should medical insurance pay for fertility treatment?

Great Debates
1

I can’t believe my post got eaten! I worked so hard on it! I’ll never be able to compose it as well again.

grumble… grumble…

OK, I’ll try…

There are currently 3 bills pending in the U.S. Congress to make it mandatory for health insurance to cover fertility treatments such as IVF. (caveat: this is how I understand the legislation, but perhaps someone who understands law-language better than I can flesh out what exactly they mean better than I can).

S 874 "A bill to require health plans to include infertility benefits, and for other purposes. "

HR 389 "To amend the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and chapter 89 of title 5, United States Code, to require coverage for the treatment of infertility. "
and

HR 1246 "To amend chapter 89 of title 5, United States Code, to provide that any health benefits plan which provides obstetrical benefits shall be required also to provide coverage for the diagnosis and treatment of infertility. "

These can all be viewed at http://thomas.loc.gov by entering the bill number

Given that there is a finite amount of money to be spent on health care, and these treatments are very expensive, is this the best way to use health care money?

Many people argue that premiums are high and not enough proceedures are paid for. If one (or all) of these bills are passed, won’t this make that situation worse?

Requiring coverage for any service, treatment or procedure increases the overall cost of insurance. Will this result in an increase in the number of uninsured?

What about Medicaid? Should it cover these treatments?

(Server… don’t you DARE eat this post again!)

2

One could split this into two questions:

  1. Should health insurance cover fertility treatments
  2. Should federal law compel health insurance to cover such treatments.

Regarding #2, I’d say NO. There are too many unforseeable consequences.

Regarding #1, I’m on the fence. On the one hand:

– It’s expensive, so people need the coverage
– Infertility is a kind of medical disability
– It’s relatively rare, so the cost can be averaged over many people,

OTOH

– It’s expensive, so it burdens the Plan
– It’s hard to prevent people taking advantage of the coverage. People are apt to already know that they’re infertile when they seek the coverage. (This argument can be turned around. If this coverage were required on every single group policy, then there would be no adverse selection by the buyer.
– It’s optional. Couples can decide not to have children or when to try to have children.

I lean toward thinking that it ought to be covered.

3

I don’t think so.

I realise that I’m lucky, I am pregnant with my third child, and I have never had to go through the experience of having trouble getting pregnant. I have no doubts that its a traumatic thing to have to go through.

But both Mr and I feel that maybe there is a reason why some of us are unable to have kids. Call it nature’s way of keeping the human population under control.

Since I have my own kids, I know its easy for me to say this, but I feel that if we had been unable to have kids, we would have just dealt with it, and possibly adopted, instead of going the medical route.

So since I don’t agree with IVF or any other forms of fertility treatment, I don’t agree that it should be covered by insurance either.

*To those who may be undergoing fertility treatments at the moment: all the best. I’m not knocking what you are doing, but its not something I would do myself.

4

It’s not very rare at all.

“An estimated one of every five American couples is infertile.” (http://www.infertile.com/quesansw/quesansw.htm)

And it’s really expensive. IVF/GIFT averages a cost of $40,909 per pregnancy. (table 2, http://www.fertilityusa.com/infertility/cost_of_IVF.html)

5

But not all those couples will need IVF, autz. Some of them will be helped by cheaper intervention.

Tsubaki – wow. I find your POV to be callous in the extreme, especially as the parent of 3 children. I probably would not choose to do IVF for myself but I would support others who need that intervention to become parents. Having been through the hell that is infertility, I can assure you that it is not simply a matter of pulling your socks up and making different life choices because kids are denied you. It is easy to think that if it were , you’d just deal. It’s not that simple for most infertile people.

I don’t know enough about the American health system to know how much of an impact forcing health insurance to treat infertility would be. I think a cap on access is fair and reasonable – FE you cannot go on and on for years trying for a baby. But to limit access to IVF etc for only the wealthy doesn’t seem equitable to me.

6

Primaflora,

You’re very correct. Only a small number would need IVF, and most of the others would successfully conceive with medication or surgery.

But can you draw the line? What about those couple who need many cycles of IVF before conceiving?

No easy answers, I know.

7

That’s a tough one.

On one hand, you’ve got infertile couples trying to get pregnant driving up the already nutty cost of health insurance even higher, making it even harder for people to pay for health coverage.

And plus the world has no shortage of babies who need to be adopted. Maybe I can never understand because I do have a child of my own, but I really do think that had I been infertile, I would have simply adopted. Maybe I just don’t understand but what is the big deal of having a child of “your own?” Doesn’t the act of adoption MAKE the baby you’ve adopted “yours?”

My answer: I just don’t know.

It’d be real NICE if an insurance company covered it … I could see a cap being a reasonable way to go: X number of tries and if it doesn’t work, that’s it. After that you pay cash if you wanna try again.

As for the Medicaid question, YES, it should pay for IVF, for one very good reason: Medicaid covers abortions. Got a medical card? Have as many abortions as you want, it’ll cover it. If Uncle Sam is willing to pay for people’s abortions, he certainly should cough up the dough for those who need help getting pregnant. It’s all about equality, right?

Maybe if this did happen (I don’t know if Medicaid currently pays for IVF), Uncle Sam would quit paying for abortions. Not a bad thing, IMHO … not just b/c I’m pro-life, but because I think the taxpayers should not be forced to pay for other people’s abortions OR their IVFs.

That’s what cash or private health insurance is for.

8

WV_Woman, can I get a cite for Medicaid covering abortions? Considering that the US has withheld funds for UN sponsored family planning programs because of the unproven possibility that they might be used to perform abortions, not to mention requirements such as 24 hour waiting periods, etc. I find that highly unlikely. Then again, I’m reading the information (or propoganda, if you will) coming from the other side.

Getting back to the OP, I’m afraid I don’t believe the government should require health insurance to cover infertility treatments. Some of this is because of my own issues – I have clinical depression; I do not plan on having children, so infertility is a non-issue. Most of this is simply because I believe that we have to face the fact that money is not unlimited. Health insurance in America is already expensive, especially if it’s not being provided by one’s employer. Why should we increase the expense for all to benefit some? Yes, I realize this is hypocritical, because I could argue that mental health care should be mandatory (I’m actually somewhat on the fence about that). On the other hand, mental illness is a life-threatening condition. Infertility, while I realize it’s heart-breaking and devastating, isn’t.

I don’t mean to come across as heartless, but having children is an option. Look, I’m in my mid-30’s, never married, and right now my income is not exactly high. Even if I were to decide that having my child is essential to my well-being, I would still need a man to marry and raise the child with (my personal standards on that one), and additional money to support the child. Should I then ask the government to provide a line of likely-looking (and thinking), willing gentlemen for me to select from? If not, how does that differ from requiring health insurance to cover fertility treatments.

I now await my flaming. If I’ve got any say in the matter, please use soy sauce, rather than barbecue sauce.

CJ

9

I am fortunate that I have children, but I also know a few couples that have had fertility problems.

Since I have never been in their position, I don’t understand the desire to have their “own” children rather then adopt, but I support any decision they made.

Medical insurance should absolutly pay for fertility treatments. I have never been there myself, but from those I know that have been, it is a horribly painful thing to go through. From, what I’ve heard, those couples go through a lot of emotional issues and they have encountered others that are very insensitive about it. Insurance should also pay for all types of birth control (Sorry, that’s another issue)

I can’t say I know much about the cost overall of insurance, but with my insurance, the co-pays are pretty high, the prescription plan is not very good and we have to pay a part of the insurance along with my husband’s company. I am fortunate, but I wonder sometimes what I am paying for. With all of the money I lay out, I would like to know, that if I did need fertility treatments, it would be covered. But, I do think a cap would be a good idea.

10

Your decision not to have a child in the absence of these circumstances is just that - a decision, a choice. Those who are medically infertile do not have a choice, they cannot say “I prefer not to have children”; they simply cannot. That’s how it’s different.

(Besides, with the general lack of respect most people give to our government, would you really want them providing your mate? smile)

Addressing the OP:

I will do my best not to tangent off onto a random rant here; I debated a very similar discussion on a different board about an Australian proposal to pay $10,000 for a donor egg, and couldn’t quite stop myself from ranting :slight_smile:

I do not think that coverage of this procedure should be required as a part of any insurance plan.

I would support almost any insurance plan - er, not monetarily, because I don’t have enough money, but philosophically - that decided to add this procedure to its coverage.

I would disagree greatly with the premise of Medicaid adding this procedure to its coverage. I do not believe it should be the taxpayers’ job to compensate a woman’s desire to give birth to a child that has gestated in her womb. While ensuring the health of our fellow citizens is definitely important to the well-being of a nation, I believe that any plan funded by tax money should provide coverage only for medical treatments that are not elective; medicine for illnesses and surgeries to correct true problems are a-OK, while pills so a very slightly “overweight” woman can lose weight for a meeting with a modelling agency or so a man can have his wrinkles smoothed with botulism or an infertile woman can give birth rather than adopt or use a surrogate mother, these things are not okay.

However, so long as it is not forced upon private insurance industries, and it is simply their choice to add this procedure to their coverage, I would be okay with it. Forcing everyone under a current health insurance plan to subsidise these expensive, elective procedures, however, is not something I could stomach.

11

Well, here’s an idea…since my medical insurance won’t cover birth control, maybe I should just pop out some babies for all those poor childless couples ….oh, wait, I forgot :smack: —they are not willing to adopt.
That alone makes it hard for me to feel much sympathy.

12

It is very unfortunate that some people who desire to have children are unable to do so. But I do not consider infertility a “disability,” or an impediment to leading a full life. Treatment for infertility seems about as elective as cosmetic surgery. Alternatives exist. Tho they may not be an infertile couple’s first choice, I do not believe they should have their personal preferences subsidized either by the public fisc or private insurance pools.

IMO - just because something is possible therough medical technology, does not mean that every person in need or desirous of that benefit is entitled to it at a subsidied rate.

13

I’m sure I’m asking for it - but I wonder about the people who were able to get pregnant and have children saying that they don’t understand the desire to have “your own” children instead of adopting - as it seems, that’s exactly what they preferred too. There were plenty of children available for adoption and they still chose to have “their own,” they were just lucky it was easy to do so.

Still, I’m not sure it should be covered entirely by insurance.

14

That is an obvious statement. Of course most people would opt to have their own, both for vanity and financial reasons (to name just a couple). However , speaking for myself , I would have gladly adopted if I had not been able to have my son. Due to the fact that I had major complications at childbirth, I probably will choose to adopt in the very near future, once I finish my college degree. I say probably because I may very well decide that one is enough for me.
My best friend has three children of her own (always wanted a big family; her prerogative) but she could no longer carry her own children to term after number three. She has, in the past three years, adopted two beautiful children, both not of her race. It mattered not to her that they weren’t of her loins. I wish more people were so open minded and truthful when they say they just want a baby to love. Most just want THEIR baby to love, to the tune of thousands upon thousands of dollars that others have to shoulder on their insurance premiums. While it’s a shame and I don’t subscribe to the notion that it was just meant to be that some would not be parents, you can’t justify to me that I should have to pay for their lack of selflessness.

15

My credentials: Adoptive mom. Also mom of one bio “surprise” baby. Infertility patient for two years, but didn’t do the IVF thing (too risky, and the hormones turned me into SuperBitchfromHell).

I don’t think that insurance should be required to pay for IVF (or the other “invasive” procedures). They have fairly low success rates. They are expensive as hell. They also open up the “fertilized embryo is a child” can o’ worms (I’m pro-choice and don’t agree with this statement, but I’d rather not have the harsh light of the pro-life movement on what goes on in fertility clinics). I think insurance should offer additional infertility protection - which they will discover that no one pays for because everyone assumes they will get pregnant the moment they try. The infertility protection would not pay for IVF until you’ve paid for it for two years. As the success rate with IVF increases, I think it will be more reasonable to expect insurance to cover it.

I do think that insurance should pay for diagnosing infertility (where possible), fertility drugs (Clomid and such) and artificial insemination (spinning the sperm and inserting it directly into the uterus at the optimal time to improve chances). These things have OK success rates and aren’t terribly expensive (although the Fertinex cost me $400 a month, after insurance covered 1/2 of it). They are also very useful in diagnosing other issues where infertility turns out to be a symptom of a more significant problem.

Where insurance does offer IVF coverage, they should certainly be allowed to limit it to a few tries over a lifetime.

Thank you amarinth. Adoptive parents everywhere say the same thing.

echo, many people adopt after exhausting their fertility options. But some people want to make sure they have exhausted every possiblity of having a genetic child. Others exhaust their fertility options and choose to remain childless.

Don’t assume that if you hadn’t conceived you would “just adopt.” Adoption is a HUGE step for most couples. Many adoption agencies do infertility counseling as part of their adoption process. If you are picky about your babies health, age or race, it can be a long, difficult and expensive process - with as much cost and risk as IVF. (There is, I hear, such a thing as adoption insurance).

One of the interesting tidbits on infertility is how its grown over the past decade or so. Seems that it is now defined as “unable to conceive after one year” (and less, I believe if the woman is somewhere in her 30s). Used to be defined as “unable to conceive after three years.” Gee, think changing the definition had anything to do with the infertility crisis?

I don’t have a problem with “only the rich being able to afford IVF.” In part, because I know some darn poor people who have never had a new car, have downsized their house, and haven’t had dinner out in years to pay for IVF or adoption, or both. And some rather well off people who think insurance should pay for IVF (or adoption should be cheaper) because they can’t afford it (did you see the new Range Rover?).

16

Boy, the sympathy displayed here for infertile couples brings a tear to my eye.:rolleyes:

echo22:

Nice sweeping generalization there. Perhaps you should speak with parents who adopted their children and find out how many went through infertility treatments before they adopted.

Tsubaki:

dragongirl:

WV_Woman:

I find it interesting that people who already have children of their own are the least sympathetic towards those who wish to do so. I also find it interesting that these expressions of not understanding are voiced when they weren’t solicited by the OP.

In any event, I don’t think the government should force insurers to cover infertility treatments. If an insurance company covers it, or part of it (like the medications), that’s great, but I wouldn’t expect them to and wouldn’t want to force it on them.

17

OK, I deserve a slap for my blanket generalization……many infertile couples do end up adopting, but I ask why does it take thousands of dollars to come to that decision? Why should the general population have to pay for it? I can’t even get my BC covered, which costs considerably less in the scheme of things. I could agree to a couple of tries at IVF or whatever, to be covered, but after that enough is enough. I don’t believe a bill should be passed in Congress however; having children is not a constitutional right… That is for insurance companies to decide.
Perhaps, as has been implied, my opinion matters very little, as I have a child of my own, but the OP did in fact solicit opinions on this .

18

And what about your own extreme callousness, Primaflora? You speak of the “equity” of “fertility treatment for all,” when the result of mandatory coverage, “capped” or not, will be that considerably more people being unable to afford any health treatments, except for emergency room visits. Where the equity in that?

Put (very) simply, health insurance works like this:

Pr = T + O + P

where Pr = premium receipts, T = payments for treatments, O = overhead, and P = profits.

Mandatory fertility treatments increases T. Pr must also go up, to cover the increase in T.

And when Pr goes up, another slice of consumers and/or businesses can no longer afford the cost of health care coverage.

Sua

19

One of the effects of infertility treatments is the rise in multiples. They are often low-birth weight and require a lot more care. I remember a commercial some years back for a health insurance plan where the mother of something like quadruplets was saying, the babies had problems and without Health Plan X, it would have cost over a million dollars. News flash, lady, it did cost a million dollars, just not to you. Of course I believe health plans should cover the costs of taking care of infants, etc., but this will be an increasing burden with more multiples. Will that cause changes in how babies are covered?

Ethically, too, does that then mean that insurance companies will set limits on how many babies should be carried? Already parents may choose to decrease the number of multiples the mom carries; could this be required?

20

That is one thing I don’t get about insurance companies.

You would think they wouldn’t WANT you to get pregnant. So why won’t they pay for BC pills and the like?