The Affordable Care Act and Infertility, Revisited

Several years ago, during the heyday of this blog and my adventure as an infertilite, I wrote a little ditty about how increasing Americans’ access to health care was a good thing, and that the law that would become known as “Obamacare” was particularly good for women.  Little did I know that post would become one of the most read and searched for of all the posts in this blog.

So I’m going to do it again.

On the “verge” of “repealing and replacing” the Affordable Care Act (ACA, aka Obamacare), we face a lot of unknowns about what will actually happen.  A draft of the first version of the bill was circulated just 24 hours ago (notably to news outlets that have been denied entry into the White House Press Room), but it’s still just a draft and there may still be many battles to fight.  Therefore it would be a waste of my time to simply go through the draft and say all the problems that are wrong with it.  Instead, I’d like to give you the information to take to your representatives – local, state, and national – so you can tell them how you, fellow infertilite or concerned citizen, are personally impacted by the benefits of the law.

Are you a woman with health insurance?  If so, you’ve probably noticed that your annual visits to your OB/GYN, mammograms and other screening procedures, and birth control contraceptives are covered.  If you have been pregnant in the last few years, all of your visits pertaining to pregnancy, whether to your general practitioner, a midwife, or MFM specialists, are covered.  The birth is covered, too.  Providing for well-care visits and pregnancy-related care is a national mandate of ACA.  The proposed repeal and replace bill removes the national mandate for insurance companies to cover pregnancy, meaning that it will be up to your state and/or the marketplace to determine how much coverage is provided for and how much you would have to pay out of pocket.  Which means that, should you happen to only have access to plans with minimal coverage, you might have to choose between keeping your electricity on and paying for your hospital stay.  Tell your representatives that providing for pregnancy-related care is a basic human right.

Do you have a pre-existing condition, such as, I don’t know, infertility caused by a uterine abnormality?  Under ACA, an insurance company cannot deny you coverage based on pre-existing conditions.  The draft bill released yesterday keeps most of this part of “Obamacare,” but does limit the kinds of conditions allowed under protection.   Tell your representatives to keep this protection of coverage for all people regardless of pre-existing conditions.

Do you want to wait a few more years to have a child just so you can get a bigger tax break on your insurance?  Currently, the ACA provides subsidies to cover some of the cost of an insurance plan based on your income, so that the burden of coverage is more evenly distributed.  The draft bill proposes that older people, who generally are sick more often and have more medications, would get a bigger tax credit than a healthy 30-year old – almost twice as much.  But where is the equality in this situation when the 30-year old might more likely have one or more dependents who need coverage, and family-level insurance plans aren’t exactly a bargain.  Tell your representatives to keep tax credits for health insurance based on need, not on an arbitrary factor such as age.

Do you think your property taxes are too high?  You might be wondering what property taxes might have to do with health insurance, so let me explain.  Services such as Medicaid are provided by your county in part from federal money that they are granted.  Republicans have talked about creating “block grants” of money, essentially capping the amount of federal money states have access to, which leaves states, counties, and cities in a terrible predicament: do we cut services to people on Medicaid – for instance, do we close nursing homes which would displace seniors and increase unemployment in our community for the doctors, nurses, and workers who worked there – or do we find another way to pay for it?  And they’ll likely find another way to pay for it through your property taxes.  Tell your representative to keep Medicaid expansion.

Finally, I’m going to address the issue of Planned Parenthood, which under the Republican bill would lose all federal funding.  Supposedly because, and solely because, it provides access to abortion services.  What they don’t tell you is that the other 97% of services provided by Planned Parenthood to men and women across the country include preventative health exams, providing contraception, tests and treatments for STIs, Pap smears, breast exams, and outreach to schools and college campuses.  One in five women have reportedly visited a Planned Parenthood at least once in her life (see the link here).  I know abortion is a highly personal topic and questions about life run so morally deep I can’t even begin to illustrate the range of them here.  But I do know that this country was settled by a brave group of individuals at Plymouth who were considered outlaws in their home country for their beliefs and who sought to find a place where they could live as they chose in peace.  Tell your representatives to let us continue to live our life as we choose, to keep our choices for what we do with our bodies our decision, not decided for us by lawmakers, and keep the funding in Planned Parenthood.

I will continue to update the blog as progress on the health care bill continues.


Update: Paul Ryan supports gay adoption

In practically the same breath earlier this week, Former Vice Presidential candidate Paul Ryan upheld his belief that marriage should remain between a man and a woman but admitted that he would support same-sex couples adopting.  So it’s okay for same-sex couples to have children but not be considered a committed couple in the eyes of the law?  <confused>  What am I missing?  If you were so conservatively stuck on marriage being defined by only a man and a woman, is the family unit not so sacred that you’d allow it to be far more liberally defined?

In the run-up to the elections, I brought up how the candidates might have supported or hindered issues relating to infertility.  There wasn’t a lot to go on, since infertility doesn’t exactly have the same lobbying power as, say, gun control.  But there had been questions about Romney and Ryan both having a softer stance toward infertilites than some of their other GOP competitors, and perhaps they had to swing further to the right than they wanted to maintain solid Republican base and Tea Party support.  Without being in the spotlight, maybe now they feel more secure in admitting how they truly would vote…

Or maybe the Republican party is warming up to being less conservative with family values in an effort to win votes…  Sheesh, all they’d have to do is support gay marriage before the Democrats do and the line between Democrat and Republican would have to be redefined entirely.

Either way, I’m all for living in a country that is more inclined to embrace alternative lifestyles, including alternative journeys to parenthood.  Kudos to you, Paul Ryan, in all your P90X glory.

The Adoption Tax Credit

We all know that children, as your dependents, are a tax deduction.  My husband keeps joking with me to have the baby on December 31st since that will grant us a tax deduction almost immediately.  But even if I don’t have the baby on December 31st of this year, I know I still will get the tax deduction for next year.  Parents who are going through the adoption process to grow their families may not be that lucky.

We infertilites know that there is more than one way to have a family.  Welcoming a child through adoption is a completely valid and beautiful option for many who struggle with having children of their own.  And between 1997 and December 31, 2012, parents could claim adoption credit on their taxes for both adopting a child and for expenses related to the adoption (such as court fees and travel expenses).  I’m specific about the end date because that is when the full credit is due to expire, unless Congress acts and renews the credit or decides to make it a permanent part of the tax code.  There are bills in both the House and Senate to accomplish just that – but a do-nothing Congress in the middle of an election season is not quick to move on much, except leaving town for vacations.

Starting January 1, 2013, only $6000 would be available to adoptive parents as a nonrefundable credit for expenses of special needs adoptions only.

Take a minute to find out what US Representatives are about to be on the ballot tomorrow in your state or district.  Are any of them one of the co-sponsors of the Making Adoption Affordable Act?  (Find the list here).  How do your US Senators stand on renewing this tax credit?  Then on Wednesday, November 7th, when we know who will be leading our country, be sure to write to your congressman/woman and senators and let them know it’s an important issue for you that they support these bills.

The Personhood Bill

First of all, I have to hand it to politicians for coming up with the common name of some of the bills they put through Congress – names which instantly strike an emotional chord and make you feel guilty if you were against it.  The Personhood Bill, aka the Sanctity of Human Life Act of 2009, aka H.R. 227 and H.R. 212, is a great example of one such bill.  Introduced into the House in 2009 by 61 representatives – 59 of which were men, 1 of whom is Paul Ryan, current GOP VP candidate – and later died, only to be taken up by individual state congresses.  The goal of the bill, and its subsequent spawns, are to declare as law “that human life shall be deemed to begin with fertilization.”  Meaning that the minute a woman’s egg is fertilized that little zygote is a human, a person, a US citizen with all the rights and protections of any other citizen in the country.  Meaning that any means to destroy that cell – the Plan B bill, early-term abortions, or discarding of embryos (relative to practices in IVF) – is tantamount to murder and punishable by law.

Sidenote – You can see why Representative Todd Akin might be a little hesitant to back down from his position that abortion shouldn’t be legal even in cases of rape since he co-sponsored this bill.

While this bill doesn’t have a chance of becoming national law – at least not yet, it has been brought up  in several states.  The implications for infertilites are pretty stark, especially for those for whom IVF is their only option for achieving pregnancy.  (This might mean you, fellow unicornuate or Mullerian anomaly sisters).  During IVF, several embryos are typically created for selection for the IVF process.  Depending on the doctor and the circumstances, the doctor might choose to transfer several embryos into a woman at a time with the odds that one of them will stick.  Some doctors, depending on the situation, would only transfer one embryo though several might have been created.  The remaining embryos are then frozen for another cycle or research, or they are discarded.  With Personhood legislation, each one of those embryos would be considered a person even at that early stage, with full rights and protections, meaning to discard of them would constitute murder.  This means that states with this legislation would see the number of IVF specialists dramatically decreasing as they move to neighboring states without such restrictions.  IVF practices under Personhood would also decrease that clinic’s success rate, especially if they choose to create and then transfer only one embryo at a time – creating an expensive cycle of trial-and-error for patients as they would see greater numbers of visits and transfer attempts.

As I mentioned, several states have brought Personhood bills forward for public voting or referendums, including Virginia, Oklahoma, Georgia, South Carolina, Colorado, Mississippi, and Arizona – all of which had their own takes on what “personhood” entails.  To my knowledge, none of them have passed – but it’s been close, especially in Oklahoma.

My advice to you: Next time you vote – tomorrow! – make sure you know what kind of laws might be up for public voting in your district, and just what you’re voting for or against!

PS: Mitt Romney was the only GOP candidate during the debates earlier this year to not sign the “Personhood Pledge” to support Personhood.  As governor of Massachusetts in 2002 he firmly attested to a woman’s right to choose; as a presidential candidate ten years later he hypothetically supports pro-life legislation, though we don’t know if that’s his true stand or if he’s just trying to woo moderates / independents any way he can.


Obamacare and infertility

So us women were lured into supporting Obamacare (aka the 2010 Affordable Health Care Act) for the promise of increased coverage of women’s health issues.  We get free birth control now, as well as well-woman visits and increased funding for mammograms and a host of other preventative health care measures.  Yay!  That means more money in our pockets and an affirmation that since we do go through a little bit more on the health side (especially related to fertility) than the opposite sex, and that we’re also responsible for the continuation of the species, that we deserve to at least not have to spend our $.72 cash earned on the man’s $1 on making sure we can do that in a healthy manner.

So great, now we get more recognition for being valued by society as productive individuals with a voice and a contribution to make.  We put off building a family for becoming better educated, earning more, starting a career, etc., with the help of all this birth control.  Then we try to start a family – once we’re financially secure – and find out that we can’t.  Where do we turn to for health?  Surely Obamacare has thought of this caveat of women’s independence.

Well… no.  Sorry ladies, there’s no provision in the President’s health care package that specifically covers any kind of assisted reproductive technologies or treatments.  There’s also no provision that outlaws it, either – so I guess no news is better than bad news.

In the meantime, here’s the good news:

  • There are currently 15 states which mandate that insurance companies provide some kind of coverage for infertility treatments: California, New York, Texas, Massachusetts, Illinois, Ohio, Connecticut, Georgia, Hawaii, Arkansas, Maryland, Montana, New Mexico, West Virginia and Rhode Island
  • For the other 35 states, there may still be coverage provided depending on the individual insurance company – so ladies look into your insurance’s policies next time open enrollment comes around.
  • A bill has been proposed in the US Senate to create a tax credit for out-of-pocket expenses related to infertility treatments: the Family Act of 2011.  Although this doesn’t decrease the immediate burden of ART’s expensive price tag, it might provide the wiggle room for some couples to pursue avenues previously too prohibitive.

Of course, all of this good news has the potential to be wiped out with the passing of the Sanctity of Human Life Act, otherwise known as the “Personhood Bill.”  More next post.

My sources consulted:

A Romney/Ryan infertility paradox?

In the last article I started to delve into what I can only guess might be the foundations of each VP candidate’s stands on infertility / fertility treatments and potential legislation.  While doing some preliminary research for that article, I found a few other interesting conversations out there more specifically pertaining to the candidates’ experiences with infertility and ART treatments.  Today let’s talk about the Elephant in the room.

I found some articles suggesting that either Ryan and his wife are part of the 1 in 4 American couples out there facing infertility, or the Ryans practiced birth control (either condoms or the pill) against their Catholic faith – otherwise there’s no explanation for there only being 3 children born from a marriage of 12 years.  Yet Ryan’s position to repeal the Affordable Health Care Act (aka Obamacare, formerly Romneycare in MA) would remove the provision making birth control free to women.  So what I’m reading into this is that Ryan would legislate as a conservative Catholic even if he didn’t live as a conservative Catholic.  (A little “Do as I say, not as I do” eh?)  Unless they did struggle with infertility, in which case I do feel for them and wish they would use their public spotlight to bring the issues of infertility into the forefront.

And the big man on the ticket, Romney, is not exempt from this discussion either: several of his grandchildren were reportedly born with the use of IVF technology.  This is clearly in contrast to Ryan’s strict Catholic position, though that doesn’t preclude them from sharing a ticket.  Does that mean a Romney administration might actually be sensitive to the struggles of infertile families, despite Ryan’s conservative position?

Maybe?  Does anyone really know?  Unfortunately there’s no one asking the question and all of the candidates are stuck in an endless scripted platform loop… none of which address fertility directly.

Here are the articles from which I derived this information:

Next up  – A look at Obamacare’s impact on fertility treatments

How the candidates compare for infertility advocacy

You’ve seen the memes, heard the “zingers,” and probably even exchanged your own play on words about Big Bird, the 47%, or the binder.  But what have we heard from the presidential candidates on the topic of infertility – their views, their stands, where they draw the line in the sand?  Very little.  And my attempts at using Google to find a neat answer proved fruitless.  So over the next three weeks as we head toward election day, I’ll be taking up some time here on the blog to talk about some of the important issues related to the cause of infertilites.  Today’s post will start with abortion, and how that very public and long-standing debate could shed light on decisions affecting infertility treatments.

Please note that while I’ll do my best to research information and present facts from an unbiased view, I can’t say I won’t let my opinion leak out here and there.  An open, transparent, and respectful discourse is what we need in this country, so please leave comments and I promise to moderate them fairly.

Our catastrophically polarized and, at times, completely immobile nation stops the public discourse of women’s health at the old standby, abortion.  In this venue, we can neatly sum it up that Democrats are pro-choice, Republicans pro-life.  The VP debate left abortion and women’s rights to the ending minutes of the debate, referencing each candidate’s Catholic faith and asking them to reflect upon their positions.  Representing the larger dichotomy currently tearing the Catholic Church apart internally, Biden clings to the social justice side while Ryan sticks to the preservation of life side.  But regardless of their personal beliefs, we at least discovered a fundamental difference in how these two men  – and ultimately, parties – would handle the question on the national level.  Biden stated very clearly he would not legislate his religion; overthrowing Roe v. Wade as some conservatives are aiming to do, would essentially be doing that.

Wait a minute: I thought the Republicans were all for personal liberty and keeping the federal government out of citizens’ lives?

So okay, you’re probably thinking, I don’t really care about abortion because I can’t get pregnant anyway.  Let me then continue down the religious road for a minute here, and again I’ll be sticking with just the VP candidates because we have clear records of their stands from the debate.  Both men claimed to adhere to the teachings of the Catholic Church and their decisions about when life begins (at the moment of conception) and all that.  Attention infertilites, do you know where your personal religion or faith stands when it comes to seeking infertility treatments, including medications, IUI, and IVF?  If you don’t and having that support of your faith through this soul-searching time is important to you, there is no time like the present to do a little Google searching yourself.  Go ahead, this blog post will still be here when you get back.

I know where my Church stands.  Both my husband and I happen to be Catholic.  And when we started discussing options like Clomid, we looked it up, partially out of curiosity, partially to know how much we would be allowed to say to a priest without being excommunicated.  Clomid, fortunately, is permitted, as is surgery to correct infertility and other medical procedures meant to enhance reproductive chances.  IUI and IVF, however, are against the Church’s teachings (as are birth control pills).  And the Sanctity of Human Life bill, co-sponsored by Ryan, would effectively define life as starting with conception and criminalize – yes, criminalize – the practice of IUI and IVF.

Remember when women used to run off to doctors in alleys or drive to Mexico for abortions, risking their lives because they weren’t legal in the U.S.?  Now picture infertile women doing the same – this time hoping to get pregnant in the first place.  How did the pendulum swing so dramatically?