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Bearing The Cost Of Bearing A Child Is Infertility Debate Insurers At Odds With Couples, Physicians On Cost Of Treatment

Roberta Kraft is $38,700 in debt. She owes money on her Visa card. She owes money on her American Express card. She owes money to her parents and to her best friend from college. She and her husband have not bought new clothes in two years and live in a cramped one-bedroom apartment because they have spent all their discretionary income - and a good chunk of their future earnings - in a single pursuit: trying to have a baby.

In her still unsuccessful quest, Kraft has economized in ways she never imagined. She bought fertility drugs from a pharmacy in Mexico because they were cheaper than those sold in her Manhattan neighborhood. She withdrew money from a retirement account, paying steep penalties. She sold a pair of diamond earrings she had inherited from her grandmother, tearfully rationalizing that her grandmother would have given her blessing.

Kraft has gone to such lengths because her insurance company will finance few of the procedures she needs to become pregnant. And so, in addition to the emotional ordeal that they face, she and her husband are also struggling with a severe financial crisis.

This crisis is striking a growing number of couples as scientists develop new treatments to combat physical problems that prevent pregnancy - treatments that few insurers are willing to cover and that few couples can easily afford.

Is infertility a disease?

To patients like Kraft - who would speak only if her maiden name was used and her husband was not identified - and the doctors who treat them, such refusals by insurance companies amount to discrimination. Infertility, they say, is a disease, like diabetes or emphysema, whose treatment should be covered by any basic insurance policy. When it is not, they argue, patients go without crucial medical care that could lead to pregnancy, or they pay enormous expenses on their own or get inappropriate care simply because it is treatment their insurance companies will pay for.

But others question whether the inability to become a biological parent is a medical condition or a social problem. And they ask whether society can, or should, pay for costly treatments that benefit a narrow group of people when growing numbers of others lack insurance for even basic health care.

“The debate comes down to this,” said Uwe Reinhardt, a health-care economist at Princeton University, “Is having your own offspring with your own genes a matter of human right? And if you can’t accomplish that on your own, do you have the right to have your efforts to achieve it financed?”

The issue came to the fore last month, when Aetna, one of the nation’s biggest health insurers, announced that its U.S. Healthcare health plans would no longer offer coverage for advanced infertility treatments. Company officials said that because few other health plans offered such benefits in their basic packages, women with fertility problems had been disproportionately joining U.S. Healthcare plans, saddling the company with an unfair share of costs for infertility treatments.

Some states require some coverage

Thirteen states require health plans to offer some coverage of infertility treatments. Two states, Massachusetts and Illinois, mandate that in vitro fertilizations be included.

But these regulations do not cover many workers because many businesses - those that insure themselves under provisions of a 1978 federal law - are exempt from state jurisdiction. This applies to many more people than one might imagine, because many large companies self-insure and use a commercial carrier to administer the plan.

Several recent studies have found that it would cost less than $3 per member per year if coverage was mandated for advanced reproductive technology - procedures that manipulate the union of sperm and egg.

In vitro fertilization, in which eggs are combined with sperm in a laboratory dish and the fertilized embryo is implanted in the woman’s uterus, is the most common of these procedures. The procedure costs about $8,000 for each attempt, and most couples try several times before they succeed.

About 6.1 million women in the United States, or 10 percent of the women of reproductive age, are infertile, according to the most recent figures from the federal government’s National Center for Health Statistics. Of those, about 600,000 have tried assisted reproductive technology in their attempt to bear children.