June 29, 2012

ACA Upheld; Focus on Preventive Care Includes Genetic Testing

This week's landmark Supreme Court decision to uphold the Affordable Care Act (ACA) has implications for the availability of genetic testing services that may become easier to get under the new law. The Court’s decision was based on a reading of the central mandate in the law as authorized by the taxing power of Congress; it characterized the mandate as an invalid exercise of its power under the Commerce Clause. The effect is to allow the law to stay in place and continue to roll out over the next few years (the widely discussed mandate does not kick in until 2014). One impact of the law is to change the insurance coverage for preventive care, including some aspects that involve genetic testing. In the U.S. newborns undergo mandatory screening for a panel of genetic and metabolic conditions – but the required list of screening tests varies according to state.  At the national level, the HHS Health Resources and Services Administration (HRSA) establishes a national “unform panel” - the Recommended Uniform Screening Panel - that currently covers 30 conditions, but the HRSA can add more tests as research warrants. In actual practice, then, each state has a different testing climate and none need follow the national guidelines. That now changes with the ACA. According to Section 2713 (a) of the ACA, insurance companies must allow payment when parents request coverage for any of the tests on the national uniform panel. Effectively, that will expand the testing options in the states. So, the effect of this provision will be to provide a national minimal screening panel to which which the states will supplement as desired. This expansion of coverage has been welcomed by patient advocates.  More broadly, this provision of the ACA tracks one of the themes in the legislation, which is to increase the visibility and availability of preventive care by mandating coverage for a wide number of relevant services in existing or newly-established health insurance policies.

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