Goodbye underwriting?
by Suzanne Seay
We received a comment on an application from a New York reviewer recently that required us to remove a medical underwriting question entirely, based on the statute that prohibits racial discrimination in insurance under section 2606. The question asked if the applicant had been diagnosed with or treated for sickle cell anemia. We assume the question was disallowed because sickle cell disease disproportionately affects people of African descent.
The comment got me thinking about race and disease. I’m no expert, but it seems that many diseases affect one race or ethnicity more than another. A recent article in the New York Times was pointing to the disparities in funding, research, and national focus on sickle cell, compared to cystic fibrosis. Cystic fibrosis mostly affects Caucasian people. There’s more money for, more drugs for, and more articles about cystic fibrosis. Lots more. And a lot fewer Americans are affected by it than by sickle cell disease.
I support addressing these disparities and focusing more attention on sickle cell. On the other hand, forcing insurers to stop underwriting for sickle cell does not seem like a good idea or the best way to address the clear disparities.
If one race-specific disease is not allowed to be underwritten, wouldn’t it follow that all race-dominant diseases be disallowed? Based on this reasoning, a well-funded cystic fibrosis organization might feel obligated to sue NY to remove cystic fibrosis as a question as well.
A grass-roots sickle cell group might get inspired to spread the word that anyone with sickle cell disease can buy life insurance in NY, because insurers are not allowed to ask applicants if they have it. This would be good for the families of people with sickle cell, but would probably bring up solvency issues for NY insurers, which is bad for everyone. A plaintiff’s attorney might think this new position taken by NY means that in-force policies should be adjusted to account for this discrimination. And what about death benefits already paid on lives that were based on this discrimination?
And depending on how many diseases or conditions can be considered to occur much more frequently in one race than another, there might not be enough diseases left to underwrite policies effectively. What is the standard for much more frequently? Does there need to be a genetic element to it? Is that what section 2606 says? What if there is a disproportionate impact on one race or ethnic group, and there is also a lifestyle or behavioral component?
I fully support anti-discrimination efforts, particularly in these times where racial and ethnic hatred seem to be on the rise. But I don’t believe removing a disease (which has significant mortality impact) from insurance applications is the route to making a difference.
