Why The Affordable Care Act Should Cover Infertility

A current petition to Whitehouse.gov asks for infertility treatments to be covered by the Affordable Care Act. The fact that it isn't already covered is concerning for a number of reasons.
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A current petition to Whitehouse.gov asks for infertility treatments to be covered by the Affordable Care Act. The fact that it isn't already covered is concerning for a number of reasons.

First of all, infertility affects over 10 percent of the U.S. population and this number is exponentially increasing. In contrast, 28 percent of women use the birth control pill.

Not only is this form of contraception covered by the ACA and most insurance plans, a prescription for it doesn't cost anything now for many individuals. The fact that preventing life is seen as a necessary health benefit while creating it isn't disturbs me.

Infertility treatments are categorized by insurance like many types of plastic surgery -- an elective procedure. To lump in trying to conceive with medical procedures like a nose job is insulting. Infertility is a disease, not just a preference.

People actually do mortgage their houses in order to try to have a baby. The cost of an average IUI ranges between $300 to $800, but it is only 10 percent effective each cycle for a woman who is under 35 and with normal sperm. Most women seek infertility treatments after 35, so the most effective treatment -- IVF -- is the most expensive.

The cost of one IVF cycle averages $12,000 but drugs cost around $5000. This is easily a year of tuition at a state school or a down payment on a house. However, one cycle only has less than a 30 percent chance of working for a woman under 40. So many women have to undergo an average of three cycles to achieve pregnancy.

Further, these estimates do not cover egg or embryo freezing, genetic testing and other procedures designed to optimize one's chances of conceiving. In total, a couple could reasonably spend $100,000 in order to have a baby.

In comparison, the cost of adoption can be around the same amount. However, adoptive parents can receive state and federal tax credits to offset their costs. There is no such benefit available for people undergoing infertility treatments.

While there are some funding options for IVF and other infertility treatments in the form of grants, scholarships and prescription discounts, these are limited and very competitive. The majority of couples seeking funding rely on personal loans, credit cards and even mortgaging their houses to help cover the costs of infertility treatments.

There is progress that has been made in terms of insurance coverage. 15 states currently mandate some form of insurance coverage for diagnosis and treatment of infertility. But this might only mean some blood tests and ultrasounds or cheaper procedures like IUIs.

Luckily, my husband works in Illinois, which has a significant mandate. Up to four cycles of IVF and an unlimited number of frozen embryo transfers are covered. However, we have a very limited amount of prescription coverage for infertility drugs and the average out of pocket expense for drugs for one IVF cycle can be around $2500.

Lest anyone say that infertility treatments would be too economically burdensome to cover, I want to point out that almost half of Americans in their lifetime will be diagnosed and treated for some form of cancer. The cost of radiation, chemotherapy and surgery is much higher than infertility treatments. But no one blinks an eye that cancer should be covered by insurance --especially by the Affordable Care Act.

I believe infertility treatments aren't already covered because it is considered a women's disease. Women's health has traditionally be under-covered -- which is why the Affordable Care Act was so progressive, because it mandated coverage for wellness exams for women and contraception, most of the time for little or no out of pocket cost.

However, the idea that infertility is a women's disease is false. Almost 50 percent of infertility cases are due to male factors such as sperm count and quality. Yet, there is much stigma surrounding male infertility.

In fact, when trying to find male celebrities who have been open about having male factor infertility, I could only find two: Gordon Ramsey and Tom Arnold. I believe that if more men spoke up, there would be a much bigger push for insurance coverage for infertility.

The fact is, insurance coverage for infertility isn't simply a health issue -- it is a political issue. Forcing people to mortgage their homes in order to treat a disease isn't the way our insurance system works. And to push through the Affordable Care Act based on the idea that our health is a priority, if not a right, without considering this disease is an injustice.

I hope everyone considers signing the petition for the ACA to cover infertility treatments. You may not be someone who needs such type of treatment but in most likelihood you know someone who has or will. Vote with your signature for all diseases to receive the treatments they need.


Melissa Miles McCarter has struggled with secondary infertility since her daughter died of SIDS in 2003. You can connect with her on Facebook or Twitter.

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