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.