LTC Insurance underwriting as a civil rights issue?

Brad Flansbaum sent along this piece on the cost of private LTC insurance which is familiar territory save one detail. The piece notes:

Last year, the National Women’s Law Center filed federal sex-discrimination complaints against four insurers, challenging such gender-based pricing on the grounds that the practice violates a provision of the Affordable Care Act barring sex discrimination in health care. The action is pending with the Department of Health and Human Services’s Office for Civil Rights.

This makes no sense to me. Long Term Care as offered in private policies (denominated in dollars per day once a claim is certified) is not a part of the mandated benefits of the ACA. And while in policy terms I am sympathetic to the burden of LTC on single women (many widows), the legal reality is that LTC insurance has not been noted as a product worthy of protection even by the Genetic Information Non Discrimination Act (GINA) 2008 (some states have barred private insurance companies from using genetic markers for LTC policy underwriting; even more on this topic).

The most interesting aspect of this issue–what is allowed to determine insurability and/or to set the appropriate premium differs so much across types of private insurance markets in the U.S. There is obviously no one acceptable rule. Gender discrimination (in the sense of setting premiums to risk of loss based on gender) is allowed in car insurance. The ACA saw fit to changing underwriting and premium variation rules for major medical, but excluded LTC insurance from such regulation as did GINA 2008.

Fascinating differences in what is socially acceptable across types of insurance in issuing policies and setting premiums.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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