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The Affordable Care Act and assisted reproductive technology use

  • Patricia Stapleton (a1) and Daniel Skinner (a2)
Abstract

The Affordable Care Act (ACA) has prompted numerous gender and sexuality controversies. We describe and analyze those involving assisted reproductive technologies (ART). ART in the United States has been regulated in piecemeal fashion, with oversight primarily by individual states. While leaving state authority largely intact, the ACA federalized key practices by establishing essential health benefits (EHBs) that regulate insurance markets and prohibit insurance-coverage denials based on pre-existing conditions. Whatever their intentions, the ACA’s drafters thus put infertility in a subtly provocative new light clinically, financially, normatively, politically, and culturally. With particular attention to normative and political dynamics embedded in plausible regulatory trajectories, we review—and attempt to preview—the ACA’s effects on infertility-related delivery of health services, on ART utilization, and on reproductive medicine as a factor in American society.

Copyright
Corresponding author
Correspondence: Patricia Stapleton, Department of Social Science and Policy Studies, Worcester Polytechnic Institute, 100 Institute Rd., Worcester, MA 01609. Email: pastapleton@wpi.edu
References
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1 Omurtag, Kenan and Adamson, G. David, “The Affordable Care Act’s impact on fertility care,” Fertility and Sterility , 2013, 99(3): 652655.
2 CDC, “What is assisted reproductive technology?,” last modified November 14, 2014, http://www.cdc.gov/art/whatis.html, accessed April 5, 2015.
3 CDC, “What is assisted reproductive technology?”.
4 CDC, “Infertility FAQs,” last updated September 16, 2015. http://www.cdc.gov/reproductivehealth/Infertility/Index.htm, accessed April 11, 2015.
5 CDC, “Infertility FAQs”.
6 American Society for Reproductive Medicine (ASRM), Third-party Reproduction: Sperm, Egg, and Embryo Donation and Surrogacy (Birmingham, AL: ASRM, 2012), https://www.asrm.org/BOOKLET_Third-party_Reproduction/, accessed April 11, 2015.
7 ASRM, 2012.
8 CDC, “What is assisted reproductive technology?”.
9 CDC, “What is assisted reproductive technology?”.
10 ASRM, Oversight of Assisted Reproductive Technology (Birmingham, AL: ASRM, 2010), http://www.reproductivefacts.org/uploadedFiles/Content/About_Us/Media_and_Public_Affairs/OversiteOfART%20(2).pdf, accessed May 15, 2014.
11 Stapleton, Patricia, “The inauspicious regulatory beginnings of preimplantation genetic diagnosis,” in Biopolitics and Utopia, Stapleton, Patricia and Byers, Andrew, eds. (New York: Palgrave, 2015), pp. 6386.
12 See Paul Starr, Remedy and Reaction: The Peculiar American Struggle over Health Care Reform (New Haven, CT: Yale University Press, 2013), and Colleen Grogan, “The role of the private sphere in U.S. healthcare entitlements: increased spending, weakened public mobilization, and reduced equity,” The Forum, 2015, 13(1): 119–142.
13 Bagley, Nicholas and Levy, Helen, “Essential health benefits and the affordable care act: law and process,” Journal of Health Politics, Policy and Law , 2014, 39(2): 441465.
14 Bovbjerg, R. R., Wiener, J. M., and Housman, M. G., “State and federal roles in health care: rationales for allocating responsibilities,” in Federalism and Health Policy, Holahan, J., Weil, A., and Wiener, J. M., eds. (Washington, DC: The Urban Institute Press, 2003), pp. 2558.
15 Gardner, James A., “Devolution and the paradox of democratic unresponsiveness,” in Comparative Federalism in the Devolution Era, McCabe, Neil Colman, ed. (Lanham, MD: Lexington Books, 2003), pp. 217246.
16 Marmor, Theodore, Mashaw, Jerry, and Oberlander, Jonathan, “National health reform: where do we go from here?,” in Health Policy, Federalism and the American States, Rich, Robert F. and White, William D., eds. (Washington, DC: Urban Institute Press, 1996), p. 284.
17 See H.R. 3607, State Health Care Choice Act, introduced by Rep. Mick Mulvaney on November 21, 2013, https://www.govtrack.us/congress/members/mick_mulvaney/412474, and H.R. 371, the Health Care Choice Act, introduced on January 20, 2011, by Rep. Marsha Blackburn, http://blackburn.house.gov/issues/issue/?IssueID=31191, accessed May 15, 2014.
18 Haussman, Melissa, Sawer, Marian, and Vickers, Jill, eds., Federalism, Feminism and Multilevel Governance (London: Ashgate, 2010).
19 Hancock, Jay, “‘Narrow networks’ trigger push-back from state officials,” Kaiser Health News, November 25, 2013, http://kaiserhealthnews.org/news/states-balk-at-narrow-networks, accessed May 15, 2014.
20 Gnadinger, Tracy, Comparing quality and prices among hospitals,” Health Affairs (blog), January 29, 2014, http://healthaffairs.org/blog/2014/01/29/health-affairs-web-first-comparing-quality-and-prices-among-hospitals/, accessed May 15, 2014.
21 Carroll, Aaron, “Narrow networks are not new,” The Incidental Economist (blog), November 26, 2013, http://theincidentaleconomist.com/wordpress/narrow-networks-are-not-new/, accessed May 15, 2014.
22 Resolve, “Embryo Donation: Myth and Facts,” http://www.resolve.org/family-building-options/donor-options/embryo-donation-myth-and-facts.html, accessed September 24, 2014, and insurance coverage for infertility treatment; Resolve, “Insurance Coverage in Your State,” http://www.resolve.org/family-building-options/insurance_coverage/state-coverage.html, accessed September 24, 2014; Gina Barton, “Surrogacy Laws Vary By State,” The Milwaukee Wisconsin Journal Sentinel, August 7, 2012, http://www.jsonline.com/news/health/surrogacy-laws-vary-by-state-co65rvg-165348756.html, accessed September 24, 2014; Find Surrogate Mother, “US Surrogacy Laws By State,” http://www.findsurrogatemother.com/surrogacy-laws/us-surrogacy-laws-by-state, accessed August 11, 2015; or MacElree Harvey Legal Office, The Legal Uncertainty Surrounding the Disposition of Frozen Embryos in American Divorce Proceedings, http://www.macelree.com/the-legal-uncertainty-surrounding-the-disposition-of-frozen-embryos-in-american-divorce-proceedings/, accessed August 11, 2015.
23 Stapleton.
24 Alison Sherwood, “Surrogacy laws in the United States,” Milwaukee Journal Sentinel, August 4, 2012, http://www.jsonline.com/news/health/163772546.html, accessed May 31, 2014.
25 Sherwood.
26 Sherwood.
27 Sherwood.
28 Sherwood.
29 Sherwood.
30 ASRM, “State infertility insurance laws,” http://www.asrm.org/insurance.aspx, accessed June 11, 2014.
31 Resolve, “Insurance coverage in your state,” http://www.resolve.org/family-building-options/insurance_coverage/state-coverage.html, accessed September 26, 2014.
32 Resolve, “Insurance coverage in your state”.
33 United States Census Bureau, “State totals: vintage 2013,” http://www.census.gov/popest/data/state/totals/2013/, accessed October 13, 2014.
34 Hamilton, Brady E., Martin, Joyce A., Osterman, Michelle J. K., and Curtin, Sally C., Births: preliminary data for 2013,” in National Vital Statistics Report (Washington, DC: U.S. Department of Health and Human Services, 2014), http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_02.pdf, accessed October 13, 2014.
35 Schmidt, Lucie, “Effects of infertility insurance mandates on fertility,” Journal of Health Economics , 2007, 26(3): 431446.
36 ASRM, Infertility: An Overview (Birmingham, AL: ASRM, 2012), http://www.asrm.org/Booklet_Infertility_An_Overview/, accessed April 19, 2015.
37 Inhorn, Marcia C. and Birenbaum-Carmeli, Daphna, “Assisted reproductive technologies and culture change,” Annual Review of Anthropology , 2008, 37: 179.
38 Hammoud, Ahmad O., Gibson, Mark, Stanford, Joseph, White, George, Carrell, Douglas T., and Peterson, Matthew, “ In vitro fertilization availability and utilization in the United States: a study of demographic, social, and economic factors,” Fertility and Sterility , 2009, 91(5):, 1630–1635, at 1634.
39 Resolve, “Insurance coverage in your state: Massachusetts,” http://www.resolve.org/family-building-options/insurance_coverage/state-coverage.html#Massachusetts, accessed September 26, 2014.
40 Jain, T. and Hornstein, M. D., “Disparities in access to infertility services in a state with mandated insurance coverage,” Fertility and Sterility , 2005, 84(1):, 221–223, at 222.
41 Staniec, J. Farley Ordovensky and Webb, Natalie J., “Utilization of infertility services: how much does money matter?,” Health Services Research , 2007, 42(3): 971989.
42 Schmidt, 10.
43 Basco, Daniel, Campo-Engelstein, Lisa, and Rodriguez, Sarah, “Insuring against infertility: expanding state infertility mandates to include fertility preservation technology for cancer patients,” The Journal of Law, Medicine & Ethics , 2010, 38(4): 832839.
44 Basco et al.
45 See Connecticut’s H.B. 5500, Act Requiring Health Insurance Coverage for Fertility Preservation for Insureds Diagnosed with Cancer, distributed to the Insurance and Real Estate Committee, http://www.cga.ct.gov/asp/CGABillStatus/cgabillstatus.asp?selBillType=Bill&bill_num=HB5500, accessed October 3, 2014.
46 Kaiser Family Foundation, “Essential health benefit (EHB) benchmark plans, as of January 3, 2013,” http://kff.org/health-reform/state-indicator/ehb-benchmark-plans, accessed October 10, 2015.
47 Aetna, “ACA Provisions 2014: Impacts to Small Groups,” 2014, http://www.aetna.com/health-reform-connection/reform-explained/video-SGimpact.html, accessed October 3, 2014.
48 Cited in Michelle Andrews, “Few women have coverage for egg freezing,” Kaiser Health News, December 16, 2014.
49 National Conference of State Legislatures (NCSL), “State health insurance mandates and the ACA essential benefits provisions,” updated June 2014, http://www.ncsl.org/research/health/state-ins-mandates-and-aca-essential-benefits.aspx#State_EHB_2013, accessed October 3, 2014.
50 Weiner, Janet and Colameco, Christopher, Essential Health Benefits: 50-State Variations on a Theme (Philadelphia: Leonard Davis Institute of Health Economics, University of Penn. & Robert Wood Johnson Foundation, 2014).
51 42 U.S. Code §18031 (d)(3)(B), “Affordable choices of health benefit plans”.
52 Weiner and Colameco, 1.
53 Centers for Medicare and Medicaid Services (CMS), “Ohio EHB benchmark plan,” http://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/ohio-ehb-benchmark-plan.pdf, accessed October 3, 2014; and CMS, “California EHB benchmark plan,” http://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/california-ehb-benchmark-plan.pdf, accessed October 3, 2014.
54 CMS, “Ohio EHB benchmark plan,” and CMS, “California EHB benchmark plan”.
55 NSCL, “State laws related to insurance coverage for infertility treatment,” updated June 2014, http://www.ncsl.org/research/health/insurance-coverage-for-infertility-laws.aspx, accessed April 29, 2015.
57 Fertility Within Reach, “Essential health benefit plans and infertility state mandates,” updated May 14, 2013, http://www.fertilitywithinreach.org/blog/essential-health-benefit-plans-and-infertility-state-mandates/, accessed April 30, 2015.
58 Resolve, “The affordable care act and infertility,” updated February 17, 2014, http://www.resolve.org/get-involved/the-center-for-infertility-justice/public-policy/the-affordable-care-act-and-infertility.html, accessed April 30, 2015.
59 Skinner, Daniel, “Defining medical necessity under the Patient Protection and Affordable Care Act,” Public Administration Review , 2013, 73(S1): S49S59.
60 Jost, Timothy Stoltzfus, Health insurance exchanges and the affordable care act: key policy issues (New York: The Commonwealth Fund, 2010), p. vi.
61 Jost, p. 11.
62 Frank Newport, “Majority say not gov’t duty to provide healthcare for all,” Gallup, November 20, 2014, http://www.gallup.com/poll/179501/majority-say-not-gov-duty-provide-healthcare.aspx, accessed August 11, 2015.
63 Democratic National Committee, “Health Care,” https://www.democrats.org/issues/health-care, accessed November 6, 2015.
64 United Nations, “The Universal Declaration of Human Rights,” http://www.un.org/en/documents/udhr/, accessed August 11, 2015.
65 See IRS publication 502, http://www.irs.gov/publications/p502/index.html, accessed August 11, 2015.
66 Cigna, “HSA, FSA, HRA: Eligible and Ineligible Expenses,” http://www.cigna.com/qualified-health-care-expenses, accessed August 11, 2015.
67 Reproductive Medicine Associates of New Jersey, “How will the ACA affect infertility benefits,” November 7, 2013, http://www.rmanj.com/2013/11/will-affordable-care-act-affect-infertility-benefits.
68 Internal Revenue Service, “Health Savings Accounts and Other Tax-Favored Health Plans,” Publication 969, March 10, 2015, https://www.irs.gov/pub/irs-pdf/p969.pdf.
69 Ashlea Ebeling, “New Healthcare Flexible Spending Account Rules for 2013, Use-It-Or Lose-It Still Undecided,” Forbes, November 16, 2012, http://www.forbes.com/sites/ashleaebeling/2012/11/16/new-healthcare-flexible-spending-account-rules-for-2013-use-it-or-lose-it-still-undecided, accessed August 11, 2015.
70 Ebeling.
71 Brezina, Paul R., Shah, Anish A., Myers, Evan R., Huang, Andy, and Decherney, Alan H., “How Obamacare will impact reproductive health,” Seminars in Reproductive Medicine , 2013, 31(3): 189197.
72 Kaiser Health Tracking Poll, “Percent who say they feel favorable about each of the following elements of the health reform law,” March 2013, http://kff.org/health-reform/poll-finding/march-2013-tracking-poll/, accessed October 11, 2014.
73 Resolve.
74 Brezina et al.
75 NCSL, “Essential health benefits implementation studies and examples,” updated June 2014, http://www.ncsl.org/research/health/state-ins-mandates-and-aca-essential-benefits.aspx#essential, accessed October 3, 2014.
76 Meena Hart Duerson, “Nadya ‘Octomom’ Suleman admits IVF fertility treatments were a ‘mistake,”’ New York Daily News, April 8, 2012.
77 Stapleton; Meredith Leigh Birdsall, “An exploration of ‘the wild west of reproductive technology’: ethical and feminist perspectives on sex-selection practices in the United States,” William and Mary Journal of Women and the Law, 2010, 17(1): 223–247; Alexander N. Hecht, “The wild wild west: inadequate regulation of assisted reproductive technology,” Houston Journal of Health Law and Policy, 2001, 1: 227–261; Kimberly M. Mutcherson, “Welcome to the wild west: protecting access to cross border fertility care in the United States,” Cornell Journal of Law and Public Policy, 2012, 22(2): 349–393.
78 Warnock, Mary, Making Babies: Is There a Right to Have Children? (New York: Oxford University Press, 2002).
79 Henry Stern, “Medical necessity vs. IVF,” InsureBlog, October 14, 2005, http://insureblog.blogspot.com/2005/10/medical-necessity-vs-ivf.html, accessed October 3, 2014.
80 Thomas J. Papadimos, “Healthcare access as a right, not a privilege: a construct of Western thought,” Philosophy, Ethics, and Humanities in Medicine, 2007, 2: 2, http://www.peh-med.com/content/2/1/2, accessed October 10, 2015.
81 Associated Press, “Costa Rica: ban on in vitro fertilization is struck down,” The New York Times, December 21, 2012, http://www.nytimes.com/2012/12/22/world/americas/costa-rican-ban-on-in-vitro-fertilization-is-struck-down.html, accessed October 3, 2014.
82 Rome Statute of the International Criminal Court, http://legal.un.org/icc/statute/romefra.htm, accessed October 3, 2014.
83 Berg Brigham, K., Cadier, B., and Chevreul, K., “The diversity of regulation and public financing of IVF in Europe and its impact on utilization,” Human Reproduction , 2013, 28(3): 666675.
84 Ben Tufft, “UK citizens are the most likely in Europe to go abroad to find a surrogate mother,” The Independent, March 15, 2015; Britta C. Van Beers, “Is Europe ‘giving in to baby markets?’ reproductive tourism in Europe and the gradual erosion of existing legal limits to reproductive markets,” Medical Law Review, 2015, 23(1): 103–134; F. Shenfield, J. de Mouzon, G. Pennings, A. P. Ferraretti, A. Nyboe Andersen, G. de Wert, and V. Goossens, “Cross border reproductive care in six European countries,” Human Reproduction, 2010, 25(6): 1361–1368.
85 Shenfield et al.; Sarah Boseley, “NHS restrictions prompt fertility tourism boom,” The Guardian, June 30, 2009.
86 See, for example, Norman Daniels, Just Health: Meeting Health Needs Fairly (New York: Cambridge University Press, 2008).
87 Rebecca J. Cook, Bernard M. Dickens, and Mahmoud F. Fathalla, Reproductive Health and Human Rights: Integrating Medicine, Ethics and the Law (Oxford: Oxford University Press, 2003), p. 3.
88 VanLare, Jordan M. and Conway, Patrick H., “Value-Based Purchasing—National Programs to Move from Volume to Value,” New England Journal of Medicine , 2012, 367(21): 292295.
89 Ryan Abbott and Carl Stevens, “Redefining medical necessity: a consumer-driven solution to the U.S. health care crisis,” Loyola of Los Angeles Law Review, 2014, 47(4): 943–966.
90 King, Leslie and Meyer, Madonna Harrington, “The politics of reproductive benefits: U.S. insurance coverage of contraceptive and infertility treatments,” Gender & Society , 1997, 11(1):, 8–30, at 8.
91 Matt Broaddus, “Childless adults who become eligible for medicaid in 2014 should receive standard benefits package,” Center on Budget and Policy Priorities (report), July 6, 2010.
92 Skoch, Ive Roze, “Why is IVF so expensive in the United States?” Newsweek, July 21, 2010.
93 Connolly, Mark P., Hoorens, Stijn, and Chambers, Georgina M., “The costs and consequences of assisted reproductive technology: an economic perspective,” Human Reproduction Update , 2010, 16(6): 603613.
94 Fertility Within Reach, “Essential health benefit plans and infertility state mandates,” May 14, 2013,http://www.fertilitywithinreach.org/blog/essential-health-benefit-plans-and-infertility-state-mandates/, accessed July 23, 2015.
95 Danielle Friedman, “Perk up: Facebook and Apple now pay for women to freeze eggs,” NBC News, October 14, 2014, http://www.nbcnews.com/news/us-news/perk-facebook-apple-now-pay-women-freeze-eggs-n225011, accessed October 14, 2014.
96 John Lawrence Hill, “What does it mean to be a ‘parent’? The claims of biology as the base for parental rights,” New York University Law Review, 1991, 353: 388–417, and Howard Fink and June Carbone, “Between private ordering and public fiat: a new paradigm for family law decision-making,” Journal of Law and Family Studies, 2003, 5(1): 18–69.
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