Florida becomes first state to enact DNA privacy law, blocking insurers

Still will effect your insurance if you have a 25% chance of a particular genetic disease.

The point the parent is making is that if you know in advance that you, will need to use the insurance, and you decide to buy it on this basis, then the premium the insurance company charges will need to increase to account for this, or the insurance company will lose money.

Since the premium has increased, the only people who will still pay the higher premium are those that know they will need to make a claim. The premium will therefore rise to the point where _only_ the ones with that extra information will pay.

Insurance markets cannot survive with this kind of information asymmetry.

This is not a North American definition. This is what insurance is.

> When I buy insurance I don't much care about other customers. They aren't part of my transaction. Maybe I am the only customer for a product. That does happen. It doesn't impact the obligations of the parties.

Unfortunately that's not actually how it works with shared pooling of insurance resources. You pay a monthly fee that gets bundled with the fees from other customers and paid out when there are claims against insurance.

If your care was only paid out of your pool of money you've paid into the insurance system, your first month of payment would cover essentially nothing.

This is a very North American discussion, dunelover, though Canadians might have a bone to pick with you concerning your categorization. While I don't imagine that insurance companies will cease to exist, I do imagine that benefits of these plans will become next to nonexistent and the cost will increase dramatically. Though it may end with differentiation and one plan might be available for traumatic injury and one for genetic disorder, exclusively. Regardless, the point stands, if the party that's supposed to pay the bill for my party has even greater incentive to litigate, then I likely will be SOL. And, you're absolutely right, it isn't very much like a commune. However, my insurance rates in North America keep going up because people are unhealthy & overweight and we've subsidized corn sugar into everything edible. For-profit insurance companies are what 'we' have and they have formalized the average cost of care into their hedges. You are not in an insurance bubble, you are in a world of statistics and actuarial science.

Ticks all the boxes, thank you

They've been banned for a decade now, so...

So, here's the background:

After the ACA was originally passed 2010, it was challenged on constitutional grounds. It went to SCOTUS in 2012 (National Federation of Independent Business v. Sebelius, 2012). In that case the court ruled in a 5-4 opinion that the Individual Mandate was a constitutional and valid use of Congress' taxation powers. The law survived the constitutional challenge.

In 2017 a subsequent (now GOP controlled congress) zeroed out the individual mandate penalty.

The individual mandate is now being challenged on constitutional grounds. The logic goes that, since there is no penalty there is no taxation. If there is no taxation, the individual mandate cannot be a constitutional under Congress' taxation powers. I'm fine with all of that.

Here's now the part that I find absurd:

The argument that the individual mandate cannot be severed from the rest of the ACA based on the way it was amended by the 2017 Congress. Therefore, since the IM is no longer constitutional the entire ACA must fall.

The reason I find it absurd is it relies on speech and debate from the original passage of the ACA which argued that the individual mandate was required for the law to function. However, a subsequent congress deliberately chose to zero out the individual mandate without eliminating the law. The subsequent congress' decision making overrides the decision that the congress that passed the ACA. The 2017 Congress very deliberately made the individual mandate completely nonfunctional, while leaving the rest of the law in place.

TL;DR

- 2010 Congress passes the ACA with the Individual Mandate

- 2012 SCOTUS rules it constitutional

- 2017 Congress zeroes out the Individual Mandate

- The argument now is that the 2010 Congress thought the ACA required the IM to function, ignoring that the 2017 Congress very obviously decided that the ACA didn't require the IM to function.

To me there's just no way to square that circle. The 2017 Congress' decision overrides the 2010 Congress' decision.

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Finally, logically I agree with you and I agree with the 2010 Congress. The Individual Mandate is necessary for the ACA to function the way it was originally designed. The ACA is a better, more functional, law with the individual mandate in place. I disagreed with the 2017 Congress' decision to remove the mandate.

But that's no longer relevant. The question now is, is the IM necessary for the ACA to function the way the 2017 Congress amended it to function. The answer—since they repealed the individual mandate—is clearly "no".

>It sounds like the argument is that the individual mandate to have health insurance has been repealed

Their argument doesn't work as the Federal individual mandate for insurance stands as law but has no penalty or requirement to report. The basically declawed that component of the ACA. It is not considered for any applications/forms/fees/etc and you no longer need a waiver.

With that in mind, the mandate for insurers to cover regardless of preexisting conditions should stand based on the 2012 decision but that doesn't mean it cannot also be declawed by congress. There are many laws like this, many of which rely on department head for discipline actions or censure but they can simply not do that. This is a common theme among the current administration where ethics laws are constantly broken but there is not mandatory fine or penalty so as long as the manager assigned to judge the penalty fails to oversee their employees, our checks and balances mean nothing.

> Starting with the 2019 plan year (for which you’ll file taxes by July 15, 2020), the Shared Responsibility Payment no longer applies.

https://www.healthcare.gov/fees/fee-for-not-being-covered/

Life, disability, and long term care are not the same as health insurance (which shouldn’t be insurance! It should be universal healthcare).

You insure against risk, you pay for care, just as you pay for gas in your car and oil changes, but your insurance covers accidents (which goes so far as to charge people of different genders and ages differently because of the risk demonstrated by the data). Should I be offended that my auto insurance charged me a crazy high premium for driving a high performance sports car at 18 years old as a single male? No! I was a high risk based on the data (which distilled down to my own risk management as then owner of an 18 year old male brain). And if the data (even genetic data) shows someone to be higher risk for an insurance product (again, we’re not talking health insurance or healthcare), they should be exposed to that cost.

Life isn’t fair, and this is a poor attempt at tilting the scales if your goal is to make it more fair (considering the size of your risk pools at typical private insurers offering these products). It’s an unfunded mandate.

What's the 'pool'?

You are implicitly arguing that it should be the entire population, but lots of people see it as a chosen group with identifiably similar levels of risks.

Right, but people that have gotten into a lot of car accidents pay higher premiums than people with accident-free records.

Insurance is not socialism. If my risk of getting into a car accident is low, shouldn't I pay low premiums? Why should I subsidize bad drivers?

> But that's the very definition of insurance: spread the risk over the entire pool.

But the devil is in the details, specifically in the definition of the "pool". To keep it fair (and subscription voluntary) generally requires pooling similar risk levels. Which is why for car insurance your driving record is important; for term life, your age and smoking status; etc.

But at least in the US, health insurance is not really an insurance (as in your definition of spreading the risk of rare but expensive events); it is a complex monster touching negotiated pricing, access to care, etc.

Why is a red Corvette more expensive to insure than a white Camry?

US long term care insurance is asset protection. The payer of last resort for things like nursing home care is Medicaid. If you don't have any assets, it starts paying right away. If you have assets, those go first, then Medicaid kicks in.

So long term care insurance is for people that want to preserve their assets and/or receive care beyond what Medicaid will fund.

Not anymore than selling cheap car insurance for safe drivers.

But, in general, I'm not sure health insurance would work without risk pooling. A large part of the problem is that health insurance isn't exactly insurance: paying for medication that someone takes everyday doesn't really fit the definition.

If we could start over from a clean slate, I don't see any reason why a health care system without insurance wouldn't work (it works it many other countries). But, as it stands, I fear that the only way we can fix our Healthcare problem is to implement single payer.

> I see the concept of punishing people for how their body behaves deeply unethical.

Your ethics is a bit roundabout. Nature is the one introducing unfairness and "punishment" to the world. In a sense you are blaming companies for treating them equally rather than taking it upon themselves to correct the unfairness of nature.

Really what we have here is a situation where insurance is an appropriate solution for some people, while others need charity. You are presuming that there is no charity for some reason, and that those people who need it are the insurance systems responsibility too.

And 20 years ago healthy young people could get insurance very cheap (Less than what people spend on phones today). It wasn't a scam. Sooner or later you might get food poisoning or fall off your bike and break your leg or something. And there's always a small chance something really horrible would happen.

A single bus can change all of that. It almost never pays to self insure unless you are fabulously wealthy

> Let's say that today you are aware of no sequences in your genome which correlate with disease. You give a sample to your provider as proof. Tomorrow, a new link is discovered between a disease and a sequence you do have. Your premiums then go up considerably.

Yes, and everyone else's rates go a bit down . It's not a negative-sum game -- assuming a reasonable competitive market, you're going to get a fair rate in a maximal-information pool.

You may increase risk somewhat, but if you know -- from personal and historical experience -- that your family is not especially high risk, you're still on average better off sharing as much information as you can.

It could work the other way to: new analysis on your DNA could reduce your premiums. As such, I don't think it's unreasonable for some people to want to submit their DNA.

Are you taking into account that your genome is inherited? If you have good knowledge of your ancestors back a few generations and their health you could probably make a pretty good guess whether or not there is some factor lurking in your genome that correlates with a disease severe enough to raise your rates.

This could make the potential savings worth the risk for some people.

(I wonder if a new kind of insurance would develop for the risk that disclosing your genome raises your rates?)

Thanks, I appreciate the thought.

We felt really violated by this, and I ended up buying the marketing list in question for my zip code to understand what happened better. It’s unlikely anything will change for the better. The scrubbing of identity data is pretty easy to reverse engineer by design, as the stream of data is used by pharmaceutical companies, insurance subrogation, etc to do all sorts of things. A pharmaceutical sales rep has a scorecard for your doctor — they bpm now how many scripts were written and filled. The people who gather prescription data have your prescription before your pharmacy does.

Some states have fed things like Medicaid claim data to companies to mesh against data from insurers to build models designed to target opioid abuse. By correlating events or behaviors tied to abuse to diagnoses, predictive models can be built from unprivileged data. (Remember when Target predicted someone’s pregnancy before they knew a few years ago?)