NEW YORK – In Idaho, a Republican lawmaker has introduced a bill to "delicense genetic counselors."
Last week, Jeff Ehlers, a Republican representing the 21st District in Idaho's House of Representatives, put forth bill No. 118, seeking to repeal a state law mandating genetic counselors obtain a professional license to practice in the state. The bill declares an "emergency" and, if passed, would make this repeal effective as soon as July 1. H.B.118 has been referred to the Idaho House Health & Welfare Committee.
Genetic counselors in Idaho and around the country have immediately pushed back against the bill. "We are deeply concerned about the introduction of H.B. 118 and the potential overhaul of genetic counseling in Idaho. Deregulating the practice of genetic counseling would remove critical protections from Idaho patients, put them at risk for unnecessary tests and procedures, and potentially subject patients and the healthcare system to unnecessary financial risk," said Rachel Westman, a certified genetic counselor in Idaho and director of outreach and community engagement at Genetic Support Foundation, a nonprofit provider of genetic counseling services.
Genetic counselors won licensure in Idaho in 2015, and a law went into effect the following year restricting anyone without a license "to hold himself out" as a genetic counselor, consultant, or associate. The Idaho Genetic Counselors Licensing Board has issued rules "governing the practice of genetic counseling in Idaho to protect the public health, safety, and welfare." Those rules stipulate that a person must have at least a master's degree in genetics from a program accredited by the American Board of Genetic Counseling (ABGC), American Board of Medical Genetics (ABMG), Accreditation Council for Genetic Counseling, or National Society of Genetic Counselors (NSGC). Applicants for licensure must also pay certain fees and pass an ABGC or ABMG certification exam.
State licensure laws for healthcare professionals are aimed at ensuring that they have the proper training and education to provide patient care. For example, medical doctors must have a license from the Idaho Board of Medicine to practice in the state.
It's not immediately clear if Ehlers has a reason to focus on genetic counselors' licensing requirements, or if he intends to introduce similar bills attempting to deregulate the practice of other healthcare professionals. An email to the representative was not answered by press time.
There appears to be some support for the bill among anti-tax and -government regulation groups like the Idaho Freedom Foundation, which is influential among Republican lawmakers in the state. "Occupational licensing is a government-created barrier to market participation, which increases costs and limits consumer choice. Additionally, the existence of licensing mandates can create a false sense of safety and sufficiency based on compliance with government standards that may be inappropriate or outdated," according to a post on House Bill 118 on the Idaho Freedom Foundation's website. "Conversely, in a more competitive and less regulated market, providers of goods and services work to outclass each other in the value they provide to consumers."
The group suggests that repealing occupational licensing requirements would also do away with associated fees and assessments, which would "benefit" genetic counselors and their clients and customers.
Genetic counselors say the bill, if passed, would have the opposite effect and end up harming patients. Genetic counselors have taken to social media to encourage their colleagues to contact Idaho legislators and urge them not to support the bill, pointing out that without licensure establishing the minimum training and education genetic counselors should have, patients would be at greater risk of receiving misleading or inaccurate information about their care from those who claim to have genetic expertise but don't.
Studies have repeatedly shown that involving genetic counselors in patient care reduces medical errors and unnecessary healthcare spending. For example, when genetic counselors at Seattle Children's Hospital reviewed 3,441 genetic test orders from hospital and ambulatory clinics over nearly five years, they modified test orders for a third of the cases, resulting in nearly $1 million in savings. When they reviewed a subset of test orders in greater detail, they found that non-genetics providers were far more likely to make mistakes in ordering genetic tests than genetics providers were, and that these errors may have impacted patients' ability to receive the right diagnosis.
Similarly, Precision Medicine Online's "Genetic Testing Challenges" series, which is done in partnership with health technology firm My Gene Counsel, has highlighted numerous cases where patients have received the wrong test or inappropriate care based on a misinterpretation of test results because providers without genetics expertise did the counseling and didn't refer patients to licensed genetic counselors.
"We will continue to engage with members of the Legislature to ensure they are aware of the value that licensed genetic counselors bring to our state," said Westman.
As the precision medicine field has grown, so has genetic testing utilization and the demand for genetics experts. This is precisely the wrong time to take away the legal guardrails on who can provide genetic counseling services, many in the community argue.
The NSGC is the professional society representing the small but rapidly growing community of genetic counselors in the US. According to NSGC's 2024 professional status survey, there are nearly 7,000 genetic counselors in the US. The community has grown more than 100 percent in the last 10 years and is expected to expand just as much in the next decade. Out of 1,756 genetic counselors answering questions about licensure in the survey, 125 indicated they held licenses in Idaho.
Despite this growth, genetic counselors have struggled to gain recognition and secure reliable reimbursement for their services. The US Centers for Medicare & Medicaid Services, for example, doesn't recognize genetic counselors as medical providers and doesn't reimburse them for counseling Medicare patients, which NSGC is trying to change through passage of the Access to Genetic Counselor Services Act. Payment from commercial payors can also be low or absent.
The NSGC, in recent years, has focused on state licensure as a way to integrate the profession into the US healthcare system and improve the recognition of genetic counseling's value in patient care. Nearly three dozen US states have licensure laws for genetic counselors. It is widely recognized in the genetic counseling community that licensure is essential if they want to be credentialed to provide services at healthcare institutions or get reimbursed by commercial insurers for their services.
In a statement, the NSGC said it will support genetic counselors in all states "pursuing or upholding" professional licensure. "NSGC supports the goal of an efficient regulatory system; however, deregulation should not be pursued at the expense of medical and financial risk to patients and the healthcare system," the group said. "NSGC remains focused on providing strategic support for genetic counselor licensure efforts that ensure the safe, fiscally responsible delivery of genetic services to patients in Idaho and all other states."