The Price of Parenthood–How Do You Pay For IVF?

For people who need to resort to ART to conceive, becoming a parent is expensive.   (Same thing for adoption, whether international or domestic.)  

I’ve written before about the role of money, but I want to take a slightly different tack today.  This morning on NPR there was a segment on the cost of IVF.   The reporter rightly raised this question:  why should your access to parenthood be conditioned on money?   People with money can pay for ART and become parents while people without money cannot.  

This seems like a fair question.  And it’s a striking one–obviously your ability to conceive via intercourse is not conditioned on money.   But if for whatever reason a person/couple has fertility issues, then money matters. 

But when you think about it, your ability to actually raise a child–and to raise a child with some level of security and comfort–is somewhat dependant on access to resources.   Children–no matter how they are conceived–are expensive.   So maybe the answer to the “why does it depend on money” question is that in this country these days an awful lot depends on money.   That being so, why shouldn’t this?  

The point of the story, however, was that some people are trying to address the economic inequities.   There’s a program–INCIID–that offers fertility scholarships.   

That’s one approach to the high price of parenthood.   Let me just note two others.  Here’s a story about how Germany is about to start paying for couples to do IVF.   Germany has an aging population and a low birth rate–it needs more children.  And state subsidies are one way to advance that end. 

And then there is the insurance question.   Should medical insurance pay for IVF?  If so, for which people?   And why?  Is it because it is a medical?  Is it a  necessary one?  Is it ever necessary to be a parent?    The insurance question is a huge one and will likely always stay a subject of some controversy.     At present some insurance in some states does pay for IVF while some does not.

There’s no clear answer to any of this.   ART will always be more expensive than conception via intercourse and so questions of access will remain.   For the moment I just wanted to flag these different approaches.

11 responses to “The Price of Parenthood–How Do You Pay For IVF?

  1. Katrina Anderson

    Interesting questions you raise that implicate the human right to form a family. The issue about state funding for IVF raises particularly vexing questions for advocates of reproductive justice/rights in the United States. The issue resonates, for example, with many women of color who have been targeted with coerced sterilization policies. Others call attention to the need to fix longstanding inequities in healthcare more broadly before tackling the issue of public funding or insurance coverage. In Germany, where the state health care system includes access to a range of reproductive healthcare, state subsidies for IVF is rightly seen as an integral part of that package. Sadly, we all know the US is not Germany. US federal restrictions prevent public funding for abortions except in very limited circumstances, which of course disproportionately impacts poor women and women of color. And now a very anti-choice Congress is trying to prevent even private insurance companies from including coverage for abortions, effectively making it available only for those who can shell out the $400+ for a procedure.

    In my view, a discussion about state funding for, or insurance coverage of, IVF should focus on the human right to healthcare in the US. This includes the availability of comprehensive reproductive healthcare available to all women, not just those who can afford it. That said, in a hostile political climate, with an ever-shrinking pot of state funding, it seems critical to prioritize hard-fought victories like access to abortion and contraception before tackling the issue of access to IVF. Your thoughts?

    • I find this topic a hard one. For starters, it makes sense to me that no system will provide all health care for everyone. Some medical care is in the luxury cagegory and so you are on your own. (Could we agree on cosmetic surgery to improve your toe cleavage?) I’m not going to worry too much about what the correct language for the sides of this divide are just now.

      So what side of the line is IVF? Does it matter why are you using IVF and who you are? Is a heterosexual couple who have eggs and sperm but need to use IVF because there is some issue with fertilization more entitled than a single woman with the same health issue?

      Of course, IVF is only one sort of fertility treatment. There are many others to consider as well. But there’s a common general question–is there some right to be pregnant/give birth/have a genetically related child? Because I can see saying that people have a right to raise children, but does that mean they have a right to the technology necessary to have genetically related children?

      I suppose partly what this gets at, in the terms you put it, is what counts as “healthcare.” Or what counts as the kind of healthcare we have a right to have access to. I just don’t know.

      • There is no right to a child, there is only a right to marry, and a right to have sex with your spouse. There is a right to carry a pregnancy to term. There is no absolute right to parent the child, the child’s rights to not be abused or neglected take precedence over the parent’s expectations to raise their own children.

        There is a right to marital and medical privacy and a strong belief in a right to conceive offspring in marriage that might create a right to homologous IVF, including insurance coverage, but does not cover extra-marital conception. Intentional extra-marital conception or IVF should not be allowed at all, let alone covered by insurance. Pregnancy and birth should be covered by insurance, but not obligate us to do extreme measures for every fetus or newborn baby, or obligate us to implant every embryo or incubate every premature baby.

        • When you say these things I cannot tell whether you are making assertions about the way things are or whether you are making assertions about the way things ought to be. Ditto whether you are talking about rights in a narrow legal sense (like under the US Constitution) or under some version of natural law.

          In any event, many if not all rights are qualified. Absolute rights are rare. Thus, there may be a right to marry but it isn’t a right to marry anyone you want. The state imposes various regulations, some of which are administrative (you have to get a license, maybe wait a few days, perhaps get blood tests) and some of which are substantive (you cannot marry your mother, you cannot marry if you are already married, etc.)

          As far as US law goes, there’s a right to marital privacy (at least under governing constitutional doctrine at the moment), but there’s also a right of privacy that operates for individuals. So while it may be true to say there is a right to have sex with your spouse it is a little misleading as a statement of law. There’s a much broader right to have sex with a much wider range of people.

          Still just sticking to law, the scope and dimensions of the right to parent is a bit hazy. A man who conceives a child via non-marital intercourse may not have the right to be a parent to that child, for example. Once one is recognized as a parent, however, one has a whole panoply of rights (and obligations). But still not absolute. They can always be limited by the rights of the child to be free from abuse/neglect.

          Now it is clear to me that the latter part of your second paragraph is what you think the law should be and of course, you are welcome to your opinion. There’s a world of controversy lurking in what you’ve said. I’ll leave it at that for now.

          • “Thus, there may be a right to marry but it isn’t a right to marry anyone you want.”

            Right, there can be restrictions on certain relationship types if there is a supportable basis, as long as they apply equally to all people.

            “There’s a much broader right to have sex with a much wider range of people. ”

            When you say such things, I can’t tell if you are referring to the way you think they ought to be, etc. I don’t think Eisenstadt went as far as everyone thinks, nor did Lawrence. Neither one said there is a right to unmarried sexual intercourse, let alone intentional conception of children of unmarried progenitors. I think fornication laws are Constitutional and could be enforced if we wanted to, and I know we could ban heterologous IVF and donor conception.

            But it’s not necessary for my Compromise proposal to agree there is no right to unmarried conception, even if there is a right to unmarried sex and donor conception, there still needs to be a right of marriages to conceive offspring.

  2. depends on the insurance. some insurances differentiate between medical and dental and optical, a differentiation that I think is totally arbitrary. On the other hand no insurance is allowed to differentiate between medical and gynecological. Strange system.

    • This reminds me of an insurance question that was discussed at that AARTA meeting I was at last week. If X is a surrogate, does her health insurance cover the pregnancy? Generally if insurance covers pregnancy, it covers pregnancy and the who/what/why/when/how seems besides the point. But you can sort of see why insurance providers might not want to pay for a for-profit pregnancy, as it were. Just food for thought.

  3. Since the insurance has no way of knowing how the conception took place they can’t make rules about it. If she shows up pregnant, her pregnancy is covered period. The surrogates clients pay for the retrieval.

    • I’m not sure what the retrieval is–the retrieval of an egg you mean? And you’re right about the surrogate. Except sometimes people actually tell their insurance companies and then things can happen, whether rightly or not.

  4. I was fixen to say something about elective procedures but then everything is pretty much elective. And Julie the tricky part is… can’t go around calling it a for profit pregnancy right? Frustrating yes, but call it that and the whole house of cards comes tumbling down.

    • I’m not sure what I think about really calling it a for profit pregnancy. But I used the term here just to convey the insurance company’s perpsective. Can’t sneak anything by you, can I?

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