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    • 4.  

    Medical underwriting is the evaluation of a person's insurability, usually assessed through a combination of answers to a written questionnaire and physical examination to identify certain conditions determined by medical underwriters (and underwriting manuals) to reduce life expectancy or increase medical care costs beyond actuarial norms. Standards for medical underwriting vary substantially by insurance company, and underwriting decisions are considered crucial business decisions by insurers, and are thus considered ''trade secrets" not subject to public disclosure.

    5.  

    The National Sickle Cell Anemia, Cooley Anemia, Tay-Sachs, and Genetic Diseases Act of 1976 (Public Law 94-278) consolidated separate 1972 legislation for sickle cell anemia (Public Law 92-294) and Cooley anemia (Public Law 92-414) and added other genetic conditions into the provisions of the law. It required the development of information and education materials "to persons providing health care, to teachers and students, and to the public in general in order to rapidly make available the latest advances in the testing, diagnosis, counseling and treatment of individuals respecting genetic disease." It also required that federally assisted programs for the disorders included were to be entirely voluntary. Although this legislation was repealed in 1981, with the passage of the Maternal and Child Health Services Block Grant Act (Public Law 97-35), the requirement that programs supported with block grant funds be entirely voluntary was never repealed.

    REFERENCES

    Beaudet, A. 1992 (published in 1994). General perspectives on DNA diagnosis drawn from the cystic fibrosis experience. In Fullarton, J. (ed.) Proceedings of the Committee on Assessing Genetic Risks. Washington, D.C.: National Academy Press.

    Bernhardt, B., and Eierman, L. 1992. Reimbursement for cystic fibrosis (CF) DNA testing (Abstract). Meeting of the American Society of Human Genetics. San Francisco. November.


    Charo, A. 1992 (published in 1994). Impact of abortion law on genetic screening. In Fullarton, J. (ed.) Proceedings of the Committee on Assessing Genetic Risks. Washington, D.C.: National Academy Press.

    Clayton, E. 1993. Reproductive genetic testing: Regulatory and liability issues. Fetal Diagnosis and Therapy 8:(suppl. 1):39-59.

    Council of Regional Networks for Genetic Services (CORN). 1991. Survey of state genetic services coordinators (unpublished data). New York, N.Y.

    Council of Regional Networks for Genetic Services (CORN). 1992. Newborn Screening Report: 1990 (Final report, February 1992). New York, N.Y.


    Employee Benefit Research Institute (EBRI). 1993. Sources of health insurance and characteristics of the uninsured, Analysis of the March 1992 Current Population Survey. Issue 133. Washington, D.C.


    Field, M., and Shapiro, H. 1993. Employment and Health Benefits: A Connection at Risk. Washington, D.C.: National Academy Press.


    Insurance Task Force. 1993. Genetic Information and Health Insurance. Report of the Task Force on Genetic Information and Insurance. HIH-DOE Working Group on Ethical, Legal, and Social Implications of Human Genome Research. Bethesda, Md.: National Institutes of Health (Pub. No. 93-3686). May.


    Office of Technology Assessment (OTA). U.S. Congress. 1992a. Cystic Fibrosis and DNA Tests: Implications of Carrier Screening. OTA-BA-532. Washington, D.C.: U.S. Government Printing Office.

    Office of Technology Assessment (OTA). U.S. Congress. 1992b. Genetic Tests and Health Insurance: Results of a Survey (background paper). OTA-BP-BA-98. Washington, D.C.: U.S. Government Printing Office.

    Office of Technology Assessment (OTA). U.S. Congress. 1992c. Panel discussion; Panel on Population Screening for Cystic Fibrosis. Washington, D.C., March 11, 1992.


    Pokorsky, R. 1989. Public and government relations issues. Pp. 10-11 in The Potential Role of Genetic Testing in Risk Classification. Report of the Genetic Testing Committee to the Medical Section of the American Council of Life Insurance, Hilton Head, S.C.



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