Should insurers be allowed to use genetic information to make actuarial decisions such as determine insurance coverage and pricing? In the literature on this issue of critical importance to bioethics and policymaking, the predominant view is no. Arguments favouring banning or curtailing the use of genetic information in insurance largely focus on the risks of genetic discrimination. However, we caution against tying the moral status of—and therefore our practical responses to—insurance underwriting to the moral status of genetic discrimination. We argue that actuarial practices based on genetic information are not distinctive, and cannot thereby ground a curtailment of the use of genetic information without at the same time undermining other seemingly permissible insurance practices. So we take a different tack. We argue that the central goal of policymakers in the context of health is to ensure adequate access to adequate healthcare. In most cases, the use of genetic information in insurance underwriting undermines this goal. Importantly, this is a contingent claim: it applies only where healthcare systems do not, and perhaps cannot, support persons with genetic disorders. This pragmatic approach has several upshots. First, we need not define the concept of genetic discrimination to argue against the use of genetic information in insurance underwriting. Second, we admit no conceptual or normative inconsistency in prohibiting the use of genetic information in insurance, while permitting the use of similar non-genetic predictive information. And third, our view of what insurers are permitted to do is appropriately sensitive to facts about penetrance.