Women’s Healthcare Is Regular Healthcare, Dammit, & Should Be Treated As Such

On IVF, abortions, and gaps in insurance coverage

With more and more women putting off having children until later in life — while they situate themselves in careers, make a dent in their student loans, move out of their parents’ basement and, oh yeah, try to find the right partner—many of them end up relying on IVF to get pregnant. The figure right now stands at about 12% of all moms. As you’ve perhaps heard, the costs of fertility treatments can be exorbitant. And whether your insurance company will cover those costs can depend on which state you live in and, the New York Times reports, even whether you’re having sex with men.

Ms. Krupa’s provider, Horizon Blue Cross Blue Shield, denied coverage [of her IVF]. The company cited a state insurance mandate from 2001 that required most women under 35 — no matter their sexual orientation — to demonstrate their infertility through “two years of unprotected sexual intercourse.” …

That language, Ms. Cretcher said, violates the constitutional rights of nonheterosexual women.

In a complaint filed last week, the plaintiffs, all lesbians trying to conceive, also sought damages for the cost of their treatments, including artificial insemination and in vitro fertilization.

Those plaintiffs are not the only ones struggling to get their insurance companies to pick up, or at least help defray, the costs of this procedure. As Doree Shafrir has been recounting on Twitter, she’s had no luck, so far, with United HealthCare.

Apparently, only some states mandate that insurers must cover the cost of IVF, so in many cases, like Doree’s, insurers can elect to cover nothing.

Since the 1980s, 15 states — Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia — have passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment. Thirteen states have laws that require insurance companies to cover infertility treatment. Louisiana and New York prohibit the exclusion of coverage for a medical condition otherwise covered solely because the condition results in infertility. Two states — California and Texas — have laws that require insurance companies to offer coverage for infertility treatment. Utah requires insurers providing coverage for maternity benefits to also provide an indemnity benefit for adoption or infertility treatments. While most states with laws requiring insurance companies to offer or provide coverage for infertility treatment include coverage for in vitro fertilization, California, Louisiana, and New York have laws that specifically exclude coverage for the procedure.

WHY SO COMPLICATED

This reminds me of something Lindy West writes about in her smart new memoir Shrill: women’s and, specifically, reproductive health care is treated like some kind of niche, or “special interest.” Abortions often aren’t covered, or covered fully, by insurance. (West recounts being told she needs to bring $400 with her to the clinic, because only payment in full on the day of service is accepted. She has a total of $100 in her bank account, and she bursts into tears.) IVF often isn’t covered, or covered fully. Even birth control remains somehow controversial.

If health care were cable, reproductive health care would be like Starz: a non-mainstream frill, available only to some, for extra money, instead of a reliable part of the basic package. But women’s health care has to be part of the basic package. Health care that covers anything to do with pregnancy — from avoiding it to enabling it — may be expensive, but considering how it’s mandatory for the propagation of the species, it should be at least as available as ESP-fucking-N. After all, it’s not like women pay lower premiums. We contribute just like the dudes do. In exchange, we should, and should expect to, get quality coverage, coverage that takes into account our entire bodies, not just the parts that some people don’t find icky.

On the plus side, we seem to gradually be coming around to this, as a society. #ShoutYourAbortion made reproductive health care visible, even unignorable, in a new way. Activists for menstrual products have successfully overcome taboos to increase access and parity in states like New York, and shouted down discriminatory Pink Taxes, too.

Just last year, menstrual activism captured so many headlines that NPR dubbed it “The Year of the Period” and Cosmopolitan proclaimed it was “the year the period went public.” As menstrual equality garners more interest and awareness, states are moving in the right direction by providing basic needs for its people. This year, 15 of the 40 states with a “tampon tax” moved to change it, and just last week, the American Medical Association released a statement urging states to exempt menstrual products from sales tax.

But as these IVF suits and complaints make clear, there remains lots of ground still to cover. As long as women are asked to pay exorbitantly for their health care, same as men, they should get quality, whole-body health care, same as men.

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