President Obama did the right thing when he decided to require coverage of contraception by health insurance plans. While the mandate may be controversial for many Americans, it is important to protect the choices of women who want to postpone or avoid pregnancy.
Ironically, the Affordable Care Act will perpetuate the bias in health care insurance against women who want to reproduce. When an infertile woman needs in vitro fertilization (IVF) to have children, her insurance plan generally does not cover the thousands of dollars in costs of the assisted reproduction services. The new health care law does not change this.
To be sure, many women are perfectly happy without becoming parents. But that should not lead people to dismiss the interests of those women who very much want to become mothers. In fact, it is surprising the extent to which society can be dismissive of the interests of the infertile.
For example, people often are told that their inability to procreate is the loss of a “lifestyle option” or that“infertility is a blessing in disguise.” Well-meaning friends commonly advise the infertile to “just relax, and then you’ll get pregnant.”
For many women, infertility is the most upsetting experience of their lives. As one young woman said, "When I was first diagnosed with cancer, my friends couldn't believe how well I took the news. But the one fear that continued to haunt me was the thought that I might become infertile."
It is often said that infertile couples can adopt, and many parents find great satisfaction through that alternative. But many other people very much want to have biological ties with their children. They also may want to have offspring without having to share parenthood with strangers or worry about their children’s medical histories.
Can society afford to pay for in vitro fertilization? In other countries that are not as wealthy as the United States, like France and Israel, the national health system covers the costs of IVF. Data from Massachusetts also demonstrate that coverage is affordable. After the state passed a mandate for insurers to cover infertility services, researchers found that the costs of coverage amounted to less than half a percent of total expenditures for health care by insurers in the state.
And there are important health benefits for mothers and children when coverage is available. Because IVF expenses are not covered by insurance, some couples try to have twins, so they can build their families in one pregnancy rather than two and reduce their treatment costs substantially. But twins have a much higher infant mortality rate than singletons, and they are at increased risk for developmental disabilities. Their mothers are more likely to experience premature labor, hypertension, or postpartum hemorrhage.
It is important to protect the interests of women who do not want to become pregnant. But it is just as important to protect the interests of women who want to have children. As we sort through the details of health care reform, we should preserve reproductive choice for all.
[cross posted at Politico's Arena page]
David's too modest to highlight his own work on this area, but I am not.
Read David's great article Discrimination Out of Dismissiveness: The Example of Infertility," 85 Indiana Law Journal 143 (2010), http://ssrn.com/abstract=1359417,
and sinking to still deeper depths of immodesty, you may also find Daniel Chen and my article of interest http://ssrn.com/abstract=1359417 (the first half discusses whether the state should fund IVF, the second provides an econometric analysis of whether insurance coverage for IVF reduces adoption rates, we find no strong evidence it odes).
Posted by: I. Glenn Cohen | February 20, 2012 at 11:04 AM