Background on Infertility & Fertility Preservation

Infertility poses a significant public health challenge, affecting roughly one in six individuals worldwide, irrespective of income levels. In the United States, married women aged 15-49 face a notable prevalence, with approximately 19% experiencing difficulties conceiving. Furthermore, within this demographic, 26% of women who do conceive encounter challenges in achieving and maintaining a pregnancy. Typically, infertility rates are assessed based on the inability to conceive after a year or more of unprotected sexual activity.

For individuals facing infertility, there exists a range of treatment options, although their high costs often render them inaccessible without insurance coverage. To tackle this issue, 21 states in the U.S. have implemented fertility insurance coverage laws. Among these, 14 states provide coverage for In Vitro Fertilization (IVF) treatments, one of the more common and effective fertility interventions. Additionally, 15 states have specific coverage laws for iatrogenic infertility, which refers to infertility caused by medical procedures or treatments.

This legislative advancement underscores a growing acknowledgment of infertility as a significant health issue, prompting the need for more accessible and affordable treatment avenues. Nevertheless, the availability of insurance coverage for fertility treatments varies widely across states, underscoring ongoing disparities in healthcare access concerning reproductive health.

Introduction to the Access to Infertility Treatment & Care Act

The Access to Infertility Treatment & Care Act is designed to broaden insurance coverage for infertility treatments and fertility preservation procedures across the United States, targeting a diverse range of individuals, particularly those in low and middle-income groups, as well as veterans, Medicaid enrollees, federal employees, and military members.

Key provisions of the bill include:

1. Prohibitions for Health Insurance Providers: The bill forbids health insurance companies from offering incentives to policyholders to opt out of infertility procedures. It also prevents these providers from decreasing reimbursement rates for healthcare providers who perform infertility and fertility preservation procedures.
2. Mandatory Coverage Requirements: The Act mandates that health insurance plans in the U.S. cover the costs of specific infertility treatments, such as In Vitro Fertilization (IVF). It ensures that individuals who need to undergo medical treatments that could impair fertility have access to fertility preservation methods.
3. Extended Coverage: Coverage for infertility treatment and fertility preservation is extended to include veterans, individuals enrolled in Medicaid, federal employees, and members of the military.

The Act is particularly focused on assisting groups that often face difficulties with infertility, including low and middle-income couples, single women, women over the age of 35, Medicaid holders, federal employees, veterans, and military personnel. By doing so, it aims to address disparities in access to fertility treatments and to support a broader range of individuals facing infertility challenges.

Arguments in Support of the Access to Infertility Treatment & Care Act

1. Financial Accessibility to Treatments

Advocates of the Access to Infertility Treatment & Care Act highlight the significant financial relief it could provide to individuals who currently find the costs of infertility and fertility preservation care prohibitive. They point to a 2015 survey conducted by the Wall Street Journal, which revealed that 44% of women who underwent infertility treatments incurred debts exceeding $10,000.

Congresswoman DeLauro emphasizes the harsh reality faced by many due to the lack of insurance coverage for such treatments. She notes that the high costs often force individuals to make difficult choices between basic necessities like food, clothing, and housing, and their desire to pursue parenthood. This financial barrier, she argues, effectively limits family growth to those of certain financial means.

Supporters of the Act argue that by reducing the financial strain associated with infertility treatments and fertility preservation, the Act will not only make these medical services more accessible but will also alleviate the emotional stress often accompanying these procedures. The aim is to create a more equitable landscape where the dream of starting or growing a family is not restricted by economic barriers, thus addressing both the financial and psychological impacts of infertility.

2. Infertility Treatments and Fertility Preservation Should Be Considered “Medically Necessary” Forms of Care

Advocates of the Access to Infertility Treatment & Care Act are highlighting the evolving dynamics of family planning in modern society. A significant number of young people are now opting to start their families later in life due to educational and career commitments. This shift means that many women are attempting pregnancy in their mid-30s and 40s, an age range often associated with more complex pregnancies compared to younger women. Supporters of the Act argue that women should not be compelled to choose between their professional ambitions or educational pursuits and their fertility aspirations due to the financial burden of infertility treatments.

Another key point raised by proponents of the Act is the promotion of “fertility equality” for the LGBTQ+ community. Currently, many insurance providers do not cover fertility treatments for same-sex couples, which advocates see as a significant inequality. The Access to Infertility Treatment and Care Act aims to address this issue by mandating that fertility treatment and preservation coverage be extended to all individuals, regardless of their gender or sexual orientation. This provision would mark a significant step towards ensuring that LGBTQ+ individuals and couples have equal access to fertility treatments and the opportunity to start families, just like their heterosexual counterparts.

Arguments Against the Access to Infertility Treatment & Care Act

1. Religious & Ethical Beliefs

Opponents of the Access to Infertility Treatment & Care Act often have religious or ethical concerns regarding the medical processes used in infertility treatments. For example, Roman Catholics and Orthodox Christians, both of which make up about 20% of the world’s population, do not support assisted reproduction. In a globally recognized 1956 proclamation by Catholic figurehead Pope Pius XII, artificial insemination was deemed “illegal” and “immoral,” as it separates procreation from the act of having sex. Other opponents grapple with the ethical implications of deciding what to do with extra embryos harvested during treatments such as IVF. Deciding whether to donate the embryos to another family, thaw and dispose of them, or store them indefinitely is a challenging moral dilemma for some. Many believe that the Act will expose more people to ethically complex choices regarding their fertility journeys.

2. Infertility Treatments as Optional Procedures & Adoption

Infertility treatments and fertility preservation procedures are not remedies to extremely serious or life threatening health conditions. As a result, opponents to the Act state that the treatments should not be considered required procedures under health insurance guidelines. Furthermore, to encourage adoption, some critics argue that there should be more benefits for those who choose to adopt, in place of coverage for infertility treatments. A 2021 study found that over 113,000 children of the 391,000 in foster care are eligible for adoption. Opponents to the Act believe that coverage for infertility treatments could potentially dissuade people from adopting a child currently in need of a home.

Conclusion

The Access to Infertility Treatment and Care Act debate grapples with diverse religious, financial, ethical, and medical perspectives on the emotionally-charged topic of fertility. Without insurance coverage for infertility treatments and fertility preservation, some people are left without the opportunity to ever have biological children. Meanwhile, opponents believe that religious contentions surrounding infertility treatments, in conjunction with the intricacies of insurance financials, should prevent fertility preservation and infertility treatments from being covered. Ultimately, the legislation, despite its final outcome, will be heavily debated for time to come.