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The Affordable Care Act and Newborn Screening

  • There is no doubt that the Affordable Care Act is the most controversial issue discussed in Washington D.C. today. Ever since its passage on March 23, 2010, and throughout the court proceedings surrounding it in 2012, the Affordable Care Act has generated a considerable amount of buzz across the country. Naturally, the common citizen’s major concern has been, “How will these changes affect me?” In our case, we wondered how the Act would impact newborn screening throughout the country.

    Simply put, the Affordable Care Act was designed to improve healthcare in America. It aims to advance the quality of healthcare and make coverage more accessible, and affordable. The Act also expands Medicaid giving citizens a duty to purchase health insurance, and incentivizes employers to provide their employees with a healthcare insurance plan. These aims are achieved through various guidelines, rules, and conditions laid out in a multitude of sections adding up to a staggering document hundreds of pages long. So how do we sift through the legal terms, countless clauses, and innumerable subsections to weed out the changes that are relevant to newborn screening?

    Here’s what you need to know!

    There are two major sections in which newborn screening is relevant. The first one involves the coverage of “preventive health services,” which aim to help people stay healthy. These services can range from immunizations, routine exams, and (you guessed it…) screenings! This section basically states that insurance providers must fully cover (among other specific services) preventive care and screenings for babies, children, and teens. This means without co-pays, co-insurance, or deductibles; the insurance provider pays for it all. Who decides what qualifies as one of these services you may ask? That would be the Secretary’s Advisory Committee on Heritable Diseases in Newborns and Children (SACHDNC) who has developed a recommended list of diseases that states should screen all newborns for. This list is known as the Recommended Uniform Screening Panel (RUSP), and every disease screening on it should be covered by insurance under the Affordable Care Act. So, even if your state does not offer a screening for one of the diseases on this list, you many request one and have insurance cover it.

    Sounds pretty reasonable, right? Here’s the catch. There are certain individual and group plans that were in existence prior to the signing of the Act that can be exempt from these provisions. In other words, they are “grandfathered plans.” This was a concept included in the Act to ensure that those who were happy with their current insurance plans did not have to experience changes. A grandfathered plan can lose its exemption status if it makes any changes included in a list developed by Health and Human Services to guarantee that the plans do not take advantage of this exemption. It is important to be aware of the status of your family’s insurance plan to know whether you will be completely covered for these preventive services, including newborn screening.

    The second section under which newborn screening could fall is “essential benefits.” The Act requires health insurance plans to include these benefits in their coverage. Unlike in the earlier section, this does not mean full coverage. There will be specified limits on co-pays, coinsurance, and deductibles. There is a list of these benefits including (among other things) emergency care, hospitalization, and yes, maternal and newborn care! This could potentially include coverage for newborn screening itself as well as early treatment for diseases found through this service. Once again, there are exemptions. This provision only applies to individual or small group plans; grandfathered and self-insured plans are exempt. Also, large group plans are not required to provide the full scope of these benefits. Once again, it is important to recognize what category you or your family’s health insurance plan falls under to learn whether or not you will definitely receive these essential benefits.

    The Affordable Care Act makes newborn screening services more accessible and affordable for families throughout the country. Furthermore, the many changes it implements in the realm of expanding coverage for those who are uninsured or underinsured have the potential to help those children who have been diagnosed with heritable diseases at birth by making the care they need more accessible. Keep checking our blog for more updates and clarifications on the Affordable Care Act and other policy measures that could potentially affect you and your current (or future) children!     

    1 Comment

    The Affordable Care Act requires most health plans to cover the federal Recommended Uniform Screening Panel of newborn screening (NBS) tests with no cost sharing. However, state NBS programs vary widely in both the number of mandated tests and their funding mechanisms, including a combination of state laboratory fees, third-party billing, and other federal and state funding. We assessed the potential impact of the Affordable Care Act coverage mandate on states' NBS funding. read more

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