A Somewhat Different Insurance Issue

I’ve written in the past (before the long hiatus–can I start saying “BH”?) about issues around ART and insurance.   There are a lot of tough questions around this.   ART is expensive.   It is health care.   Is it/should it be covered by insurance?   Does the need for ART have to arise from medical infertility rather than social infertility?

(These are tricky questions/categories.   A lesbian couple where at least one woman has fully functioning reproductive systems is sometimes said to be socially rather than medically infertile. But how is this different from a woman  with a fully functioning reproductive system who is partnered with a man who cannot produce sperm?  She is also socially infertile, I think?)

Anyway, I’m not going to review all that here.    I am sure these issues will arise again and I will discuss them as needed.  You can always dig around in the older entries, too.  (This reminds me–I have not been using tags, but I think I will start to do so again.)

So to today’s thoughts, spurred by this article from the morning paper.  (There’s a slightly more detailed version here, but I can only access page one of two.)    Erin and Marianne Krupa are a married lesbian couple who live in Montclair, NJ.  (This happens to be my hometown.)   They want to have a child.   But Erin Krupa, who they decided would carry the first child, has stage 3 endometriosis.   That means she is infertile.  And here I do mean medically infertile.  She has a medical condition that prevents her from conceiving/carrying a pregnancy by ordinary means.   It has nothing to do with the health or sex/gender of her spouse.  

There are various ways you could think about approaching this.  One thing you might say is that Erin Krupa has a medical condition and if you would treat that medical condition for a heterosexual woman, surely you must treat it for a lesbian.   And though I cannot tell for sure, it seems to me impossible that she was denied coverage for treatment of endometriosis.   I think the issue must be coverage for fertility treatments made necessary because of the endometriosis.

Again, a number of ways you could think about this.   But let me focus on what NJ law actually says.  It says you aren’t infertile unless you’ve had unprotected intercourse with a man for two years.   So Erin Krupa cannot prove infertility (because she doesn’t engage in sexual intercourse with men) and thus, cannot qualify for insurance coverage.

There are other ways you could impose something akin to the same limit.  NY and Connecticut apparently define infertility as the failure to become pregnant after repeated exposure to sperm–without specifying how you happen to be exposed to it.   This means, presumably, that you’d be infertile after you tried multiple assisted inseminations.

I have to say, even with many of the details murky, the NJ policy seems indefensible.  If you provide insurance coverage for women who do not become pregnant when exposed to sperm why would you care how the sperm got there?  The point of the restriction seems to be to identify cases of medical infertility.   Insurance in NJ will cover cases of medical infertility, but the definition of when you are medically infertile excludes lesbians.

I will take a guess at what some people are thinking:   The Krupas can have a child without Erin becoming pregnant because  Marianne can carry the child.   Let’s assume this is factually true–that she can  do so.  Is it an answer?    I don’t think it is, but I think there might be a longer discussion there and so I will save it for next time–which I hope will be tomorrow.  By which time I also hope to have a better grip on the facts.



One response to “A Somewhat Different Insurance Issue

  1. I saw a few Facebook discussions on this, and a few individuals thought it was wrong that heterosexuals had to wait 24 months with trying via the conjugal act before qualifying for ART. If someone wants it why make them wait two years!

    Growing up with contraception as a teen and young adult, knowing (as an act of fear) it just takes ‘once’ to get pregnant, that when you stop contraception/condoms you become frustrated easily that you don’t have a lot of control when you become pregnant. Trying for four months even, charting and having lots and lots of conjugal, either not to be pregnant or a miscarriage can well be very upsetting considering a woman waited and planned to have a baby. Baby now, because that’s what we planned. Now!!!

    It’s hard to give up that kind of control, and when we are not in control we want someone to fix it and put us back in control.

    One argument would be that both women have zero sperm count, so they should qualify. The side of the argument is that using someone else’s sperm is NOT treating fertility in the individual. Using another person’s fertility, isn’t not trying to increase the sperm count of the woman who wants to be the non-egg parent.

    The problem isn’t fertility, but attraction. Neither woman is attracted to individuals who produce sperm. Now it isn’t their fault, if they experience same-sex attraction. It is what it is, and no one should force a woman to have sex with a man if she has no desire to. The woman wants a baby, she wants sperm. She just doesn’t want the man. There are plenty of men willing to oblige I guess. One way if a woman chooses is to seek therapy to see if there is a chance she may be interested in men, or bite the bullet and be in an honest queer marriage, but that may lead itself to adultery and multiple adults in and out of the child’s life being open.

    I can’t make the father of my children disappear, I don’t have that right. He has as much right and obligation to parent as I do. I can not do that, only a court with evidence that he is unfit to parent can termination that right and obligation.

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