The concept of health insurance to cover medical illness started catching on in the 1940’s and the current system of health insurance has evolved with surprisingly little change. Of course there was the start of Medicare in the late 1960’s to cover the seniors, the development of PPO’s and HMO’s, Medicaid to cover the indigent population and most recently, the Affordable Care Act (ACA) or Obamacare.
One common feature of most of these insurance plans has been that infertility has not been a covered service except in very few. The Supreme Court has ruled that reproduction is a vital life function, yet the reproductive tract has always taken a back seat to other systems. Perhaps it’s because people don’t generally die from infertility and ,many look at it more as a life choice rather than a vital bodily function.
Nevertheless, with the repeal and replacement of Obamacare we may have an opportunity to get infertility and IVF mandated in all health insurance policies.
One of the first hopeful signs is a bill introduced in California by California state Sen. Anthony Portantino (D-La Cañada Flintridge) which proposed legislation this month that would require insurers beginning in 2018 to cover fertility preservation services when necessary medical treatments may cause infertility. Covering this type of care is the “right thing to do” for young patients, many of whom are facing life-threatening diagnoses, Portantino said.
The key here is that it is linked to other serious illness which could result in death. So they take it more seriously.
“You should think about getting healthy,” said Portantino. “You shouldn’t have to worry about losing your fertility.”
A similar bill passed both houses in 2013 but was vetoed by Gov. Jerry Brown, who wrote that he did not want to mandate additional benefits given the “comprehensive package of reforms that are required by the federal Affordable Care Act.”
Legislators across the nation also have proposed bills in recent years to make it easier for patients facing fertility-threatening treatments to get such care. Legislation has been introduced in New York, Hawaii, Connecticut and elsewhere.
Alison Loren, an associate professor at the University of Pennsylvania’s Perelman School of Medicine, noted that insurers have no problem paying for wigs when patients lose their hair, or for implants when patients need breast tissue removed.
“Those are well-recognized complications of cancer therapy,” said Loren, who treats patients with leukemia and does bone marrow transplants. “So is fertility, and it should be covered.”
I could not agree more. This is just one example that seems like an easy mandate to justify. But we need to get the government to mandate fertility treatment much beyond this one situation. With the repeal and replacement of Obamacare this would be the time to include in the new bill that infertility evaluation and treatment must be a covered service. This would seem to be a slam-dunk family building issue for an administration that seems poised to eliminate coverage for abortions and birth control.
I hope that our professional organizations are in there lobbying not just to preserve coverage for abortions, Planned Parenthood or birth control, but also to add coverage for infertility as a requirement for basic coverage.
It’s time for your voice to be heard. Contact your state and federal legislators to demand a mandate for health insurance to cover infertility.