New technologies that help achieve pregnancy for couples who have difficulty conceiving are controversial because of their expense and their success rates.
Yes. Infertility is clearly an illness, with dysfunction of ovaries, testicles or some other system, and all legitimate treatments should be covered by insurance. Most indeed are, but the majority of companies still exclude donor insemination, in vitro fertilization and GIFT -- gamete intrafallopian transfer.
Donor insemination wasn't a major issue before because it was inexpensive. But now the need for sperm freezing and multiple blood tests to rule out HIV has driven up the cost dramatically.
Insurance companies say that while surgery should be covered because you can fix the tubes and "cure" the problem, such treatments as IVF aren't curative. But tubal surgery's success rate is often 10 to 15 percent -- below that of a good IVF program. And IVF is substantially cheaper. Tubal surgery and hospitalization can cost $12,000 to $15,000, while IVF ranges from $5,000 to $7,000. In the states that mandate IVF coverage, it is nowhere near as costly as the companies expected, because couples tend to use it as a last resort.
A recent national study found that family is the most important aspect of people's lives, so by denying coverage, companies are undercutting the national interest. We shouldn't be allowing insurance companies to make policy decisions about our national priorities.
We hope insurers will come to recognize that family building is truly a national priority and voluntarily cover infertility treatment even where it's not yet mandatory. All infertile couples are saying is that they are entitled to a chance at the most important thing in most Americans' lives -- a family. -- Dan Clements Board vice chairman, Resolve Inc., a nonprofit group for infertile couples
No. Such coverage should not be mandatory and is usually not appropriate. Large businesses are mostly self-insured and exempt from mandates, which then fall largely on smaller firms that can't afford to self-insure and are already struggling with the cost of basic health care.
The decision to cover any treatment ought to be made by the buyer of the insurance -- the employer. Usually, employers buy what's going to benefit the most people. There are very few people who want such things as in vitro fertilization in the package, and very few who need it.
It's reasonable for insurers to produce packages that people can afford, and infertility treatments such as IVF can easily tilt the balance. IVF's cost -- usually $10,000 to $20,000 because it involves several cycles -- is exorbitant.
IVF is a technology that is being marketed before it is ready. It doesn't necessarily do anything but burn up money in 19 out of 20 cases. To produce a live baby from this process, you must not only pay for the one out of 20 that's going to be successful, but for 19 failures.
We're not talking here about disease, we are talking about dysfunction. Nobody suffers a moment of physical discomfort over the inability to have a child. It surely affects emotions, but it does not threaten life or health.
I'm not denying that these people earnestly want and need the treatment. They don't want to adopt, and that's legitimate. But in seeking mandates, they are asking small businesses to pay for it.
Is it fair for members of this interest group, no matter how heartfelt their need, to demand through the law that their benefit package be enriched, at perhaps great cost to a larger interest group? -- Robert Waldron Former director, New York Office, Health Insurance Association of America