Jessica Tincopa, an accomplished photographer with 14 years of experience, is contemplating leaving her beloved profession for a cause that has consumed her life: the pursuit of affordable fertility treatment coverage. After enduring the heartbreak of six miscarriages, Tincopa and her husband set out to save for in vitro fertilization (IVF), an expensive procedure costing well over $20,000. Unfortunately, their dreams were derailed by the financial impact of the pandemic, leaving them unable to secure coverage for IVF through their state’s health insurance marketplace. Determined to overcome the obstacles they face, the couple is not only striving to rebuild their savings but also imploring politicians to take action and expand access to fertility treatments for all.
Infertility affects a significant portion of the population, with nearly one in five married girls or women aged 15 to 49 experiencing difficulties in conceiving, according to the federal Centers for Disease Control and Prevention. However, access to comprehensive fertility treatment coverage remains elusive for many, leading to an ever-widening divide between those who can afford these services and those who cannot. While prominent employers increasingly recognize the importance of providing fertility benefits to attract and retain talent, researchers warn that the majority of coverage options still cater primarily to those with substantial financial means, perpetuating a system where accessibility hinges on one’s ability to pay out-of-pocket.
Usha Ranji, associate director of women’s health policy at KFF, a nonprofit organization dedicated to studying healthcare issues, emphasized the inherent inequity within the current system. She noted, “It is still primarily for people who can afford to pay quite a bit out of pocket.” Insurers, grappling with concerns about cost and balancing the emphasis on fertility treatments versus other avenues of building families such as adoption, contribute to the complexity of the situation. Medical ethicist Dr. Philip Rosoff advocated for a balanced approach, asserting that if fertility treatment coverage is offered, it should be accompanied by equally significant benefits and support for adoption.
While progress is being made in some sectors, with 54% of the largest U.S. employers now covering IVF, there remains a stark disparity in coverage availability among smaller employers. Lauderhill Fire Rescue Lt. Ame Mason, who has personally experienced the emotional and financial toll of fertility treatments, highlighted the absurdity of the situation. Her brother-in-law, employed by a larger fire department in a neighboring county, received coverage for fertility treatments, resulting in the birth of his son. In contrast, Mason and her husband, who both work for the same department, have had to spend nearly $100,000 of their own money on unsuccessful IVF attempts. The lack of regulatory standards governing coverage perpetuates the inconsistencies, leaving couples like Mason and Tincopa at the mercy of their employers’ policies.
Although 21 states have enacted laws mandating coverage for fertility treatments or preservation, these requirements often do not extend to individual insurance plans or coverage offered by small employers. Barbara Collura, CEO of Resolve, a nonprofit patient advocacy organization, highlighted the significant impact of inadequate insurance coverage on individuals’ ability to build families, stating, “People tell us that their biggest barrier to family building is lack of insurance coverage.” Disproportionately affecting Black and Hispanic women, the limited coverage of fertility issues under state and federally funded Medicaid programs further exacerbates the inequities. While birth control and sterilization procedures are covered, fertility treatments and medications are often excluded, sending a discouraging message to those with limited financial means.
In the face of these challenges, individuals like Jessica Tincopa are taking matters into their own hands, advocating for change at both the state and federal levels. Tincopa has engaged in discussions with legislators to explore the possibility of creating options for individuals to purchase individual insurance plans that include fertility treatment coverage. In California, the state Senate is currently considering a bill that would require large employers to provide coverage for fertility treatments, including IVF. However, the California Association of Health Plans opposes the bill, citing potential cost increases and coverage gaps.
Critics argue that the cost estimates associated with fertility treatment coverage often overstate the number of individuals who would utilize such benefits. Sean Tipton of the American Society for Reproductive Medicine points out that the majority of people with fertility issues do not require IVF and that the coverage expansion may be more feasible for smaller employers seeking to attract and retain talent. However, medical ethicist Dr. Philip Rosoff emphasizes the importance of ensuring fairness and justice by not only expanding fertility treatment coverage but also providing comprehensive support for adoption, promoting the social good of finding loving homes for children in need.
As the push for more inclusive fertility treatment coverage gains momentum, it becomes apparent that this issue extends beyond medical necessity. It encompasses the fundamental desire to create a society where access to building a family is not limited by financial means. While many businesses have taken strides in expanding fertility benefits to include LGBTQ+ couples and single women, there is still work to be done to bridge the coverage gap, particularly for smaller employers and those seeking individual insurance plans.
For individuals like Ame Mason, whose employer does not offer fertility benefits or support adoption, the journey towards parenthood becomes a grueling uphill battle. Despite the staggering costs and emotional toll, Mason remains steadfast in her pursuit of IVF, cherishing every glimmer of hope that each attempt brings.
In a society that values equality and family, it is imperative that we address the discrepancies in fertility treatment coverage. The stories of Jessica Tincopa, Ame Mason, and countless others serve as a poignant reminder that the quest for accessible and affordable fertility treatments is not just a personal struggle but a societal issue that demands attention and action. It is a call for compassion, fairness, and a reimagining of the healthcare system to ensure that everyone, regardless of their economic standing or sexual orientation, has an equal opportunity to build the family they desire.