Thematic Areas

Insurance Discrimination on the Basis of Health Status

Sara Rosenbaum, JD

Paper Summary

Actuarial underwriting, or discrimination based on an individual's health status, is a business feature of the voluntary private insurance market. The term “discrimination” in this paper is not intended to convey the concept of unfair treatment, but rather how the insurance industry differentiates among individuals in designing and administering health insurance and employee health benefit products.

Discrimination can occur at the point of enrollment, coverage design, or decisions regarding scope of coverage. Several major federal laws aimed at regulating insurance discrimination based on health status focus at the point of enrollment. However, because of multiple exceptions and loopholes, these laws offer relatively limited protections.

This paper provides a brief overview of discrimination practices, the federal law, and federal reform options to manage discriminatory practices in the insurance and employee health benefit markets.

About the Author

Sara Rosenbaum, J.D., is the Harold and Jane Hirsh Professor and founding Chair of the Department of Health Policy at the George Washington University School of Public Health and Health Services, a unique center of learning, scholarship, and service focusing on all aspects of health policy.

Professor Rosenbaum has devoted her career to issues of health law and policy affecting low income, minority, and medically underserved populations as well as the health care safety net. Between 1993 and 1994, Professor Rosenbaum worked for President Clinton, directing the legislative drafting of the Health Security Act and developing the Vaccines for Children program. Professor Rosenbaum also served on the Presidential Transition Team for President-Elect Obama.

A graduate of Wesleyan University and Boston University School of Law, Professor Rosenbaum has authored more than 250 articles and studies focusing on all phases of health law and health care for medically underserved populations. She is co-author of Law and the American Health Care System (Foundation Press, NY) and has won many national awards for her scholarship and service including the Richard and Barbara Hansen National Health Leadership Award (University of Iowa), a Robert Wood Johnson Foundation Investigator Award in Health Policy Research, and the Oscar and Shoshanna Trachtenberg Award for Scholarship, the George Washington University's highest faculty award.