June 19, 2012 at 8:17 AM ET
A government proposal that all baby boomers get tested for hepatitis C may be drawing high praise for its potential health benefits, but it’s also raising questions about the unintended consequences of screening for those seeking insurance.
Experts in health insurance, life insurance and long-term care insurance warn that boomers who test positive for the blood-borne virus before being approved may dash their chances for coverage.
“I would never, ever tell anybody to delay getting any kind of medical exam,” said Jesse Slome, executive director of the American Association for Long-Term Care Insurance. “But you have an advantage over the insurance company if you apply for insurance before undergoing any kind of medical checkups.”
For the first time, government health officials suggested in May that anyone born between 1945 and 1965 be tested for the hepatitis C virus, which can destroy the liver.
The draft proposal, which could see a final ruling later this year, is aimed at getting some 800,000 baby boomers into treatment and potentially saving more than 120,000 lives, according to the Centers for Disease Control and Prevention.
Baby boomers make up about 2 million of the estimated 3.2 million people infected with hepatitis C, the CDC says. About three-quarters of those who have the virus don’t know it -- and many don’t think they’re at risk for it, said Dr. John Ward, director for the Division for Viral Hepatitis.
“Testing is the only way to identify these individuals in order to connect them to life-saving care and treatment,” he said.
Hepatitis C is spread through contact with contaminated blood or organs. It was widely transmitted through routine health care practices before the virus was identified in 1989 and before widespread screening of the U.S. blood supply began in 1992.
Social practices such as injection drug use and tattooing contributed to the problem, but so did unexpected transmission from routine exposures such as sharing toothbrushes or razors, even manicures and pedicures.
Getting tested may confirm the unsuspected exposure and prompt treatment, a plan that’s drawing praise from many of the dozens who publicly commented on the CDC’s draft proposal.
“This birth cohort screening, in my opinion, is the right methodology at the right time,” wrote Dr. Donald Jensen, a clinical and research expert in hepatitis at the University of Chicago. “The baby boomers are aging and need to be identified quickly before their disease and co-morbidities overtake them.”
But a positive test for hepatitis C also can raise worries for those who aren’t insured or who want more or different insurance.
“I am concerned that this will allow insurance companies to deny treatment for pre-existing conditions,” wrote Donna Bailey, a consumer commenter on the site.
Even treatment for hepatitis C might not guarantee acceptance since current protocols may not be 100 percent effective.
It’s true that hepatitis C is one of several chronic, life-threatening diseases that can exclude people from being insured, said Susan M. Pisano, vice president of communications for America’s Health Insurance Plans, the national trade association representing the industry.
“You would have a condition if you were diagnosed, the same way you’d have a condition if you had asthma, diabetes or another condition,” she said.
The difference is, a leading government health agency is suddenly recommending that an entire generation be screened for the condition in question.
CDC officials say they’ve considered the problem. About two out of three people diagnosed with hepatitis C have health insurance -- but about a third of those diagnosed do not, officials said.
“Considerations regarding insurance coverage are real, affecting individuals and their loved ones ... ” Ward said in a statement to msnbc.com. “ ... These issues are ones we must continue to consider as part of any implementation of these recommendations.”
Under the Obama Administration’s health reform law, insurers would not be able to reject adults with hepatitis C or another pre-existing condition starting in 2014. But the Supreme Court is expected to rule within the week on overturning all or part of the Affordable Care Act, so that mandate is unclear.
Anticipating that the hepatitis C proposal may become final, CDC officials are working with insurance providers, public health agencies, commercial labs and others to coordinate the mechanics of such large-scale testing.
Until something changes, at least one insurance broker advises his clients to think about the consequences of the test results.
“It’s up to you,” said Michael McDonnell, a financial adviser who works at Individual Commercial Brokerage in northern California. “Test or not, insure or not. If you’re going to insure, wait until you are approved before doing the test.”