How does health care reform impact fertility treatment?

Since the healthcare reform bill does not address specific diseases, infertility is not addressed in the bill. However, in 2014, small businesses and individuals will begin to purchase health insurance under the state-based American Health Benefit Exchanges so it may be included in these policies. Also in 2014, an “essential health benefits package” will be drafted. The intent is to include a comprehensive list of services, but it cannot be more extensive than a typical employer plan. Since this plan has not yet been drafted, the details are forthcoming.

Currently, several states have mandates requiring insurance coverage for the diagnosis and treatment of infertility. Florida is not among those mandated states. The plan does not specifically address state mandates so this will be an issue to watch.
On a positive note, the elimination of lifetime caps is a benefit for fertility patients. Patients who have a premature birth or need specific prenatal or neonatal care can often exceed the lifetime caps set by insurance companies.

In addition, the elimination of pre-existing conditions exclusion is also a plus for fertility patients. In some cases, patients have been denied coverage due to their pre-existing condition of infertility. Under the new reform bill, companies can no longer deny coverage based on pre-existing conditions.

The National Infertility Association, RESOLVE, has been monitoring the health reform discussions since they began and has met with Members of Congress to convey the needs of infertility patients in the U.S. While RESOLVE did not endorse any specific healthcare reform legislation, as a member of the National Health Council RESOLVE does support the Council’s Campaign to Put Patients First, a campaign which has identified five health care principles that must be part of meaningful healthcare reform.  As the new reform law is implemented, RESOLVE will continue to advocate for the millions of Americans with infertility to ensure their voice is heard.
For more information on fertility treatments or health reform, visit or call 239-275-8118.