 Hi. Good afternoon. I used to see a lot of Damian when I was on economic development, but we don't usually see you up here. Well, it's a... Etchelons of finance. Yeah, finance is... It's usually too complicated for me, I'll be honest. It's been that way today. Okay. But we're here to talk about 247, which is prohibiting discrimination based on genetic information. And this is just our first kind of walkthrough on this one. So we'll do that. And then we can decide either to go forward with it or to just ship it over to health and welfare. And then we can decide whether to go forward with it or not. And then we'll do that. I mean, I'm not sure that there's an insurance bill. So we might want to do that. Senator Hardy. I just want to let people or maybe faith know that when you click on 247 under Damian's name, it comes up as 269. Thank you very much. I'll fix it. Okay. Thank you. Okay. So Damian, you want to walk us through this one. Do you want to go ahead and look at the document on their own device or do you want me to share it? Usually we share it. Okay. Great. Every committee is a little different. So, All right. Let me go ahead and pull that up. All right. Okay. So here's S247. This is based on a lengthier bill. It's passed out of Senate health and welfare. Right before the pandemic started in 2019. Is that right? 2020. Sorry, it's been so long at this point. I can't remember when. Yeah. Thanks for all of that started on. So this is a trimmed down version of that bill that focuses on the, the sort of core provisions of that bill. Okay. The very first two changes in the bill. In sections one and two. Are in title 18 on the section covering it, covering genetic information and testing or the chapter. The first would amend our definition of genetic information. To mean the results of genetic testing related to an individual or a individual's interpretation of valuation or other record. Or the manifestation of a disease or disorder in a family member of the individual. And this definition is important because all of the other sections in the bill are going to cross reference it. And the definition has been amended to bring it in line with the definition under the. The federal genetic information. Non-discrimination act or Gina. So. Okay. Damian. That be the manifestation of a disease or disorder in a family member. Does that mean every time they ask about a cancer history in my family, they can't use that anymore. So what this. What this means and we'll, we'll get into it within the context of insurance. But yeah, what this means is that genetic information now includes. That history of whatever it might be. If there's a genetic. There is a genetic predisposition for a certain type of history or a certain type of cancer. Then. A family history of that. Cancer. Is considered genetic information. Same as with. Things like heart disease. Where there's genetic predisposition. Substance use disorder. There's some genetic predisposition, I believe. There are any condition like that where there's a genetic predisposition. That's sort of medical history and your, and your family is considered genetic information. Okay. We will definitely have the insurance companies in. Yes. Yes. Okay. The. So the next section, section two gets into. The requirements around genetic testing as a condition of insurance coverage. And so the current. I'm sure I'm sorry to interrupt. Damon. Sorry to interrupt. Damian, but. In the definition. Does that cover. Say somebody gets a, what's it called the. Something 23 or whatever the DNA test. Is that covered under those definitions? Cause I've, I've often worried that those companies sell. Your data the way a browser does and those kinds of things that, that. People unknowingly. Effectively put their DNA information out in public. So. Can you just help me understand if, if that's connected to this. Yeah. So that is actually addressed later in the bill. And the, the use of genetic information acquired from a. Direct to consumer genetic testing company is, is prohibited. In certain contexts. Later on the bill. So the. Genetic testing as a condition of insurance coverage. Are law already. Prohibits. Requiring genetic testing. As a condition. Of a policy or prohibits a policy and insurance policy from containing a requirement that an individual undergo genetic testing. Or. That the individual provide the results of genetic testing for. A member of their family. What this adds is that. You can't condition the insurance on the basis of genetic information of the individual that may be associated with a potential genetic condition. But that has not resulted in a diagnosed condition in the individual. So this gets into the chair's question. So if you have genetic information that indicates that you may. Have a heightened risk of developing something. You can't condition the insurance on the basis of that. You can't condition the insurance on the basis of genetic information. However, if the individual has actually developed that medical condition. That can be something that you condition the insurance on. Within the restrictions of the rest of the law. They mean, is this. Life insurance specifically, or just any insurance. So. This is going to relate primarily to life insurance in the bill. But there are some more generally applicable insurance provisions. There's also some reporting provisions for. Non-profit. Health and medical. Facilities that are under title eight that are affected. So we'll get to that in just a minute. So now we're getting into the insurance and section three. Eighth VSA 30702. I'm just going to go to my notes since insurance is. A little bit outside of my normal area of practice. So this is life insurance here that we're dealing with in section three. So life insurance company doing business. Shall not. Issue a policy. The changes in one through four. Are just style changes for our drafting manual. And then in five, we get to condition insurance rates. The provision or renewal of insurance coverage or benefits. Or other conditions of insurance for any individual on a requirement or agreement that the individual undergo genetic testing. Genetic information of the individual that may be associated with a potential genetic condition. But has not resulted in a diagnosed condition. Or the genetic information of an individual's family member. So it repeats. Those provisions from title 18. And so the, the issue. The. What this does. For life insurance here. Is not only does it prohibit them from requiring an individual to undergo genetic testing. But it also says you can't condition insurance rates. Or the provision or renewal of insurance coverage. On genetic information that might be associated with a potential genetic condition. That hasn't actually manifested. And so the issue. The. What this does for life insurance here. Is not only does it prohibit them from requiring an individual to undergo genetic testing. But it also says it prohibits them from requiring an individual to undergo genetic testing. And that has actually manifested itself at this point. So. The next piece here. Subdivision B just cross references the. The definitions that we added in title 18. Subdivision C here says that notwithstanding the prior language. A life insurance company can condition rates. Or renewal or provision of insurance coverage. Or other conditions of insurance. In other words, including the manifestation of a disease or disorder and one or more family members. Provided that there's a relationship between the individuals, family medical history. And the cost of the insurance risk that the insurer would assume by ensuring the individual. So this is a carve out. In the life insurance. Category here, which basically says if you have a family medical history. You know, say. If you have a family medical history. You know, if you have a family medical history. You know, if your grandparents and your grandparents all had. A history of heart disease. They could take that into account when they're. Determining your life insurance rate and the conditions of your life insurance policy. But what they can't do is look at genetic testing. Or other genetic information when they're doing that. And that's the first line that says any history and. Yeah, so this is. This is a. This is just for life insurance. This is for life insurance. And it's a carve out. From that portion of genetic information related to. The individual's family member. And the genetic information that might be associated with potential genetic conditions. So it's basically saying. You can't look at genetic testing, but you can look at documented medical history. For life insurance. Does that make sense? Yeah. Yeah. Yeah. So it's, it's narrowing down what life insurance could potentially look at. But still leaving open the option of looking at documented medical history. And this is something that was the part of the committee's amendment when this passed out of health and welfare in 2020. They added this provision in here. Based on testimony from the insurers. But of course you'll want to hear from them on this issue. Yeah. Madam chair. May I ask a question? Damien. The documented medical history. What, what specifically does that mean that doesn't mean that they can get or request or require a patient's. Medical chart, does it, or whatever? No, I, I think what. What I'm, what I'm getting at. Probably in artfully is, is the questions that you would get asked right now about. You know, Did, has anyone in your family suffered from, you know, heart disease or the following conditions. When they're the sort of medical history that they would take. When you're, you're applying for the policy. Where there are certain things that they'll ask you, you know, has anyone in your family ever had condition acts or condition why. They would have to follow up questions or base there, the rate that you get. Get quoted off of some of those answers. Okay. So it's basically the form that they make you fill out in the, but not, they don't request your medical records. Right. Or if you've had a genetic test or your children have had a genetic test, which is becoming more common. Or something like that. They can't ask you for those test results. But they can ask you general questions about your family's medical history. Got it. Thank you. Yep. Yeah. Sorry to muddy the waters there by using the term documented. That's. And then the final piece here, and this gets to Senator Pearson's. And then. Concern from earlier is this prohibits the life insurance company from requesting requiring purchasing or using information. Obtained from an entity providing direct to consumer genetic testing. Without the informed written consent of the individual who's been tested. So only if you get the. Individuals informed written consent to the release and use of that information. Can they, can they acquire that information and use it? All right. Section four. Is a. General unfair methods of competition or unfair. Or deceptive acts or practices for insurance. In the business of insurance. And this adds. It makes a couple of changes to the underlying law here. The first, if we go to page five. Is we strike out the current language relating to genetic testing. So currently the law says it's an unfair or arbitrary underwriting action. To make her permit any unfair discrimination. By conditioning insurance rates, the provision or renewal of insurance or other condition of insurance based on medical information. Including the results of genetic testing and we're striking that language out. Where there's not a relationship between that information and the cost of the insurance risk. That the insurer would assume. And then what we're. Replacing that with is this new subdivision F here. Which. Provides that it's on an unfair practice to make her permit. Any unfair discrimination against an individual by conditioning insurance rates. The provision or renewal of insurance coverage or other condition of insurance on. A requirement or agreement that the individual undergo genetic testing. The genetic information of the individual that is associated with a potential genetic condition. But that has not resulted in a diagnosed condition in the individual. Or genetic information of the individual's family. Members. And then the cross reference back to the. Now universal definition of genetic testing and genetic information. So that, that is new language, bringing this into line with the protections provided under the federal law. The genetic information non-discrimination act. So. And this applies across the board, the more. The more precise language that we discussed above with life insurance. Would apply to life insurance, although you may want to indicate. Except as otherwise provided in that section here. As just a drafting note. The next here in the existing section on genetic testing. Which already prohibits a requirement or agreement. Of an individual to undergo genetic testing. There. Again. This is repetitive of the language above. Where we're just adding in the identical language here. To line it up with the federal protections. And then again, the same cross reference to title 18. The next brings us over to HMOs. So that's section five brings us over to HMOs. And this adds to. The language providing that any nonprofit HMO. Shall offer non-group plans in accordance with section 4080 B of this title without discrimination based on age gender industry. And we're adding the word genetic and the words genetic information. So we're adding the word genetic information. And we're adding the word genetic information to the word genetic information. So this is a technical history, except as allowed by. And we're correcting the cross reference to 33. 1811. F2 a. To correct that because those provisions moved a few years back. So this is a technical. Correction here on the cross reference. And then we're adding the cross reference to the word genetic information. And then we're adding the term genetic information to the prohibited. Basis for discrimination. The next section, section six relates to long-term care insurance. The, the changes in subdivision B one are just technical changes. Subdivision B two a or B two adds substantive changes. To the long-term care insurance policies. By adding the same prohibitions. And protections to line up with the federal law here. Related to long-term care insurance policies. And then again, the same cross reference to the definitions of genetic testing and genetic information. The next section, section seven, eight and nine relate to. Social and medical services. So. Section seven relates to nonprofit medical service corporations. And they annually have to file a statement with the commissioner of financial regulation. To qualify for their tax exemption. And it has to include a certification. That they offer. They offer their plans. Their medical service plans to individuals without discrimination. Currently based on age, gender, geographic area, industry and medical history. And this would add genetic information. To that. And then correct the cross reference. To 33 VSA 18 11 f two a. And then add the cross reference to the. Definition of genetic information and title 18. The next change in section eight relates to hospital service corporations, which again, to maintain their nonprofit status, have to file an annual statement. Or to qualify for their tax exemption, excuse me, have to file. An annual statement that they operate on a nonprofit basis. And without discrimination again, based on age, gender, geographic area, industry and medical history. And this adds genetic information to that list. Then corrects the cross reference to title 33 and adds the cross reference to genetic information. And then finally, section nine addresses. 33 VSA one oh one, which relates to the provision of assistance and benefits by the state to individuals. And this adds to. And currently it has to be provided without restriction or discrimination on account of race, religion, political affiliation or place of residence. And this adds genetic information to that list. Of non-discrimination provisions. And then section 10 is the effective date. Thank you. Thank you. I apologize in advance. I think I missed the first minute or two of your presentation, but in. Wolven into your testimony was several times we reference federal law. So is this bill primarily to. Repeat federal law, but give enforcement powers at the state level or are there many substantive advances here? So what it does is it expands on the federal. Genetic information non-discrimination act or Gina. Which currently provides. Prohibitions against discrimination or. On the basis of genetic information with respect to health insurance and employment among other things. And so what this is doing is expanding that. Into long-term care insurance. In the state. And that's the big change. In this bill. Is that it expands on the protections provided by the federal law. Have many other states done this already or to your knowledge? That was the. Research that I did not get to today. What I was able to find is that in 2020. Or that's the research I didn't finish today. I was able to find those that in 2020. Or 2021 2021. Connecticut added this language. With respect to. Insurance for life, credit life, disability, long-term care, injury, accidental injury. Specific disease insurance hospital indemnity and accident insurance here. Related to. The genetic information protection. So they've added this protection to their law. And then. Main in. 2019. Added the prohibition. On life insurance companies. Obtaining. And using information from a direct consumer genetic testing company. And then. And then. The federal. For informed written consent of the individual who's been tested. So. Two other New England states have done. Portions of this bill. But I don't know that either have done, has done the entire thing. And. Unfortunately, I didn't have enough time to. Finish looking through. The federal. The. The national human genome research institute has links to. A genome state. Statute and legislation database that has information on this. I don't know how up to date that database is kept, but that's what I was using for my research today. And I'd be happy if the committee moves forward on this bill to. To do further looking through that database to find out what at the state level. Thank you. Okay. And we will have. We'll have to find the life insurers. It's not our usual suspects. But I think I have several located in Montpelier. And we'll see if we can find someone that does long-term care. We can probably. We can probably use DFR as a source for who we might contact. And. Probably should just send it up to human resources at the. State level since it requires they do something. Ask if they want to say anything. Anybody can think of anybody else we need to hear from. Let me know. Send it to someone else. I can think of anybody else we need to hear from. Let me know. Senator Pearson. Yeah, I wonder about. Senior groups, AARP or, or. Related folks. I mean. This does strike me as. Something well worth considering given our aging population. And frankly, the explosive. Data banks of DNA out there, but. I would love to hear from some consumer groups. Or folks. Which looks at thing nationally would be our best. Resource. Yeah. Although I'm reminded that they're an insurer. So. Yes, they are. It'll be interesting, but. Long their name. We could try to see in your center. Yeah. That's, yeah. The office on aging. In Vermont. Senator Hardy. I believe you and I, and perhaps Senator Lyons got an email from. UVM health network, and they've done some work in this area. And they asked if they could come testify. I could be wrong about that, but I'm pretty sure we did. Yeah. Yeah. If I got it, I haven't seen it today. Okay. It was a couple of days ago. I'll, I'll find it in Florida. I know you BM testified in health and welfare. And it was their genetic specialist. And her concern was that people put off. Being genetically tested. Because they were afraid there would be ramifications. So, I don't know if the results got out. And she felt that. Genetic testing was a really good thing because if you knew. You had a predisposition. You would get. Might get tested sooner earlier. All those kinds of things. So. Yeah, we'll make sure she comes down. Yeah. It may be too academic, but I was thinking there. UVM because. Why range of people they have working and stuff like this. Maybe there's a bio ethicist, you know, the right sort of person in terms of figuring out how you maintain this sort of. Data and rights. I mean, it's just an emerging area in terms of. The things that we never used to be able to learn. Oh yeah. I know that the Vermont ethics network, because we hit them up to see if they'd talk to us about the. Securities. Ethics. Remember the question that came from. Yeah. Administrative rules on setting up an ethics system. For securities. Yeah. And they did their response was they did primarily. Medical ethics and I'm. Ed Mahoney wrote us a letter in. Health and welfare and another topic, but he is a bioethicist that used to teach at St. Michael's. Those are. But I think the, and he's helped set up the ethics network. So they might be our best source. For this. I don't. Yeah. And we're looking at two issues. It's what does 23 and me or, you know, do with their information. And then what we're really looking at is does the health insurance or the life insurance company get it at all. This says they don't get it at all. But it's another step up. To say. And I'm not sure it's in the purview of this committee. What is, what are the restraints around what. 23 and me. And I don't know all the other ones that are out there. I know that one because my sister had our. Bloodlines run. And sent me the results. But we will. So we can. An artist center. Which one are you asking about? Which one of those two pieces? The third one I missed. Well, I think anyway, from the bioethics point of view, I just felt like that's an expert neutral party. They're not selling anything. They're not even necessarily that closely connected to medical services. They're not necessarily that closely connected to medical services. They're not necessarily that, you know, like delivering them. And the other side of the coin, I can imagine is. If you can get tests that are truly diagnostic. And, you know, does it. Does it create an opportunity for adverse selection? And so. I mean, that's a legitimate concern for an insurer. We want, we don't want people. We want to be able to do that in the future. And we want to be able to do that for, for having information sort of leaked about them. But I, you know, I suppose it cuts both ways. Right. You could find out something. And say, well, now I'm signing up for that. And once you know that we have position. So I don't know how you balance all those. Yeah. And that, that'll be a good law. We'll talk with DFR, we'll talk with the insurers. If I know. And at 30, I go out and buy a million dollar life insurance product and I die. The rest of the insurance, you know, that's going to get figured into the cost of the rest of the insurance market. So we'll hear from everybody.