Everyone has at least seven genes that can trigger a disease at any time -- or they can have no effect. Those genes are identifiable through DNA, the genetic code in chromosomes, and they are indicators of every person's risk to disease. DNA even marks the hereditary pattern that family members have to certain health risks.
Health-care advocates such as Dorothy Ono contend that medical records containing DNA test results, obtained through blood and saliva samples, must remain confidential to prohibit discrimination in insurance coverage.
But under one of the nearly 360 bills up for consideration by the Senate today, providers of life insurance, disability-income insurance or long-term care insurance will be able to seek patient records containing genetic test results.
The bill began as a proposal to amend the state insurance code to bar discrimination based on genetic information.
But the Senate Consumer Protection Committee was swayed by insurance-industry concerns and amended the bill to include the exemption that appears to undermine the bill's original intent.
Insurance representatives said the ban on insurers requesting or requiring the collection or disclosure of DNA information would mean the end of medical underwriting in Hawaii. It would even prohibit the industry's standard practice of risk classification, they testified.
The co-chairs of the Senate panel, Sens. Rosalyn Baker (D, Lahaina) and David Ige (D, Pearl City), said in their committee report the panel "supports the intent of the bill, but believes the concerns of the insurance industry have merit."
That provides no solace to Ono.
"With technology the way it is today, every condition is going to be tied to a genetic marker - be it for cancer, alcoholism, the whole spectrum," she said yesterday. "Even if you do not develop cancer, the marker might be there. To take it one step further, you can have genetic information on all of these conditions released and you might as well say nobody can have insurance.
"I feel we need to be cautious with genetic information. I still feel strongly that there has to be confidentiality and information can only be released if it is based on informed consent."
In his testimony to the Senate panel, Rick Tsujimura, the lobbyist for State Farm Insurance Cos., said: "Insurance is based on an assessment of risks. Bad risks pay more and good risks pay less. If people can be assessed and their risks accurately determined, then all of us will pay according to our risks, no more, no less. The requirement of genetic tests, like blood tests and other exams, seems reasonable given the goal of accurately assessing risk. If a genetic test has already been performed, the insurer as part of the assessment of risk of the individual should be entitled to such information."
State Health Director Lawrence Miike, who supports a prohibition on genetic-information discrimination, said studies have revealed that insurers have discriminated.
"In the 1970s, insurance companies denied coverage or charged higher rates to African-Americans who were carriers of the sickle cell gene, even though this condition did not cause disease or increased medical problems," Miike said.
He added there have also been instances of insurers in California denying health coverage for women with a family history of breast cancer, although in the majority of cases breast cancer is not inherited.