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Women in Arkansas who have small-group or individual health insurance have been able to get coverage up to $15,000 for in vitro infertility treatments since 1991, thanks to a state mandate. In the years since, the legislation has helped hundreds of couples start a family who would otherwise not have been able to afford it.
State Rep. Dan Greenberg of Little Rock wants to end the in vitro coverage, and has pre-filed legislation to repeal the state law. Using information provided by an insurance advocacy group, Greenberg said the mandate adds an extra 3 to 5 percent to insurance premiums. He said the bill wasn't driven by any one constituent group. “My motivation is to have people pay $1 and not $1.05,” Greenberg said.
Dr. Dean Moutos of Arkansas Fertility Associates, the only fertility clinic in Arkansas, said he performed 220 “cycles” — transfers of embryos conceived outside the womb — this year for an estimated 210 women. (Some women will require more than one cycle to become pregnant.) About 50 to 60 percent of those women had some kind of infertility coverage, Moutos said.
Arkansas law allows insurance companies to apply the benefit limit to all infertility treatments, not just in vitro, Dan Honey, head of the state Insurance Department Life and Health division, said.
The law does not apply to Health Maintenance Organizations or entities that are self-insured — such as Wal-Mart or the state of Arkansas. Its $15,000 limit is the same imposed when the act creating the law was passed nearly two decades ago. Today, one cycle costs between $10,000 and $12,000, Moutos said.
The 3 to 5 percent figure was cited in a study on state mandates by the Council for Affordable Health Insurance. The Council is opposed to mandates. J.P. Wieske, one of the authors of the CAHI study, said the data was arrived at by asking an actuarial committee how much small-group and individual insurers would have to add to their premiums if they were required to cover in vitro fertilization. The estimate is not based on actual Arkansas figures. “We feel it's a good, fair estimate,” Wieske said.
Of all state mandates, Wieske said, “an in vitro [one] worries me the most. And I'll tell you why: It's a straight income transfer from the poor to the rich. I don't think you're finding that the local mechanic [and his wife] are going through in vitro fertilization.”
Fertility doctor Moutos strongly disputed Wieske's assumption that only those who can afford IVF are taking advantage of the procedure. He said his patients include “teachers, coaches, working people. They are reflective of the general population of Arkansas. The majority of our [patients] are not wealthy.”
If the state lifted the mandate would insurance premiums drop 3 to 5 percent? “I don't know,” Weiske said.
“I don't think in vitro fertilization is something people think of when they think of health,” Greenberg said. “What constitutes health is a philosophical question.” Men and women who suffer from infertility, however, would argue with that position: They see infertility as a disease, not an inconvenience. About one in eight couples nationally seek treatment for infertility.
Infertility is not caused by lifestyle choices, Moutos added, as are cancer, diabetes and alcohol-related diseases. “It's not their fault.”
The New England Journal of Medicine reported in 2002 that in states with no mandated coverage, women were more likely to deliver multiple babies, because more embryos were transferred per cycle to increase the chance of a successful pregnancy.
Dr. Moutos wondered what the cost of multiple births was to insurance companies — especially since those babies are in intensive care for several weeks after birth. “There's no question that IVF is very expensive,” Moutos said, “but utilization is very low.”
Though he claims not to be inspired by religious activists, and though he is Jewish and not Catholic, Greenberg's proposal would sit well with the Vatican, which in mid-December said its position is that in vitro fertilization is unethical and that babies should be conceived only through intercourse.
Greenberg has decided to drop his effort to repeal the state's insurance mandate for in vitro fertilization. According to a Jan. 8 post on the Arkansas Project website, he made the decision “a while back,” previous to the publication of this article. The Times did not call Greenberg to ask him if he'd changed his mind on the bill before running its story.
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