What Health Care Reform Means For Infertility Coverage

The Senate version of the recently enacted health care reform does not provide any obvious, direct relief for couples looking for infertility health insurance coverage. Upon closer inspection there are areas where our friends in Washington have taken away, and places that show a glimmer of hope. Much will change over time as more details begin to emerge. Take a look at what can be learned from a high level overview of the bill.

I was interested to see what help the "Patient Protection and Affordable Care Act" offered, if any, to couples facing infertility. One can learn very interesting things by downloading the 2,409 page PDF document available online. Adobe Acrobat provides a handy word search feature that allows us to quickly see what, if anything was done to address the needs of couples trying to conceive.

So I typed in a number of keyword phrases, and got the following results: Infertility: 0, IVF: 0, Fertility: 0, In Vitro Fertilization: 0, Assistive Reproduction Technology: 0

Okay so it seems that the new law does not provide any obvious direct help for couple trying to conceive. Is there indirect help? Let's try typing in "pregnancy" as see what comes up. We find twenty one entries; now we may be onto something! The entries break down to these categories:

• Establishment of a pregnancy assistance fund to help pregnant and parenting college students.


• "A sense of Congress" to study the mental health consequences of women "resolving" pregnancy.


• Funding tied to state-established goals to reduce teen pregnancy rates.


• Personal responsibility programs designed to educate adolescents on abstinence, contraception, and sexually transmitted diseases.


• Pregnancy Risk Assessment Monitoring System (PRAMS) as it relates to oral healthcare.


• Removal of cost share for counseling and pharmacotherapy for cessation of tobacco use by pregnant women.

It seems we are out of luck once again. Funding and attention are allocated to preventing pregnancy, and keeping already pregnant women healthy, but nothing about helping get people pregnant.

Flexible Spending Accounts can be very useful for infertile couples. Pre-taxing helps lower costs for the very high level of unreimbursed medical expenses associated with infertility treatments. Let's see if the bill provides any help in this area? The news is not good. Health Care Flexible Spending Accounts contribution limits have been capped at $2,500 for any plans with tax year's beginning after December 31, 2010. It still makes sense to utilize your FSA to keep costs low, but a $2,500 limit does not make much of a dent in a $15,000 IVF payment.

Let's not give up yet. There are those state run health exchanges to examine. Their principle purpose is to provide some level of coverage for individuals with pre-existing conditions. The funds by nature lose money for the states that currently run such programs; which means your benefit may exceed your premium. Each state is given some level of flexibility it how it will set up and run its exchange. Perhaps there may be something for infertility hidden amongst these exchanges.

And then there is prescription drugs: 136 mentions, and a few that aren't related to Medicare (the program for people over age 65). Perhaps we can explore these topics in another article. Stay tuned.