingpurposes.
Whataboutsubmittingclaimstomyhealthinsurancecompany? Withregardtomakingcoveragedeterminationsforaspecificclaim,theinsurercouldrequiregeneticinformation.Forexample,theinsurermayrequestinformationaboutanindividual’sBRCAstatustodeterminecoverageforprophylacticmastectomy.Theinsurermayrequestonlytheminimumamountofinformationnecessaryfordecision‐making.Ifanindividualwouldnotliketoprovidegeneticinformationtotheirhealthinsureraboutsuchaclaim,theindividualcanelecttopayforthetestortreatmentout‐of‐pocket.
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WhatdoesGINAnotdo?ThehealthinsuranceprovisionsofGINAdonotapplytomembersoftheUSmilitary,toveteransobtaininghealthcarethroughtheVeteran’sAdministration,ortotheIndianHealthService.Furthermore,theprotectionsofGINAdonotincludeprotectionsfromgeneticdiscriminationinlife,disability,orlong‐term‐careinsurance.GINAdoesnotrestrictgeneticservices,thepracticeofmedicine,ortheauthorityofhealthcareprofessionals,whetherornottheyareaffiliatedwithahealthplanorissueroranemployer.Cliniciansandhealthcareproviderscanrequestthatanindividualoranindividual’sfamilymemberundergoagenetictestforthepurposesofthatindividual’smedicalbenefit.ThehealthinsuranceprovisionsofGINAdonotcoveranindividual’smanifesteddiseaseorcondition—onethathasalreadyappeared.GINAprotectsanindividual’spredictivegeneticinformation.However,GINAdoesprotectinformationaboutmanifesteddiseaseinanindividual’sfamilymembers(forexample,theirfamilyhistoryofdisease).GINAprovidesabaselineforprotectionagainstgeneticdiscriminationforallAmericans.GINAdoesnotpreemptstatelaw;thereforeifastate’sgeneticdiscriminationlawprovidesmoreextensiveprotectionsthanGINA,GINAdoesnotchangeit.
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TitleII:GeneticNondiscriminationinEmploymentTitleIIoftheGeneticInformationNondiscriminationAct(GINA)outlinesunlawfulactivitiesforanemployer,employmentagency,labororganization,ortrainingprogramintheuseofgeneticinformation.Morespecifically,GINAstrictlyprohibitsthefollowing:
Anemployermaynotusegeneticinformationinmakingdecisionsregardinghiring,promotion,termsorconditions,privilegesofemployment,compensation,ortermination.
Anemployer,employmentagency,labororganization,ortrainingprogrammaynotlimit,segregate,orclassifyanemployeeormember,ordeprivethatemployeeormemberofemploymentopportunities,onthebasisofgeneticinformation.
Anemployer,employmentagency,labororganization,ortrainingprogrammaynotrequest,require,orpurchasegeneticinformationoftheindividualorafamilymemberoftheindividualexceptinrarecases.Pleaserefertothenextsection.
Anemploymentagency,labororganization,ortrainingprogrammaynotfailorrefuseto
referanindividualforemploymentonthebasisofgeneticinformation,normaytheagency,labororganization,ortrainingprogramattempttocauseanemployertodiscriminateagainstanindividualonthebasisofgeneticinformation.
• Anemployer,labororganization,orjointlabor‐managementcommitteemaynotuse
geneticinformationinmakingdecisionsregardingadmissiontooremploymentinanyprogramforapprenticeshiportrainingandretraining,includingon‐the‐jobtraining.
• Alabororganizationmaynotexcludeorexpelfrommembership,orotherwise
discriminateagainst,anindividualbecauseofgeneticinformation.
Underwhatcircumstancescananemployer,employmentagency,laborunion,ortrainingprogramhaveaccesstomygeneticinformation?
Whentheinformationisinadvertentlyprovidedaspartoftheindividual’smedicalhistoryorthemedicalhistoryofafamilymember;
Whentheinformationispubliclyavailable(althoughnotwhentheinformationiscontainedinmedicaldatabasesorcourtrecords);
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Whentheemployerhasobtainedtheindividual’swrittenauthorizationaspartofanemployer‐sponsoredgeneticmonitoringprogramofthebiologicaleffectsoftoxicsubstancesintheworkplace,orifstateorfederallawrequiresthegeneticmonitoringprogram.Ineithercase,onlythehealthcareprofessionalandtheemployeecanknowoftheindividualandidentifiablegeneticinformation,andtheemployeemustbeinformedofindividualmonitoringresults.Theemployercanonlyhaveaccesstothecollectivegeneticinformationoftheentiregroupofemployees,withoutidentifyinginformation.
Whentheemployeroffershealthorgeneticservices,includingservicesofferedaspart
ofawellnessprogram,andwiththeindividual’swrittenauthorization.Insuchcases,onlythehealthcareprofessionalorboardcertifiedgeneticcounselorinvolvedinprovidingtheservicesmayknowofindividuallyidentifiablegeneticinformation.Again,theemployermayknowonlyofthecollectivegeneticinformationoftheentiregroupofemployees,withoutidentifyinginformation;and
Wheretheemployeroperatesasalawenforcemententityandrequirestheindividual’s
DNAforqualitycontrolpurposesintheforensiclaborhumanremainsidentificationsettings.Theinformationmaynotbeusedforanydeterminationsofthetermsofemployment.
Ifanemployer,employmentagency,labororganization,orjointlabor‐managementcommitteedoespossessmygeneticinformation,whateffortsmustbemadetoensuremyinformationiskeptconfidential?Anygeneticinformationthattheypossessaboutanindividualmustbetreatedastheconfidentialmedicalrecordoftheindividualandmustbemaintainedinseparateformsandinseparatefiles.Anindividual’sgeneticinformationmaynotbedisclosedexceptattheindividual’swrittenrequestorinresponsetoacourtorder.Furthermore,inordertomaintaincompliancewithexistinglaws,theaforementionedorganizationsorgroupsmayalsoprovidetheindividual’sgeneticinformationtotheFederal,State,orlocalauthorities.
WhatdoesGINAnotdo?TheemploymentprovisionsofGINAapplytothoseemployerscoveredundertheAmericanswithDisabilitiesAct(ADA)andTitleVIIoftheCivilRightsActof1964;thereforeitdoesnotcoveremployerswithfewerthan15employees.Furthermore,GINAdoesnotapplytomembersoftheUSmilitary.TheemploymentprovisionsofGINAdonotinterferewithanemployee’sabilitytoqualifyforfamilyormedicalleaveunderstateorfederalFamilyandMedicalLeavelaws,nortoparticipate
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inanemployer‐sponsoredwellnessprogramorothergeneticservicesofferedbyanemployer.Furthermore,GINAdoesnotinterferewithanemployer’sabilitytoofferasafeandhealthyworkenvironmentthroughfederalorstaterequiredgeneticmonitoringofthebiologicaleffectsonemployeesoftoxicsubstancesintheworkplace.GINAprovidesabaselineforprotectionagainstgeneticdiscriminationforallAmericans.GINAdoesnotpreemptstatelaw;thereforeifastate’sgeneticdiscriminationlawprovidesmoreextensiveprotectionsthanGINA,GINAdoesnotchangeit.
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HypotheticalExamplesofGeneticDiscriminationThefollowingexampleshavebeenadaptedfrom“GeneticDiscrimination.”CouncilforResponsibleGenetics.2001.http://www.gene‐watch.org/programs/privacy/genetic‐disc‐position.html.
InHealthInsurance• Lisa’syoungsonhasbeenhavingdifficultyinschool.Suspectingalearningdisability,she
consultsherdoctor.Herdoctorperformsafewgenetictests,anduponreceiptoftheresults,informsLisathathersonhasfragileXsyndrome,aninheritedformofintellectualimpairment.Nottoolongaftervisitingthedoctor,herhealthinsurancecompanyeliminatesherson’shealthcoverage,claimingthathisdisabilityrepresentsapreexistingcondition.Lisasearchesunsuccessfullyforanothercompanythatiswillingtoinsureherson.SheultimatelyquitsherjobinordertoqualifyforMedicaid.
• Lastyear,Jonathon’smotherAprilwasdiagnosedwithcoloncancer.BecauseApril’saunt
diedofcoloncancer,andhersisterwasundergoingchemotherapyforthecancer,Aprildecidedtoundergogenetictestingtodetermineifthecancercouldbehereditary.ShetestedpositiveforamutationinoneoffourgenesregulatingthereplicationofDNAinhercells,alsoknownasLynchsyndrome.Lastmonth,Jonathon’shealthinsurancecostsincreaseddramaticallyinresponsetothegenetictestresultsofhismother.
InEmployment• Marissahasworkedinalawfirmforfiveyearsandhasbecomeveryclosewithher
colleagues.Overlunchoneafternoon,shementionedtoapartnerinherfirmthatherfatherdiedofHuntington’sdisease.Marissaherselfhasa50%chanceofdevelopingthisgeneticcondition.Overthefollowingmonth,Marissabegantonoticehercaseloadwaning,andmanyofhercolleagueswhohadbeenwiththelawfirmforlesstimethanshewerereceivinghigherprofilecases.Shehasreceivednothingbutoutstandingperformancereviewsthroughouthertimeatthelawfirm,andcanfindnootherreasonasidefromthelunchconversationwithhercolleaguesthatcouldberesponsibleforthissuddenchange.
• Paullearnsthroughacompanymemothatamemberofthelargecardboardfactoryhe
worksforwasrecentlyfiredduetodrugabuseonthejob.Thecompanyhasdecidedtoinstitutemandatorydrugscreeningofallemployees.Paulwillinglyparticipatedintherandomdrug‐testingprogram,havingnoconcernsaboutpassing.Healwaystakeshisjobveryseriously,unlikesomeofhiscoworkers.Twomonthslater,Pauloverheardhissupervisorsdiscussingtheimpacttheeconomywashavingonthecompany.Thefollowing
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month,Paulwascalledintohissupervisor’soffice,wherehewasinformedthatthecompanyhadfallenonsomehardtimesandwouldneedtolethimgo.Confusedastowhyhewouldbeselectedamongtheindividualstobedischarged,overthenextfewweekshemetwithfriendsstillworkingatthecardboardfactoryandlearnedofsimilarlyconfusingcasesofhigh‐performing,dedicatedindividualswhowereletgowithlittlereason.Paulhasageneticpredispositiontoaheartconditionandhighcholesterol,whichcouldmeanhigherhealthcarecoststothecompany,buthedidn’tthinkhisemployerwouldknowthat.
Theaboveexamplesdonotconclusivelyidentifygeneticdiscriminationinhealthinsuranceandemployment;theyrepresentsituationsinwhichgeneticdiscriminationcouldbetakingplace.Individualsshouldconsultlawexpertisetodetermineiftheyhaveacaseforgeneticdiscrimination.
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ForHealthInsurersGINAoutlinesthefollowingactivitiesasunlawfulinsurancepracticesanddiscriminatoryonthebasisofgeneticinformation:
• Therequirementthatindividualsprovidegeneticinformationorthegeneticinformationofafamilymemberindeterminingeligibility,coverage,underwriting,orpremium‐settingdecisions,inthegroup,Medicaresupplementalpolicy,orindividualhealthinsurancemarkets;
• Theusegeneticinformationeithercollectedwithintent,orincidentally,tomakeenrollmentorcoveragedecisions;
• Therequestorrequirementthatanindividualoranindividual’sfamilymemberundergo
agenetictest;and;
• TheuseofgeneticinformationasapreexistingconditionintheMedicaresupplementalpolicyandindividualhealthinsurancemarkets.
Researchexception:Forjointresearchactivitiesconductedincollaborationwithexternalresearchentities,ahealthinsurerineitherthegrouporindividualmarketmayrequest,butnotrequire,inwritingthatanindividualundergoagenetictest.Thecompliancebytheindividualwithsucharequestisvoluntary,andnoncomplianceshallnothaveanegativeeffectonthepremiumorenrollmentstatusoftheindividual.Geneticinformationmayonlybeusedforresearchandnotforunderwritingpurposes.
Whatinformationcaninsurersrequestinmakingcoveragedeterminationsforspecificclaims?Aninsurercanrequiregeneticinformationtomakecoveragedeterminationsforaspecificclaim.Forexample,theinsurermayrequestinformationaboutanindividual’sBRCAstatustodeterminecoverageforprophylacticmastectomy.Theinsurermayrequestonlytheminimumamountofinformationnecessaryfordecision‐making.Anindividualcanelectnottosubmitgeneticinformationtotheinsureraboutsuchaclaim,andpayforthetreatment,test,orserviceout‐of‐pocket.
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ForEmployersGINAoutlinesthefollowingactivitiesasunlawfulemploymentpracticesanddiscriminatoryonthebasisofgeneticinformation:
Theuseofgeneticinformationinmakingdecisionsregardinghiring,promotion,termsorconditions,privilegesofemployment,compensation,ortermination.
Limiting,segregating,orclassifyinganemployee,ordeprivingthatemployeeofemploymentopportunities,onthebasisofgeneticinformation.
Therequest,requirement,orpurchaseofgeneticinformationoftheindividualorafamilymemberoftheindividualexceptinrarecases,
• Theuseofgeneticinformationinmakingdecisionsregardingadmissiontoor
employmentinanyprogramforapprenticeshiportrainingandretraining,includingon‐the‐jobtraining.
Furthermore,employersshouldbeawarethatitisunlawfulforanemploymentagency,labororganization,ortrainingprogramtofailorrefusetoreferanindividualforemploymentonthebasisofgeneticinformation,normaytheagencyorlabororganizationattempttocauseanemployertodiscriminateagainstanindividualonthebasisofgeneticinformation.
Whenmayanemployerrequestoruseanemployee’sgeneticinformation?
Whentheinformationisinadvertentlyprovidedaspartoftheindividual’smedicalhistoryorthemedicalhistoryofafamilymember;
Whentheinformationispubliclyavailable(althoughnotwhentheinformationiscontainedinmedicaldatabasesorcourtrecords);
Whentheemployerhasobtainedtheindividual’swrittenauthorizationaspartofan
employer‐sponsoredgeneticmonitoringprogramofthebiologicaleffectsoftoxicsubstancesintheworkplace,orifstateorfederallawrequiresthegeneticmonitoringprogram.Ineithercase,onlythehealthcareprofessionalandtheemployeecanknowoftheindividualandidentifiablegeneticinformation,andtheemployeemustbeinformedofindividualmonitoringresults.Theemployercanonlyhaveaccesstothecollectivegeneticinformationoftheentiregroupofemployees,withoutidentifyinginformation.
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Whentheemployeroffershealthorgeneticservices,includingservicesofferedaspartofawellnessprogram,andwiththeindividual’swrittenauthorization.Insuchcases,onlythehealthcareprofessionalorboardcertifiedgeneticcounselorinvolvedinprovidingtheservicesmayknowofindividuallyidentifiablegeneticinformation.Again,theemployermayknowonlyofthecollectivegeneticinformationoftheentiregroupofemployees,withoutidentifyinginformation;and
Wheretheemployeroperatesasalawenforcemententityandrequirestheindividual’s
DNAforqualitycontrolpurposesintheforensiclaborhumanremainsidentificationsettings.Theinformationmaynotbeusedforanydeterminationsofthetermsofemployment.
Whateffortsmustemployersmaketoensurethegeneticinformationofemployeesiskeptconfidential?Anygeneticinformationanemployerpossessesaboutanindividualmustbetreatedastheconfidentialmedicalrecordoftheindividualandmustbemaintainedinseparateformsandinseparatefiles.Anindividual’sgeneticinformationmaynotbedisclosedexceptattheindividual’swrittenrequestorinresponsetoacourtorder.Furthermore,inordertomaintaincompliancewithexistinglaws,anemployermayalsoprovidetheindividual’sgeneticinformationtotheFederal,State,orlocalauthorities.TheprovisionsofGINAhaveimpactsatvariouslevelsoftheemploymentsector,especiallyinthehumanresourcesdivision.BusinessesandorganizationsneedtopreparefortheimpactofGINAontheirhumanresourcepractices.
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ForCliniciansandHealthcareProvidersGINAdoesnotrestrictgeneticservices,thepracticeofmedicine,ortheauthorityofhealthcareprofessionals,whetherornottheymaybeaffiliatedwithahealthplanissueroranemployer.Cliniciansandhealthcareproviderscanrequestthatanindividualoranindividual’sfamilymemberundergoesagenetictestforthepurposesofthatindividual’smedicalbenefit.
ForResearchersTheresearchcommunitywillbenefitfromincreasedenrollmentinclinicaltrialsandresearchactivitiesduetotheprotectionsagainstgeneticdiscriminationasaffordedbyGINA.Intheinformedconsentprocess,whendiscussingthepotentialrisksassociatedwithaparticularresearchactivityorstudy,researchersshouldpreparetoincludeinformationaboutGINAorresourcesforparticipantstoaccesstoobtainadditionalinformationaboutGINAonceGINAbecomesfullyactive.Thehealthinsuranceprovisionsofthebillwilltakeeffect12monthsafterthedateofsigning,onMay21,2009.Theprotectionsinemploymentwilltakeeffect18monthsafterthedateofsigning,onNovember21,2009.AtthispointGINAwillbeconsideredfullyactive.
ForStatesTheGeneticInformationNondiscriminationAct(GINA)providesabaselineforprotectionagainstgeneticdiscriminationforallAmericans.However,GINAdoesnotpreemptastateanti‐discriminationlawthatprovidesmoreextensiveprotectionsthanGINA,eitherinhealthinsuranceoremployment.Todeterminecompliancewithbothstateandfederallaw,stateswillneedtocompareGINAtothecurrentstatelawsinplaceandbesuretocomplywiththehighestlevelofprotectionprovidedbythelegislation.
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ImportantGINADefinitionsandExamplesGeneticinformation: informationaboutanindividual’sgenetictestsorthegenetictestsoftheindividual’sfamilymembers,andthemanifestationofadiseaseordisorderintheindividual’sfamilymembers.Furthermore,geneticinformationalsoincludestherequestorreceiptofgeneticservicesorparticipationinclinicalresearchthatincludesgeneticservices,forboththeindividualandtheindividual’sfamilymembers.Informationregardinganindividual’ssexorageisNOTprotectedgeneticinformationunderGINA.Genetictest:theanalysisofhumanDNA,RNA,chromosomes,proteins,ormetabolitesthatdetectsgenotypes,mutations,orchromosomalchanges.UnderGINA,agenetictestdoesnotincludetheanalysisofproteinsormetabolitesdirectlyrelatedtothemanifestationofadiseasethatcouldreasonablybedetectedbyahealthcareprofessionalwithappropriatetrainingandexpertiseinthefieldofmedicineinvolved.ExamplesoftestscoveredbyGINA:testsforBRCA1/BRCA2(breastcancer)orHNPCC(coloncancer)mutations;testsforHuntington’sdiseasemutations,carrierscreeningfordisorderssuchascysticfibrosisandfragileXsyndrome,andclassificationsofgeneticpropertiesofanexistingtumortohelpdeterminetherapy.ExamplesoftestsNOTcoveredbyGINA:routinetestssuchasroutinebloodcounts,cholesteroltests,andliver‐functiontests.1Geneticservices:agenetictest,geneticcounseling,geneticeducation,orparticipationinaresearchstudy.Familymember:adependentoranyotherindividualwhoisafirst,second,third,orfourthdegreerelative.Geneticmonitoring: theperiodicexaminationofemployeestoevaluateacquiredmodificationstotheirgeneticmaterials,suchaschromosomaldamageorevidenceofincreasedoccurrenceofmutations,thatmayhavedevelopedinthecourseofemploymentduetoexposuretotoxicsubstancesintheworkplace,inordertoidentify,evaluate,andrespondtoptheeffectsorcontroladverseenvironmentalexposuresintheworkplace.
1 Hudson,KathyL.,Ph.D.,M.K.Holohan,J.D.,andFrancisS.Collins,M.D.,Ph.D.“KeepingPacewiththeTimes—TheGeneticInformationNondiscriminationActof2008.”NewEnglandJournalofMedicine.358.25(2008):2661‐2663.
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AdditionalResourcesCoalitionforGeneticFairnesswww.geneticfairness.orgTheCoalitionforGeneticFairness(CGF)wasfoundedin1997toaddressthegrowingconcernsurroundingthemisuseofgeneticinformationininsuranceandemploymentdecisions.TheCoalition’sobjectivewastourgeCongresstopasscomprehensivefederallegislationoutlawinggeneticdiscriminationandtoeducatethepublicabouttheseprotections.Initially,theCoalitionconsistedofcivilrights,patientandhealthcareorganizations,butwasexpandedin2005toincludeindustrygroupsandemployers.WithGINA’spassage,theCoalitionforGeneticFairnesswilleducatethepublicandraiseawarenessofthelegislation,whatitmeans,andhowitwillimpactnotonlyhealthinsuranceandemployment,buthealthcaredelivery,research,andemergingtechnologies.TheCoalitionwillencouragedialogueandcreatethespacetoshareintheexcitementforthefuture,voiceconcerns,andseeksolutionstothoseconcerns.GeneticsandPublicPolicyCenterwww.dnapolicy.orgThetremendoussuccessoftheHumanGenomeProjecthaslaidthefoundationforatruerevolutioninpublichealth,promisingimproveddiagnosis,moreeffectivemedicines,andindividuallytailoredhealthcare.TheGeneticsandPublicPolicyCenterwascreatedin2002atJohnsHopkinsUniversitybyPewCharitableTruststohelppolicymakers,thepress,andthepublicunderstandandrespondtothechallengesandopportunitiesofgeneticmedicineanditspotentialtotransformglobalpublichealth.NationalHumanGenomeResearchInstitute(NHGRI),NationalInstitutesofHealthwww.genome.govTheNationalHumanGenomeResearchInstitute(NHGRI)ledtheNationalInstitutesofHealth's(NIH)contributiontotheInternationalHumanGenomeProject,whichhadasitsprimarygoalthesequencingofthehumangenome.ThisprojectwassuccessfullycompletedinApril2003.Now,theNHGRI'smissionhasexpandedtoencompassabroadrangeofstudiesaimedatunderstandingthestructureandfunctionofthehumangenomeanditsroleinhealthanddisease.TothatendNHGRIsupportsthedevelopmentofresourcesandtechnologythatwillaccelerategenomeresearchanditsapplicationtohumanhealth.AcriticalpartoftheNHGRImissioncontinuestobethestudyoftheethical,legalandsocialimplications(ELSI)ofgenomeresearch.NHGRIalsosupportsthetrainingofinvestigatorsandthedisseminationofgenomeinformationtothepublicandtohealthprofessionals.
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U.S.EqualEmploymentOpportunityCommissionwww.eeoc.govThefive‐memberCommissionmakesequalemploymentopportunitypolicyandapprovesmostlitigation.TheGeneralCounselisresponsibleforconductingEEOCenforcementlitigationunderTitleVIIoftheCivilRightsActof1964(TitleVII),theEqualPayAct(EPA),theAgeDiscriminationinEmploymentAct(ADEA),andtheAmericanswithDisabilitiesAct(ADA).U.S.DepartmentofHealthandHumanServices(HHS),OfficeforCivilRights(OCR)www.hhs.gov/ocrTheDepartmentofHealthandHumanServices(HHS),throughtheOfficeforCivilRights(OCR),promotesandensuresthatpeoplehaveequalaccesstoandopportunitytoparticipateinandreceiveservicesfromallHHSprogramswithoutfacingunlawfuldiscrimination,andthattheprivacyoftheirhealthinformationisprotectedwhileensuringaccesstocare.Throughpreventionandeliminationofunlawfuldiscriminationandbyprotectingtheprivacyofindividuallyidentifiablehealthinformation,OCRhelpsHHScarryoutitsoverallmissionofimprovingthehealthandwellbeingofallpeopleaffectedbyitsmanyprograms.
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WewouldliketoacknowledgethemembersoftheCoalitionforGeneticFairnessfortheircontributionstothisresource,aswellastheentiregeneticscommunity—healthcareprofessionals,disease‐specificorganizations,researchers,industrypartners,andindividuals,families,andcommunitiesaffectedbygeneticconditions.WeworkedasoneforGINA’spassage,andnoweveryindividualinthenationwillbenefitfromitsprotections.Thenextstep:InordertorealizeGINA’spotential,wemustnotstopatthelegislation’spassage.WemusteducateeachotherandraiseawarenessofGINA,whatitmeans,andhowitwillimpactnotonlyhealthinsuranceandemployment,buthealthcaredelivery,research,andemergingtechnologies.Wemustencouragedialogue,shareintheexcitementforthefuture,voiceconcerns,andseeksolutionstothoseconcerns.TheCoalitionforGeneticFairnesswillconvenethespaceforthisdialogue—spacethatisopenandwhereallperspectivesarerepresented.Throughthis,wewillinformtheregulatoryprocess,addresstheneedsofthecommunity,andcreateanddisseminateavarietyofeducationalmaterialsandresources.WouldyouoryourorganizationliketobecomeinvolvedintheCoalition’sinitiatives,butarenotyetamember?Visithttp://www.geneticfairness.orgorcontactAndriaCornellatacornell@geneticalliance.orgformoreinformationandtolearnhowyoucanensurethevalueofGINAisrealized!