Hostname: page-component-745bb68f8f-mzp66 Total loading time: 0 Render date: 2025-01-11T09:46:13.708Z Has data issue: false hasContentIssue false
  • English
  • Français

The Proactive Patient: Long-Term Care Insurance Discrimination Risks of Alzheimer's Disease Biomarkers

Published online by Cambridge University Press:  01 January 2021

Jalayne J. Arias ,
Ana M. Tyler ,
Benjamin J. Oster  and
Jason Karlawish
Get access Rights & Permissions [Opens in a new window]

Extract

Previously diagnosed by symptoms alone, Alzheimer's disease is now also defined by measures of amyloid and tau, referred to as “biomarkers.” Biomarkers are detectible up to twenty years before symptoms present and open the door to predicting the risk of Alzheimer's disease. While these biomarkers provide information that can help individuals and families plan for long-term care services and supports, insurers could also use this information to discriminate against those who are more likely to need such services. In this article, we evaluate whether state laws prohibit long-term care insurers from making discriminatory or unfair underwriting and coverage decisions based Alzheimer's disease biomarkers status. We report data demonstrating that current state laws do not provide meaningful protections from discrimination by long-term care insurers based on biomarker information.

Type
Independent Articles
Information
Journal of Law, Medicine & Ethics , Volume 46 , Issue 2: Law and the Opioid Crisis: An Inter-Disciplinary Examination , Summer 2018 , pp. 485 - 498
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Jack, C.R., Bennet, D.A., Blennow, K., et al., “A/T/N: An unbiased descriptive classification scheme for Alzheimer disease biomarkers,” Neurology 87, no. 5 (2016): 539-547.Google Scholar
Sperling, R.A., Aisen, P.S., Beckett, L.A., et al., “Toward Defining the Preclinical Stages of Alzheimer’s Disease: Recommendations from the National Institute on Aging and the Alzheimer’s Association Workgroup NIA-AA Preclinical Criteria,” Alzheimer’s & Dementia 7, no. 3 (2011): 280-292.Google Scholar
Id.Google Scholar
Arias, J.J. and Karlawish, J., “Confidentiality in Preclinical Alzheimer’s Disease Studies: When Research Clinical Records Meet,” Neurology 82, no. 8 (2014): 725-729.CrossRefGoogle Scholar
Avraham, R., Logue, K.D., and Schwarcz, D., “Understanding Insurance Antidiscrimination Law,” Southern California Law Review 87, no. 2 (2014): 195-274.Google Scholar
See Arias, supra note 4.Google Scholar
Id.Google Scholar
15 U.S.C.A. § 1012 (1945).Google Scholar
National Association of Insurance Commissioners, “About the NAIC,” available at <http://www.naic.org/index_about.htm> (last visited March 26, 2018).+(last+visited+March+26,+2018).>Google Scholar
Assistant Secretary for Planning and Evaluation (ASPE), ASPE Research Brief: Long-term Care Insurance (June 2012); National Association of Insurance Commissioners (NAIC), Long-term Care Insurance Model Act, Section 6(C), (2009) (the NAIC Model Act was revised in 2017, however no amendments affected our analysis).Google Scholar
Cornell, P.Y., Grabowski, D.C., Cohen, M., et al., “Medical Underwriting in Long-Term Care Insurance: Market Conditions Limit Options for Higher-Risk Consumers,” Health Affairs 35, no. 8 (2016): 1494-1503.CrossRefGoogle Scholar
Commission on Long-Term Care, Report to the Congress, 3 (September 30, 2013); Holt, J.D., “Navigating Long-term Care,” Gerontology & Geriatric Medicine 3, no. 1 (2017): 1-5.Google Scholar
See Commission, supra note 12.Google Scholar
Id.Google Scholar
Fox-Grage, W., “Medicaid: A Last Resort for People Needing Long-term Services and Supports,” AARP Public Policy Institute (March 2017).Google Scholar
Id.Google Scholar
National Health Policy Forum, “National Spending for Long-Term Services and Supports (LTSS),” (March 27, 2014).Google Scholar
42 § 300gg-91(a)(2)Google Scholar
See Commission, supra note 12.Google Scholar
Id.Google Scholar
Alzheimer’s Association, “2017 Alzheimer’s Disease Facts and Figures,” (2017): 18, 24 (also available at Alzheimer’s & Dementia 13, no. 4 (2017): 325-373).Google Scholar
Dementia is defined as a cognitive decline that interferes with the ability to function and not explained by delirium or psychiatric illness. McKhann, G.M., et al., “The Diagnosis of Dementia Due to Alzheimer’s Disease: Recommendations from the National Institute on Aging — Alzheimer’s Association Workgroups on Diagnostic Guidelines for Alzheimer’s Disease,” Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association 7, no. 3 (2011): 263–269.Google Scholar
See Alzheimer’s Association, supra note 21 at 5.Google Scholar
Id.Google Scholar
Id.Google Scholar
Deb, A., Thornton, J.D., Sambamoorthi, U., and Innes, K., “Direct and Indirect Cost of Managing Alzheimer’s Disease and Related Dementias in the United States,” Expert Review of Pharmacoeconomics & Outcomes Research 17, no. 2 (2017): 189-202.Google Scholar
See Alzheimer’s Association, supra note 21 at 5.Google Scholar
Alzheimer’s Association, “Fact Sheet: Cost of Alzheimer’s to Medicare and Medicaid” (2017).Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
See Jack, supra note 1.Google Scholar
Sperling, R.A., Aisen, P.S., Beckett, L.A., et al., ‘Toward Defining the Preclinical Stages of Alzheimer’s Disease: Recommendations from the National Institute on Aging and the Alzheimer’s Association Workgroup NIA-AA Preclinical Criteria,” Alzheimer’s & Dementia 7, no. 3 (2011): 280-292.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Office of the Assistant Secretary for Planning and Evaluation, “National Plans to Address Alzheimer’s Disease,” available at <https://aspe.hhs.gov/national-plans-address-alzheimers-disease> (last visited March 26, 2018).+(last+visited+March+26,+2018).>Google Scholar
Id.Google Scholar
Id.Google Scholar
The A4 Study, available at <a4study.org> (last visited March 26, 2018).+(last+visited+March+26,+2018).>Google Scholar
See NAIC Model Act, supra note 10 at Section 6(C).Google Scholar
Frolik, L.A., “Private Long-term Care Insurance: Not the Solution to the Hight Cost of Long-term Care for the Elderly,” Elder Law Journal 23, no. 2 (2016): 371-416.Google Scholar
Id.Google Scholar
Favreault, M.M., Gleckman, H., and Johnson, R.W., “Financing Long-term Services and Supports: Options Reflect Trade-offs for Older Americans and Federal Spending,” Health Affairs 34, no. 12 (2015): 2181-2191.Google Scholar
Id.Google Scholar
See Cornell, supra note 11.Google Scholar
See Favreault supra note 44; see Commission supra note 12.Google Scholar
See Cornell, supra note 11.Google Scholar
26 USCA § 7702(B)(c)(1).Google Scholar
Id.Google Scholar
See NAIC, supra note 9.Google Scholar
See NAIC Model Act, supra note 10.Google Scholar
Id. at Section 1.Google Scholar
See NAIC Model Act, supra note 10 (Appendix report on Adoption).Google Scholar
Tremper, C., Thomas, S., and Wagenaar, A.C., “Measuring law for Evaluation Research,” Evaluation Research 34, no. 3 (2010): 242-266.Google Scholar
Id.Google Scholar
Harris, P.A., Taylor, R., Thielke, R., et al., “Research Electronic Data Capture (REDCap) — A Metadata-Driven Methodology and Workflow Process for Providing Translational Research Informatics Support,” Journal of Biomedical Informatics 42, no. 2 (2009): 377-381.Google Scholar
Elo, S. and Kyngas, E., “The Qualitative Content Analysis Process,” Journal of Advanced Nursing 62, no. 1 (2008): 107-115.Google Scholar
See NAIC Model Act, supra note 10 at Section 6.Google Scholar
Id.Google Scholar
Id. at Section 7.Google Scholar
See NAIC Model Act, supra note 10 at Section 6.Google Scholar
Id.Google Scholar
215 ILCS 5/351A-5 (1991) (“Preexisting condition means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care or treatment, or a condition for which medical advice or treatment was recommended […]”).Google Scholar
IC § 27-8-12-10 (2013); IC § 27-8-12-10.5 (2013); Minn. Stat. § 62A.48 (2015).Google Scholar
See for example, 40 P.S. §§ 991.1105-991.1107 (2015).Google Scholar
IC § 27-8-12-10 (2013); IC § 27-8-12-10.5 (2013).Google Scholar
IC § 27-8-12-10 (2013).Google Scholar
IC § 27-8-12-10.5 (2013).Google Scholar
Minn. Stat. § 62A.48 (2015).Google Scholar
See NAIC Model Act, supra note 10.Google Scholar
Dubois, B. et al., “Preclinical Alzheimer’s Disease: Definition, Natural History, and Diagnostic Criteria,” Alzheimer’s & Dementia 12, no. 3 (2016): 292-323.Google Scholar
Id.Google Scholar
Cummings, J. et al., “Alzheimer’s Disease Drug Development Pipeline: 2017,” Alzheimer’s & Dementia 3, no. 3 (2017); 367-384.Google Scholar
45 CFR 147.103Google Scholar
Id.Google Scholar
Polin, G.M., “Health Law: Medical Advices Constitutes a Preexisting Condition and Results in Denial of Disability Benefits,” Journal of Health & Biomedical Law 6 (2010): 391-408 (citing Doroshow v. Hartford Life & Accident Ins. Co., 574 F.3d 230 (3d Cur. 2009).Google Scholar
Id.Google Scholar
Wickland v. American Travellers Life Ins. Co., 204 W.Va. 430 (1998).Google Scholar
See NAIC Model Act, supra note 10 at Section 6.Google Scholar
Id.Google Scholar
NAIC Model Long-term Care Insurance Model Regulation, section 11.Google Scholar
See Avraham, supra note 5.Google Scholar
Id.Google Scholar
See Arias, supra note 4.Google Scholar
Id.Google Scholar
The Offices of CLASS, ASPE, and the General Counsel, A Report on the Actuarial, Marketing, and Legal Analyses of the CLASS Program (2011), available at <https://aspe.hhs.gov/system/files/pdf/76321/appJ.pdf> (last visited March 26, 2018).+(last+visited+March+26,+2018).>Google Scholar
See Cornell, supra note 11.Google Scholar
Id.Google Scholar
Temkin-Greener, H., Mukamel, D.B., and Meiners, M.R., “Long-term Care Insurance Underwriting: Understanding Eventual Claims Experience,” Inquiry 37, no. 4 (2000/2001): 348-358.Google Scholar
American Association for Long-term Care Insurance, available at <http://www.aaltci.org/long-term-care-insurance/learning-center/are-you-even-insurable.php> (last accessed March 26, 2018).+(last+accessed+March+26,+2018).>Google Scholar
Id.Google Scholar
Farely, J., “Parental Medical History Now Influencing the Cost of Long-term Care Premiums,” Financial Advisor (2014).Google Scholar
Taylor, D.H., Cook-Deegan, R.M., Hiraki, S., et al., “Genetic Testing for Alzheimer’s and Long-term Care Insurance,” Health Affairs 29, no. 1 (2010): 102-108.Google Scholar
See Commission, supra note 12.Google Scholar
Patient Protection and Affordable Care Act, PL 111-148, §8002 (2010); Health Affairs, Health Policy Brief, The CLASS Act: A Report on the Actuarial, Marketing, and Legal Analysis of the CLASS Program, US Department of Health And Human Services (2012).Google Scholar
See Commission, supra note 12.Google Scholar
Id. at 31.Google Scholar
Id.Google Scholar
American Academy of Actuaries, “Essential Elements: Long-term Care Financing,” (2014).Google Scholar
The Federal Long-term Care Insurance Partnership Program, available at <https://www.ltcfeds.com/help/faq/miscellaneous_partnership.html> (last accessed March 26, 2018).+(last+accessed+March+26,+2018).>Google Scholar
See Commission, supra note 12.Google Scholar