Could infertility insurance be part of a basic insurance plan?

January 20, 2011Carole 5 Comments »

You may wonder what national healthcare reform will mean to you and your family. Although a few of the simpler reforms have come to pass, such as letting parents keep their adult children on their health insurance longer, most of the reforms have not gone into effect. It will take six years until all the reforms are rolled out. At this stage, many of the critical definitions such as what constitutes an “essential benefit” and what is “medically necessary” are yet to be determined.

The hard work of defining the details started this week. The Institute of Medicine (IOM)’s Committee on the Determination of Essential Health Benefits will attempt to define what should be included in “essential benefits” that will be mandated for all new insurance plans, basically defining the floor beneath which no plan could fall, according to this Washington Post article by  N.C. Aizenman. The original health care reform listed 10 categories of health coverage including:

  • Emergency services;
  • Mental health care;
  • Outpatient and inpatient care;
  • Pediatric dental and vision care;
  • Rehab therapy; and
  • Wellness services.

The IOM committee has a year to come up with recommendations for the office of Health and Human Services. One of the issues that needs to be hashed out is what to do with the 2000 individual state mandates for various illnesses.

Fifteen states currently mandate some level of infertility insurance coverage. If the essential benefits package does not include fertility coverage, would patients in states that previously enjoyed coverage lose their mandate? If fertility coverage is included in the essential benefits, some argue that the essential plan would be too expensive. A group representing insurance companies, America’s Health Insurance Plans (AHIP), is lobbying against including existing state mandates for various types of health care under essential benefits.

Frankly, I have little hope that the essential benefits will include coverage for infertility diagnosis and treatment. Why am I so pessimistic? Because when this topic is brought up, fertility insurance coverage is always brought up as an example of gold-plated insurance coverage, never as basic or essential insurance coverage. Even though wanting to have a family is as basic as it gets, when you can’t do it by yourself, society is not interested in paying for it. Why? In part, because even today, the pain of infertility is not well-understood by the majority of people. And fertility patients have not been vocal about advocating for themselves.

This article in Self explores why it is so hard to break the silence surrounding infertility and becoming politically active. This quote sums it up, “We can get only a handful of our own volunteers to speak out, because of the shame,” says Barbara Collura, executive director of Resolve, the national infertility association in McLean, Virginia. “Because we have so little patient advocacy, we have so little progress.

Resolve’s  infertility support website has information about how patients and professionals can become advocates for infertility patients. Did you know that the Family Building Act, (H.R. 697), U.S. House of Representatives and the senate version, the Family Building Act, (S. 1258), U.S. Senate, both of which seek to amend the Public Health Service Act and the Employee Retirement Income Security Act (ERISA). This laws would be amended to require that group health plans that provides coverage for obstetrical services must also include coverage for non-experimental treatment of infertility. This anemic bill only recovers assisted reproductive technology if “certain conditions” are met.  Even without ART coverage, it didn’t even come to a vote but died in committee in 2010. To be considered, it will have to reintroduced next year. Whether it will be reintroduced is anyone’s guess.

You can watch this  Resolve “call for action” video on You Tube called “People with infertility are being ignored’. You can receive action alerts from Resolve to let you know when legislative action is being considered. You can write letters to your representatives. You can talk to your friends and family who love you and vote. Healthcare reform is happening.  If you have a stake in its outcome, now is the time to be heard.

© 2011, Carole. All rights reserved.

5 Responses to this entry

  • Josey Says:

    As always, thank you for the great information!

  • Carole Says:

    You are welcome. If you want even more reason to become an activist for persons suffering from infertility, you should listen to this radio interview with a Resolve advocate who was once a fertility patient herself. She describes the political movement in her state whose objective goes beyond merely blocking insurance coverage for infertility, but wants to actually ban IVF outright or make it much harder to get.

  • gingerandlime Says:

    Thank you for posting this. I have been struggling with my reasons for keeping quiet in real life (all the while oversharing in blog world), and it’s absolutely true that without political will from the people who are affected, change will never happen. By staying quiet and ashamed we are ceding the floor to the aren’t-there-enough-people-in-the-world-already crowd and the profits-before-compassion crowd and the afraid-of-science crowd.

  • Carole Says:

    No infertility patient should ever feel ashamed. Infertility is like any other medical condition. I realize that in the midst of infertility treatments, political activism is probably one effort too much. But I hope that patients who have been successful with fertility treatments– even though they are now busy parents– could consider supporting the “cause” in some way to benefit the couples that come after them. Likewise, infertility treatment providers who make their bread and butter from infertility treatments need to become active against a vocal minority that would prefer that IVF and infertility patients simply go away.

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