(The following editorial was authored by state Reps. Jennifer O’Mara, Steve Malagari and Sara Innamorato.)
Across the country and across our commonwealth, families are having the all-important discussion of planning a family. But when the time comes to move forward with that plan, health issues — like infertility — can get in the way.
In 2019, the country’s fertility rate reached a record low. More than one in 10 women struggle to get pregnant or carry a pregnancy to term. Infertility doesn’t discriminate, either. One-third of infertility cases are caused by male reproductive issues, one-third are caused by female reproductive issues, and the final third are caused by a combination of the two or unknown causes.
Even if a family does know the reason for their fertility problems, the process of trying to expand their family can become an ongoing struggle. It’s a deep emotional burden for those who, like us, go each month hoping for the chance to bring our own child into a loving family. Each month that goes by can bring hope, disappointment, and sometimes even jealousy and despair.
And this is where starting a family becomes more of a privilege and less of a right in Pennsylvania and across the country. The pain of navigating fertility issues is physical and deeply emotional. It is also a financial burden.
There are several different options available to treat infertility or have a baby as a same-sex couple or single person, and many specialists to consult when starting the process. Men could have a surgery known as a varicocelectomy, which is the surgical repairing of sperm blockages. Women could undergo procedures like intrauterine insemination (IUI), which involves physically inserting sperm inside the womb for fertilization, or in-vitro fertilization (IVF), a procedure where the sperm and egg are fertilized in a test tube and the embryo is placed inside the womb for further development. The latter two are also common for same-sex couples or people without a partner who want a child.
The average cost for successful infertility treatments ranges widely from $18,000 to $85,000. And that’s just if the treatment is successful. Sometimes treatment doesn’t work the first time, which is not only emotionally devastating, but also requires tens of thousands of extra dollars for additional services.
In many instances, fertility treatment and procedures are not covered by insurance. Fifteen states require some private insurance companies to cover some of the costs; only one state’s Medicaid program (non-private insurance) requires any fertility treatment coverage, and not a single state in the country requires their Medicaid program to cover artificial insemination or in-vitro fertilization. What’s worse for Pennsylvanians — each of our surrounding states are included in the 15 that require some sort of insurance coverage for fertility services.
Given all these factors, having a baby despite infertility becomes an issue of inequality. Families who are determined to bring children into their loving homes can be setback by hundreds of thousands of dollars before their child is even born. For many Pennsylvanians, the prospect of getting pregnant and bringing life into the world simply becomes impossible even though the treatment exists.
That’s where our proposed legislation can help. We are authoring a bill that would require insurance companies in Pennsylvania to provide coverage for infertility services. If passed, this bill would help break down barriers for all couples and residents looking to start a family, no matter the color of their skin or how much money they make. The decision to start — and continue — infertility treatment is difficult enough without having to wonder how much will be covered by insurance, if at all.
This can be done with a minimal increase to insurance premiums. For example, the average monthly premium cost for a New York resident with infertility coverage rose by just 55 cents per month. In Connecticut, it rose by $1.06 per member per month. And in Rhode Island, premiums increased by just $1.29 per member per month. We’re talking an increase equivalent to less than the cost of a cup of coffee per month for comprehensive infertility coverage through insurance.
Pittsburgh has already jumped on this opportunity. Last year, the city announced it would offer fertility coverage to its employees for free. Starting this year, Pittsburgh city employees have access to two cycles of in-vitro fertilization. And they made this happen without raising the employee insurance contribution for those taking advantage of the service. The state legislature can follow their lead and pass this legislation so all Pennsylvanians can explore and afford fertility treatment.
Insurance coverage for infertility treatment can be done and it should be done. We’ve seen it happen in other states, and even in one of the largest cities in our commonwealth. Everyone deserves the opportunity to start a family, regardless of their circumstance. It’s a right, and it’s time we start treating it that way.
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