A woman I met at a long term care insurance meeting presented a troubling question, one the LTC industry needs to address. “How,” she asked, “do you think LTC insurers will view my application, when they learn my mother and sister both had breast cancer, I have a genetic marker for breast cancer, and I had a double mastectomy as a preventive measure?
“Will the insurer say, ‘Good for you. It was a life-changing decision to have both breasts removed. Therefore, we’re happy to approve your request for LTC coverage.’
“Or will it say, ‘We understand you did a very difficult thing. But how can we know you will never get breast cancer? Your genetic test is not 100% certain so you may still be at risk. Therefore, we can’t issue you coverage, despite your current health.’”
Her question raises a number of points of importance for the LTC industry involving genetic test results.
Let’s apply this to the growing concern about Americans with Alzheimer’s disease. If every baby boomer decided to take a DNA test to determine personal risk for AD, the results could be devastating for the LTC insurance industry, especially since there are 78 million boomers approaching the ages where AD strikes most often.
What would those who test positive do? What would LTC insurers do? What is fair? What is not? How can this be dealt with?
These questions prompted me to conduct a survey to see how the public feels about genetic testing and insurance coverage. I polled 100s of people, ages 30 to 60+. The responses, all anonymous, were overwhelming, in number and passion. A few brought tears to my eyes. Some might startle, upset and/or inform insurance professionals and executives.
Those in their early 30s said they’d have little trouble taking DNA tests. They felt they would want to know the results because it would give them the rest of their lives to try to avoid getting whatever disease might come to light. Besides, they reasoned they could live 60 more years, so cures may be found along the way.
But the 50- and 60-year-olds went the other way: “Why would I want to know at this point in my life?” “What could I do if I did find out I could get a disease?” “I have lived most of my life already; it would be difficult to change my habits.” “I just want to enjoy my later years.”
What about telling their doctors? Once again, the younger respondents said they’d tell; maybe that’s because younger people tend to have less troubling diseases and do not see doctors very often. But many older respondents said they wouldn’t tell–primarily because they had little or no trust in their doctor’s ability to guide them.
The big issue among both younger and older respondents was what to do about LTC insurance if a test shows there is possibility of a disease in the future.
For LTC insurance owners, this was a moot point. They said they’d have no reason to tell their insurer and felt relieved that they had the coverage. Even if the insurer wanted an update on their medical condition, they say they wouldn’t tell.
Those who currently have no insurance, whether LTC or basic health, said they would research more about LTC insurance and, if appropriate, apply for it–before letting anyone know the results. This may be good for LTC sales people who write policies and make commissions, but very bad for the industry long term.
A portion of respondents who said they understand LTC insurance said they would take out the insurance first, then possibly take the DNA test. If the test came back negative, some said they’d subsequently cancel the policy, while others weren’t sure.
Most respondents were either afraid or unclear about the way insurers might decide who should or should not be covered based on DNA test information. Most expressed a negative view of the industry, in general.
Now, let’s return to the staggering numbers of anticipated AD cases that are expected to develop among today’s baby boomers. How will insurers deal with this? Genetic testing thrusts its head forward as a possible strategy. But insurers who consider this will face a myriad of complex issues.
LTC insurers still cover only a small percentage of the population, compared to their desired market penetration. So they keep probing for reasons. (See chart.)
The positive side of DNA testing is prevention. Those who learn they are at risk for diseases like Type 2 diabetes can head off the worst effects by adopting a healthier lifestyle. But the negative side can be very scary. Would you want to learn that you are at risk for Huntington’s disease, which is an inherited condition and always fatal?
Critical health information will soon be at the fingertips due to DNA testing. What will be the options for insurers, once that information is available? And how will the nation, and the LTC insurance industry, handle the 78 million boomers who are approaching their senior years with this knowledge at their own fingertips?
Ellen Eichelbaum is president of The SpeakEasy Group, Northport, N.Y., and her e-mail address is firstname.lastname@example.org