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.
Get full access to this article
View all access options for this article.
References
1.
C.R.Jack, D.A.Bennet, K.Blennow, et al., “A/T/N: An unbiased descriptive classification scheme for Alzheimer disease biomarkers,”Neurology87, no. 5 (2016): 539-547.
2.
R.A.Sperling, P.S.Aisen, L.A.Beckett, 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 & Dementia7, no. 3 (2011): 280-292.
3.
Id.
4.
J.J.Arias and J.Karlawish, “Confidentiality in Preclinical Alzheimer’s Disease Studies: When Research Clinical Records Meet,”Neurology82, no. 8 (2014): 725-729.
5.
R.Avraham, K.D.Logue, and D.Schwarcz, “Understanding Insurance Antidiscrimination Law,”Southern California Law Review87, no. 2 (2014): 195-274.
6.
See Arias, supra note 4.
7.
Id.
8.
15 U.S.C.A. § 1012 (1945).
9.
National Association of Insurance Commissioners, “About the NAIC,”available at <http://www.naic.org/index_about.htm> (last visited March 26, 2018).
10.
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).
11.
P.Y.Cornell, D.C.Grabowski, M.Cohen, et al., “Medical Underwriting in Long-Term Care Insurance: Market Conditions Limit Options for Higher-Risk Consumers,”Health Affairs35, no. 8 (2016): 1494-1503.
12.
Commission on Long-Term Care, Report to the Congress, 3 (September 30, 2013); J.D.Holt, “Navigating Long-term Care,”Gerontology & Geriatric Medicine3, no. 1 (2017): 1-5.
13.
See Commission, supra note 12.
14.
Id.
15.
W.Fox-Grage, “Medicaid: A Last Resort for People Needing Long-term Services and Supports,”AARP Public Policy Institute (March2017).
16.
Id.
17.
National Health Policy Forum, “National Spending for Long-Term Services and Supports (LTSS),” (March27, 2014).
18.
42 § 300gg-91(a)(2)
19.
See Commission, supra note 12.
20.
Id.
21.
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).
22.
Dementia is defined as a cognitive decline that interferes with the ability to function and not explained by delirium or psychiatric illness. G.M.McKhann, 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 Association7, no. 3 (2011): 263–269.
23.
See Alzheimer’s Association, supra note 21 at 5.
24.
Id.
25.
Id.
26.
A.Deb, J.D.Thornton, U.Sambamoorthi, and K.Innes, “Direct and Indirect Cost of Managing Alzheimer’s Disease and Related Dementias in the United States,”Expert Review of Pharmacoeconomics & Outcomes Research17, no. 2 (2017): 189-202.
27.
See Alzheimer’s Association, supra note 21 at 5.
28.
Alzheimer’s Association, “Fact Sheet: Cost of Alzheimer’s to Medicare and Medicaid” (2017).
29.
Id.
30.
Id.
31.
Id.
32.
See Jack, supra note 1.
33.
R.A.Sperling, P.S.Aisen, L.A.Beckett, 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 & Dementia7, no. 3 (2011): 280-292.
The A4 Study, available at <a4study.org> (last visited March 26, 2018).
41.
See NAIC Model Act, supra note 10 at Section 6(C).
42.
L.A.Frolik, “Private Long-term Care Insurance: Not the Solution to the Hight Cost of Long-term Care for the Elderly,”Elder Law Journal23, no. 2 (2016): 371-416.
43.
Id.
44.
M.M.Favreault, H.Gleckman, and R.W.Johnson, “Financing Long-term Services and Supports: Options Reflect Trade-offs for Older Americans and Federal Spending,”Health Affairs34, no. 12 (2015): 2181-2191.
45.
Id.
46.
See Cornell, supra note 11.
47.
See Favreault supra note 44; see Commission supra note 12.
48.
See Cornell, supra note 11.
49.
26 USCA § 7702(B)(c)(1).
50.
Id.
51.
See NAIC, supra note 9.
52.
See NAIC Model Act, supra note 10.
53.
Id. at Section 1.
54.
See NAIC Model Act, supra note 10 (Appendix report on Adoption).
55.
C.Tremper, S.Thomas, and A.C.Wagenaar, “Measuring law for Evaluation Research,”Evaluation Research34, no. 3 (2010): 242-266.
56.
Id.
57.
P.A.Harris, R.Taylor, R.Thielke, et al., “Research Electronic Data Capture (REDCap) — A Metadata-Driven Methodology and Workflow Process for Providing Translational Research Informatics Support,”Journal of Biomedical Informatics42, no. 2 (2009): 377-381.
58.
S.Elo and E.Kyngas, “The Qualitative Content Analysis Process,”Journal of Advanced Nursing62, no. 1 (2008): 107-115.
59.
See NAIC Model Act, supra note 10 at Section 6.
60.
Id.
61.
Id. at Section 7.
62.
See NAIC Model Act, supra note 10 at Section 6.
63.
Id.
64.
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 […]”).
65.
IC § 27-8-12-10 (2013); IC § 27-8-12-10.5 (2013); Minn. Stat. § 62A.48 (2015).
66.
See for example, 40 P.S. §§ 991.1105-991.1107 (2015).
J.Cummingset al., “Alzheimer’s Disease Drug Development Pipeline: 2017,”Alzheimer’s & Dementia3, no. 3 (2017); 367-384.
75.
45 CFR 147.103
76.
Id.
77.
G.M.Polin, “Health Law: Medical Advices Constitutes a Preexisting Condition and Results in Denial of Disability Benefits,”Journal of Health & Biomedical Law6 (2010): 391-408 (citing Doroshow v. Hartford Life & Accident Ins. Co., 574 F.3d 230 (3d Cur. 2009).
78.
Id.
79.
Wickland v. American Travellers Life Ins. Co., 204 W.Va. 430 (1998).
80.
See NAIC Model Act, supra note 10 at Section 6.
81.
Id.
82.
NAIC Model Long-term Care Insurance Model Regulation, section 11.
83.
See Avraham, supra note 5.
84.
Id.
85.
See Arias, supra note 4.
86.
Id.
87.
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).
88.
See Cornell, supra note 11.
89.
Id.
90.
H.Temkin-Greener, D.B.Mukamel, and M.R.Meiners, “Long-term Care Insurance Underwriting: Understanding Eventual Claims Experience,”Inquiry37, no. 4 (2000/2001): 348-358.
J.Farely, “Parental Medical History Now Influencing the Cost of Long-term Care Premiums,”Financial Advisor (2014).
94.
D.H.Taylor, R.M.Cook-Deegan, S.Hiraki, et al., “Genetic Testing for Alzheimer’s and Long-term Care Insurance,”Health Affairs29, no. 1 (2010): 102-108.
95.
See Commission, supra note 12.
96.
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).
97.
See Commission, supra note 12.
98.
Id. at 31.
99.
Id.
100.
American Academy of Actuaries, “Essential Elements: Long-term Care Financing,” (2014).
