Down syndrome screening is no longer listed as a recommended preventive care service by the U.S. Preventive Services Task Force. This renders many insurance policies outdated and may avoid instituting an explicitly eugenic policy under the Affordable Care Act.
The U.S. Preventive Services Task Force (USPSTF) issues recommendations on clinical preventive services, giving them various ratings, e.g. A, B, etc. Private insurance companies base coverage of clinical preventive services on the USPSTF recommendations. Further, the Affordable Care Act (ACA or “Obamacare”) mandates that clinical preventive care services for women be provided at no-cost. The ACA’s listing of these no-cost services is based on the USPSTF recommendations.
The exclusion of Down syndrome screening from the 2014 Recommendations is significant.
The 1996 USPSTF Recommendations
In 1996, the USPSTF recommended the following:
Recommendation
The offering of amniocentesis or chorionic villus sampling (CVS) for chromosome studies is recommended for pregnant women at high risk for Down syndrome.
The offering of screening for Down syndrome by serum multiple-marker testing is recommended for:
● All low-risk pregnant women.
● As an alternative to amniocentesis and CVS for high-risk women.
This testing should be offered only to women who are seen for prenatal care in locations that have adequate counseling and follow-up services.
There is currently insufficient evidence to recommend for or against screening for Down syndrome by individual serum marker testing or ultrasound examination, but recommendations against such screening may be made on other grounds.
The recommendation of offering diagnostic testing for high risk women and offering screening testing to all women were both given “B” ratings:
Insurance Coverage
When insurers have covered the cost of prenatal screening and diagnostic testing for Down syndrome, the 1996 USPSTF Recommendations are cited. For instance, Coventry Health Care Clinical Preventive Services for 2012 state:
2014 USPSTF Recommendations
A review of the newest version of USPSTF recommendations, however, does not list either diagnostic testing (CVS or amniocentesis) or maternal serum multiple marker testing for Down syndrome as a recommended clinical preventive service. By clicking this link, you can view the current recommendations published on the USPSF’s website. Here’s a screen shot of what you’ll find at the link:
The A-Z topic guide, the recommendations for adults, and the recommendations for children and adolescents do not include prenatal testing for Down syndrome in the listing of recommended preventive services. Similarly, the version of the recommendations published in hardcopy also are available on-line at this link. The listing of recommendations does not include prenatal testing for Down syndrome.
ACA/Obamacare
The screenshot above of the USPSTF webpage has a link for “Affordable Care Act USPSTF A and B Recommendations.” This is because certain preventive services are to be covered by all insurance policies not grandfathered since Obamacare’s enactment.
Specific to the issue of prenatal testing for Down syndrome, a reading of the regulations that mandated no-cost preventive care services for women allowed for the possibility that prenatal testing for Down syndrome would be included in the no-cost preventive care services.
However, accessing the link to the listing of USPSTF A and B Recommendations again shows the same list as in the 2014 Recommendations, which do not include prenatal testing for Down syndrome. That prenatal testing for Down syndrome had been a B recommendation in earlier versions of the USPSTF recommendations makes its exclusion significant, as it had been a recommended preventive service, but currently is not.
On the page for the A and B recommendations, the introductory paragraph further directs readers as follows:
For more information about the Affordable Care Act and preventive services, go to https://www.healthcare.gov/what-are-my-preventive-care-benefits/.
That link leads to the following webpage:
Again, reviewing this listing, there are many, actual preventable conditions listed, e.g. folic acid supplementation to prevent open neural tube defects and screening for Rh Incompatibility, but prenatal testing for Down syndrome is not one of the listed preventive health services.
When the regulations promulgated under Obamacare were issued for no-cost preventive care services, however, it appeared that prenatal testing for Down syndrome would be covered as part of the required no-cost “well woman visit.” This service is listed on the HealthCare.gov site for women. Accessing that webpage, several services are listed, such as having a physical and screenings for HIV, but prenatal testing for Down syndrome is not a listed service.
Prenatal testing for Down syndrome no longer preventive care
The 2014 USPSTF Recommendations for clinical preventive care services are significant for no longer listing prenatal testing for Down syndrome. These recommendations have been relied upon by private insurance companies to cover prenatal testing for Down syndrome as a preventive care service. Further, under Obamacare, preventive care services for women were mandated to be provided at no-cost. Including prenatal testing for Down syndrome as a preventive care service would have been an explicit eugenics policy, since the policy would be to provide prenatal testing for Down syndrome for the purpose of “preventing” it through termination of the pregnancy. But, from a review of the listed services, prenatal testing for Down syndrome is not included.
This is not to say that under no terms should prenatal testing for Down syndrome be covered or provided at no-cost. That is a different discussion, and one that hopefully will be deliberated on whether such testing should be covered and, if so, what else should be covered along with the testing itself.
Further, it appears that the reason the USPSTF no longer lists prenatal testing for Down syndrome among its list of recommended preventive services is because it is reviewing it’s recommendation to update it in light of advances made in prenatal testing for Down syndrome (see Page 5 at this link).
That said, the absence of prenatal testing for Down syndrome from the 2014 USPSTF recommendations, hopefully reflects a position of common ground that people of goodwill can share: that prenatal testing is not a preventive service and the U.S. government never should recognize prenatal testing for that purpose.
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