News | Equity in Reproductive Care: Low-Income Women Call for Greater Medical Support
Mary Delgado's first pregnancy went smoothly, but when she tried to conceive again seven years later, she was unsuccessful. After 10 months, Delgado, now 34, and her partner, Joaquin Rodriguez, visited an obstetrician-gynecologist. Tests showed that Delgado had endometriosis affecting her ability to conceive. Her doctor said in vitro fertilization (IVF) was her only option.
“I was heartbroken when the doctor told me because I knew it was so expensive,” Delgado said.
Delgado lives in New York City and is enrolled in Medicaid, the jointly funded federal and state health program for people with low incomes and disabilities. One IVF cycle costs about $20,000, a substantial expense for many people and nearly unaffordable for a Medicaid household with an annual income limit just above $26,000.
In recent years, some large companies have offered employees fertility-treatment benefits, including free egg freezing and unlimited IVF cycles, often described as a major improvement in employee benefits. People with lower incomes, especially racial and ethnic minorities, are more likely to rely on Medicaid or commercial insurance without such coverage. This raises the question of whether fertility care is available only to wealthy people or those with generous benefits.
“The U.S. healthcare system does not want poor people to have children,” Delgado said. She cares full-time for a son with a rare genetic disorder who has needed multiple surgeries. Her partner works for a company that maintains yellow taxis, and his individual plan purchased through the state insurance marketplace also excludes fertility coverage.
Some medical experts understand why people like Delgado believe the system is unfair.
“It certainly feels somewhat that way,” said Dr. Elizabeth Ginsburg, professor of obstetrics and gynecology at Harvard Medical School and president of the American Society for Reproductive Medicine (ASRM).
Whether intentional or not, many believe this inequity reflects poorly on the United States.
“This is a striking problem in a country that says it cares about vulnerable people and tries to help them,” said Eli Adashi, professor of medicine at Brown University and former president of the Society for Reproductive Endocrinology and Infertility.
However, expanding Medicaid coverage for fertility care faces substantial resistance, Ginsburg said.
Barbara Collura, president and CEO of the National Infertility Association, Resolve, has heard many arguments against fertility treatment for Medicaid beneficiaries. Legislators have asked: “If they cannot afford fertility treatment, do they know how expensive it is to raise a child?”
“As a country, we are deciding who is allowed to have children,” Collura said.
The legacy of the early 20th-century eugenics movement remains; states then passed laws allowing the forced sterilization of poor, nonwhite, and disabled people.
“As an advocate for reproductive justice, I believe having children is a human right, and supporting that right is a broader ethical issue,” said Regina Davis Moss, president and CEO of In Our Own Voice: National Black Women's Reproductive Justice Agenda.
Coverage decisions involving the healthcare safety net can nevertheless require difficult choices because resources are limited.
Even if state Medicaid programs want to cover fertility treatment, they must weigh that benefit against investments in other care, including maternity care, said Kate McEvoy, executive director of the National Association of Medicaid Directors. “The focus and urgency surrounding maternity care are clear,” she said.
Medicaid pays for about 40% of births in the United States. Since 2022, 46 states and the District of Columbia have chosen to extend postpartum Medicaid coverage to 12 months instead of 60 days.
Infertility is relatively common, affecting about 10% of reproductive-age men and women, according to the National Institute of Child Health and Human Development.
Traditionally, couples who did not conceive after 12 months of trying were considered infertile. Last year, ASRM broadened its definition beyond heterosexual couples to include prospective parents unable to conceive for medical, sexual, or other reasons, as well as those who need interventions such as donor eggs or sperm.
The World Health Organization defines infertility as a disease of the reproductive system marked by failure to achieve pregnancy after one year of regular unprotected sexual intercourse. WHO considers the high cost of fertility treatment a major equity issue and calls for better policies and public funding to improve access.
Regardless of the definition, many private health plans deny fertility-treatment coverage because they do not consider it “medically necessary.” Twenty states and the District of Columbia require health plans to provide some fertility coverage, but the laws vary widely and apply only to state-regulated employer plans.
Many companies have recently added fertility treatment to attract and retain leading employees. According to benefits consultant Mercer, 45% of companies with at least 500 employees covered IVF and/or medication treatment in 2023.
That does not help people who rely on Medicaid. Only two state Medicaid programs currently provide any fertility treatment: New York covers certain oral ovulation-induction medications, and Illinois covers fertility preservation, such as freezing eggs or sperm for people undergoing treatment that may cause infertility. Several other states are considering fertility-preservation services.
In Delgado's case, Medicaid covered the testing that diagnosed her endometriosis but no further treatment. While searching online for options, she found CNY Fertility, a clinic group that was much less expensive than others and offered in-house financing. Headquartered in Syracuse, New York, it operates clinics in upstate New York and four other U.S. locations.
Although Delgado and her partner had to travel more than 300 miles round-trip to Albany for procedures, the savings made it worthwhile. They completed an entire IVF cycle for $14,000, including medication, egg retrieval, genetic testing, and embryo transfer. They used $7,000 saved for a home purchase and financed the other half through the clinic.
She became pregnant on the first attempt, and their daughter, Emilia, is now nearly 1 year old.
Delgado does not resent people with greater resources or better insurance, but she wants the system to be fairer.
“I had a medical problem,” she said. “I did not undergo IVF to choose my baby's sex.”
One reason CNY charges less than other clinics is that the privately held company chooses lower prices, said William Kiltz, vice president of marketing and business development. Since its founding in 1997, it has grown into a large, high-volume IVF practice, helping keep prices low.
More than half its clients now come from outside the state, and many earn significantly less than typical patients at other clinics. Twenty percent have incomes below $50,000. “We have quite a few Medicaid patients,” Kiltz said.
Now that their son Joaquin attends a good school, Delgado has started working for a home-health agency. She works 30 hours a week and will qualify for health insurance after 90 days.
News | Equity in Reproductive Care: Low-Income Women Call for Greater Medical Support
News | Equity in Reproductive Care: Low-Income Women Call for Greater Medical Support
Mary Delgado's first pregnancy went smoothly, but when she tried to conceive again seven years later, she was unsuccessful. After 10 months, Delgado, now 34, and her partner, Joaquin Rodriguez, visited an obstetrician-gynecologist. Tests showed that Delgado had endometriosis affecting her ability to conceive. Her doctor said in vitro fertilization (IVF) was her only option.
“I was heartbroken when the doctor told me because I knew it was so expensive,” Delgado said.
Delgado lives in New York City and is enrolled in Medicaid, the jointly funded federal and state health program for people with low incomes and disabilities. One IVF cycle costs about $20,000, a substantial expense for many people and nearly unaffordable for a Medicaid household with an annual income limit just above $26,000.
In recent years, some large companies have offered employees fertility-treatment benefits, including free egg freezing and unlimited IVF cycles, often described as a major improvement in employee benefits. People with lower incomes, especially racial and ethnic minorities, are more likely to rely on Medicaid or commercial insurance without such coverage. This raises the question of whether fertility care is available only to wealthy people or those with generous benefits.
“The U.S. healthcare system does not want poor people to have children,” Delgado said. She cares full-time for a son with a rare genetic disorder who has needed multiple surgeries. Her partner works for a company that maintains yellow taxis, and his individual plan purchased through the state insurance marketplace also excludes fertility coverage.
Some medical experts understand why people like Delgado believe the system is unfair.
“It certainly feels somewhat that way,” said Dr. Elizabeth Ginsburg, professor of obstetrics and gynecology at Harvard Medical School and president of the American Society for Reproductive Medicine (ASRM).
Whether intentional or not, many believe this inequity reflects poorly on the United States.
“This is a striking problem in a country that says it cares about vulnerable people and tries to help them,” said Eli Adashi, professor of medicine at Brown University and former president of the Society for Reproductive Endocrinology and Infertility.
However, expanding Medicaid coverage for fertility care faces substantial resistance, Ginsburg said.
Barbara Collura, president and CEO of the National Infertility Association, Resolve, has heard many arguments against fertility treatment for Medicaid beneficiaries. Legislators have asked: “If they cannot afford fertility treatment, do they know how expensive it is to raise a child?”
“As a country, we are deciding who is allowed to have children,” Collura said.
The legacy of the early 20th-century eugenics movement remains; states then passed laws allowing the forced sterilization of poor, nonwhite, and disabled people.
“As an advocate for reproductive justice, I believe having children is a human right, and supporting that right is a broader ethical issue,” said Regina Davis Moss, president and CEO of In Our Own Voice: National Black Women's Reproductive Justice Agenda.
Coverage decisions involving the healthcare safety net can nevertheless require difficult choices because resources are limited.
Even if state Medicaid programs want to cover fertility treatment, they must weigh that benefit against investments in other care, including maternity care, said Kate McEvoy, executive director of the National Association of Medicaid Directors. “The focus and urgency surrounding maternity care are clear,” she said.
Medicaid pays for about 40% of births in the United States. Since 2022, 46 states and the District of Columbia have chosen to extend postpartum Medicaid coverage to 12 months instead of 60 days.
Infertility is relatively common, affecting about 10% of reproductive-age men and women, according to the National Institute of Child Health and Human Development.
Traditionally, couples who did not conceive after 12 months of trying were considered infertile. Last year, ASRM broadened its definition beyond heterosexual couples to include prospective parents unable to conceive for medical, sexual, or other reasons, as well as those who need interventions such as donor eggs or sperm.
The World Health Organization defines infertility as a disease of the reproductive system marked by failure to achieve pregnancy after one year of regular unprotected sexual intercourse. WHO considers the high cost of fertility treatment a major equity issue and calls for better policies and public funding to improve access.
Regardless of the definition, many private health plans deny fertility-treatment coverage because they do not consider it “medically necessary.” Twenty states and the District of Columbia require health plans to provide some fertility coverage, but the laws vary widely and apply only to state-regulated employer plans.
Many companies have recently added fertility treatment to attract and retain leading employees. According to benefits consultant Mercer, 45% of companies with at least 500 employees covered IVF and/or medication treatment in 2023.
That does not help people who rely on Medicaid. Only two state Medicaid programs currently provide any fertility treatment: New York covers certain oral ovulation-induction medications, and Illinois covers fertility preservation, such as freezing eggs or sperm for people undergoing treatment that may cause infertility. Several other states are considering fertility-preservation services.
In Delgado's case, Medicaid covered the testing that diagnosed her endometriosis but no further treatment. While searching online for options, she found CNY Fertility, a clinic group that was much less expensive than others and offered in-house financing. Headquartered in Syracuse, New York, it operates clinics in upstate New York and four other U.S. locations.
Although Delgado and her partner had to travel more than 300 miles round-trip to Albany for procedures, the savings made it worthwhile. They completed an entire IVF cycle for $14,000, including medication, egg retrieval, genetic testing, and embryo transfer. They used $7,000 saved for a home purchase and financed the other half through the clinic.
She became pregnant on the first attempt, and their daughter, Emilia, is now nearly 1 year old.
Delgado does not resent people with greater resources or better insurance, but she wants the system to be fairer.
“I had a medical problem,” she said. “I did not undergo IVF to choose my baby's sex.”
One reason CNY charges less than other clinics is that the privately held company chooses lower prices, said William Kiltz, vice president of marketing and business development. Since its founding in 1997, it has grown into a large, high-volume IVF practice, helping keep prices low.
More than half its clients now come from outside the state, and many earn significantly less than typical patients at other clinics. Twenty percent have incomes below $50,000. “We have quite a few Medicaid patients,” Kiltz said.
Now that their son Joaquin attends a good school, Delgado has started working for a home-health agency. She works 30 hours a week and will qualify for health insurance after 90 days.
One benefit is fertility coverage.
Source:
Collected online