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Advances in genetics
have raised hopes for new medical treatments and also fears of
a new form of discrimination. There is concern that to reduce
costs, insurers and employers will exclude healthy individuals
who have genetic risks of future illnesses. These individuals
- a "biological underclass" - will be unable to obtain work or
insurance, although they may never experience the predicted illnesses.
There
is little credible evidence that genetic discrimination is now
occurring. However, reports of the increasing 
predictive power of genetics have prompted the adoption of measures
prohibiting the use of genetic information as a basis for discrimination.
A federal
law bars genetic discrimination by group health insurers, and
an executive order bars genetic discrimination in federal employment.
Congress is
considering several bills that would impose a broader federal
prohibition on genetic discrimination. Most states already prohibit
genetic discrimination by health insurers, employers, or both.
These genetic
anti-discrimination measures protect only asymptomatic individuals
(those who have an increased risk, but no symptoms, of a genetic
disorder). Ironically, the genetic anti-discrimination measures
cease to protect a person at risk for a genetic disorder when
the disorder actually occurs.
More general
anti-discrimination laws may, however, protect persons with expressed,
or existing, genetic disorders. For example, laws barring employment
discrimination against persons with disabilities protect persons
whose disabilities are caused by genetic disorders.
But insurance
laws permit consideration of an applicant's medical history, including
expressed genetic disorders, in underwriting health coverage.
(Universal health coverage would, of course, eliminate the incentive
for genetic discrimination in health insurance.)
Leslie
Gornstein
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