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Laws in 15 states mandate that health-insurance providers cover infertility treatments, and there's a push to make it more. But should health insurers be required to pay for a service unrelated to ensuring health?
Healthcare is hella expensive. According to the California Health Care Foundation, in 2014 $3 trillion was spent on healthcare, accounting for 17.5% of U.S. GDP. However much Hillary Clinton and Donald Trump may have been diametrically opposed on almost every issue, they agreed on one thing: we're spending too much on healthcare.
Since no-one wants people to be less healthy, spending less on healthcare means three things: 1) better preventive treatment so that in the long run there is less sickness requiring treatment, 2) the reduction of treatment costs, and 3) fewer needless healthcare expenditures.
With this in mind, perhaps it's worth considering whether infertility treatment is a pragmatic use of healthcare money. Since helping people have babies does not contribute to keeping people healthy, should healthcare providers be compelled to help people do so?
Currently, 15 states—Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia—require health-insurance providers to cover infertility treatment to one degree or another; and only 25% of U.S. health plans offer such coverage.
That number may be poised to grow. Infertility is more common than is popularly believed. A 2013 Reuters report, for example, noted that studies on female infertility typically find that "between 12 and 18 percent of women may have trouble getting pregnant." With that in mind, the Reproductive Medicine Associates of New Jersey's claim that more than half of Americans want insurance companies to cover fertility treatments doesn't sound especially far-fetched.
For many the question of whether infertility treatment ought to be covered by medical insurance comes down to how the infertility is defined. The World Health Organization defines it as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” But in 1999 a group of researchers from the Louisiana State University School of Medicine and Fertility Institute of New Orleans signed a letter to the journal Fertility and Sterility arguing that fertility is a symptom of a number of conditions and not in and of itself a disease. But the broader argument that infertility treatment—and having babies in general—is an elective procedure. You may want children, but you do not need children to be physically well.
Infertility treatment ain't cheap, and so the issues hinges on whether other insurers and insurees should pay for this or any other purely elective procedure. According to the American Society for Reproductive Medicine (ASRM), the average success rate of IUI tops out at 20% for each cycle—which, in other words, means pregnancy does not result in 4 out of every 5 attempts. If the cost of IUI is $1,100 per cycle (roughly the median price found by the National Infertility Association (NIF) in 2006), the mean cost of each pregnancy from IUI is about $5,500. In vitro fertilization is far more expensive. Using the ASRM estimate of $12,400 per cycle and NIF's success rate of 20–35%, we can loosely estimate a cost of $45,000 per pregnancy.
But the Reproductive Medicine Associates of New Jersey (RMANJ) takes a pragmatic line, arguing that quality infertility coverage actually saves everyone money in the long run. Quality is key, because without proper guidance many infertile couples select treatments that often result in twins or other high-risk pregnancies. "Employers spend 12 times as much on healthcare costs for premature or low-weight babies as they do for babies without complications," RMANJ says. And based on data compiled by the Centers for Disease Control and Prevention, if multiple births from infertility treatment were eliminated, the resulting total savings would be $6.3 billion per year.
Trying to decide whether healthcare providers ought to provide—or even ought to be compelled to provide—coverage for infertility treatment might seem to be a moral or ethical issue. But if the bottom line is that such coverage costs society less in the big picture, then that should end the debate. Whether we're there yet is not entirely clear, but viewing the question from that angle may be the best guiding star for both government and business.
About the Author:
Except for a four-month sojourn in Comoros (a small island nation near the northwest of Madagascar), Greggory Moore has lived his entire life in Southern California. Currently he resides in Long Beach, CA, where he engages in a variety of activities, including playing in the band MOVE, performing as a member of RIOTstage, and, of course, writing.
His work has appeared in the Los Angeles Times, OC Weekly, Daily Kos, the Long Beach Post, Random Lengths News, The District Weekly, GreaterLongBeach.com, and a variety of academic and literary journals. HIs first novel, The Use of Regret, was published in 2011, and he is currently at work on his follow-up. For more information: greggorymoore.com
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