Preimplantation Genetic Diagnosis - Genetics & Public Policy Center

ACCESS TO PGD
Federal and State Oversight
Option: Mandate Coverage by Medicaid and Medicare
The federal government has significant control over Medicaid
and Medicare benefits.
Medicaid is a program that pays for medical assistance for
individuals and families with low incomes. It is jointly funded
by the federal government and state governments and
provides medical care for people who meet the eligibility
requirements. Federal law determines the minimum standards
that state Medicaid programs must meet in order to receive
federal funds. Beyond that, each state determines the benefits
included in its program. Medicaid is the largest source of
funding for medical and health-related services for people with
limited incomes.
The federal government could provide an incentive for states
to include PGD in the state Medicaid benefit package by
providing additional funding (an "enhanced match") for PGD
tests and procedures. Alternatively, additional funds could be
made available for one component of PGD, either the IVF or
the genetic testing of the embryo.
Medicare is commonly known as the national health insurance
program for people over 65 years of age, patients who have
passed their reproductive years and have no need for PGD or
IVF. However, Medicare also provides health insurance to
some people under age 65 with disabilities.
The federal government could require Medicare to cover PGD
for beneficiaries of reproductive age.
Significant obstetrical care is provided to patients in both
programs, particularly those receiving care through Medicaid,
who often are of reproductive age. The care provided includes
prenatal diagnosis when indicated. Many patients may be
interested in obtaining PGD, especially if there is a known
genetic condition in the family and they would like to avoid
prenatal testing and possible abortion.
Arguments for:
• PGD services would provide an important benefit for
Medicaid and Medicare recipients by increasing the chance
that they would have healthy children free of genetic
disease.
• Low-income patients on Medicaid or disabled patients on
Medicare may be interested in avoiding the burden of caring
for a ch ild with a disability.
Arguments against:
• Very few Medicaid and Medicare patients would pursue
PGD, thus creating a mandate is a solution without a
problem.
• Medicaid and Medicare reform should focus on providing
basic preventive care, diagnosis and treatment to patients,
not on providing every possible technology, especially when
it is relatively untested and very expensive.
Non-Governmental Approaches
Option: Use Employer Purchasing Power
Employers could include PGD in their employee benefit
plans.
Large employers spend significant money on purchasing
health care for their employees. Smaller employers often work
through purchasing coalitions, which are groups of employers
who use their collective leverage in purchasing health care for
their employees. Together, these employers determine the
health benefits that will be made available to the millions of
Americans who depend upon their employer for health
insurance, and influence the benefits insurers offer more
generally.
Employers make purchasing decisions based primarily on an
analysis of what benefits they think will result in a more
productive workforce (e.g., fewer sick days, greater efficiency
at work). Employers may find that covering PGD improves
workplace productivity. For example, an employee with a child
affected by a serious genetic disease may frequently be absent
from work to care for the child. This scenario could be
avoided if the disease could be detected via PGD and the
procedure were covered by the employee plan. Similarly, for
an infertile woman, each cycle of IVF can result in days of
work missed and decreased productivity. If chromosome
screening using PGD could improve the IVF pregnancy
success rate, the end result would be cost savings to
employers.
Arguments for:
• This non-governmental solution avoids the challenge of
passing new laws for insurance mandates.
Arguments against:
• Most employers do not have enough purchasing power to
make tailored purchasing decisions. They make decisions
based on what the market offers them, which may or may
not conform to their notion of what benefits are best for
their employees.
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