Bill would expand Md. in vitro insurance to cover unwed women

ANNAPOLIS (Feb. 15, 2020)—A Maryland mandate that health insurance plans pay for in vitro fertilization doesn't cover unwed women.

But a bill filed in the General Assembly and supported by the Women's Law Center of Maryland aims to end the state's distinction of a woman's marital status, expanding coverage under certain insurance plans that is already offered to heterosexual and homosexual couples.

The bill would also decrease the time any woman must try and fail to conceive by other methods before insurance must pay—reducing the requirement from two years to one.

The change would help people like Dr. Deborah Brooks, an assistant professor at the University of Maryland School of Medicine. She expected her state insurance to cover the fertility treatments she needed to conceive.

"They say, 'We're sorry, you're not married, you're paying out of pocket.'" Brooks told the House Health and Government Operations Committee Thursday. "If I was married, and all of my colleagues (who were married), this was all covered."

It was calls from Brooks and other women to the bill's sponsor, Sen. Shelly Hettleman, D-Baltimore County, and the Women's Law Center of Maryland that prompted the legislation.

"It seemed fundamentally unfair to me that some women were being excluded from the ability to start a family based on their marital status," said Michelle Daugherty Siri, the law center's executive director who had both of her children with in vitro fertilization. "Especially that our laws would have anything that distinguishes between married and unmarried individuals."

Maryland is one of 16 states that mandates some form of coverage for in vitro fertilizations, but is also one of five that only applies the rule to married couples, according to a Maryland Department of Legislative Services analysis. Maryland law requires most health insurance providers cover the cost after a couple has failed to conceive through less costly infertility treatments like artificial insemination.

If the legislature passes this bill, Maryland would follow New York and New Jersey in updating their laws to ensure unwed women have coverage, said Rebecca Flick, chief external affairs officer of RESOLVE: The National Infertility Association. The organization supports the Maryland bill.

"It's modern family-building and this is 2020. Providing coverage to as many people as possible who need assistance is the right thing to do," Flick told Capital News Service.

"For those that are faced with the disease of infertility, it's a medical health issue."

Maryland lawmakers last changed the law in 2015, when it expanded the in vitro mandate to cover homosexual couples.

House bill 781 and a cross-filed version in the Senate, bill 988, would halve the number of years a women must try and fail to conceive to one, as well as the number of times they must try less costly procedures, from six to three. The bill would take effect in 2021.

Maryland also caps the number of covered in vitro treatments a woman may have per birth to three. It also limits the maximum lifetime benefit to $100,000.

Under current law, a woman must show a history of infertility of at least two years or suffer from specified diseases, including endometriosis. The law does not generally apply to small businesses.

Advocates said the reduced period a woman must wait to get in vitro fertilization treatment covered could actually save health insurance providers money because a woman would be younger when she starts the treatment.

A study published by the American Society for Reproductive Medicine in 2010 found the rate of pregnancies went up and the cost per couple was reduced by $2,624 when women skipped three tries at artificial insemination before starting in vitro fertilization.

Advocates said they have worked with representatives of the health insurance industry to try to gain their support. No one testified in opposition.

The bill is scheduled to be heard by the Senate Finance Committee on Feb. 26.

Brooks won't have to wait for the legislature to act. Because in vitro was "prohibitively expensive," she tried a fourth artificial insemination procedure even though the odds were against her.

She got lucky.

Now, she's expecting a child—and for women to get equal treatment regardless of their marital status. Hettleman sees it in a similar way.

"If there are real medical reasons why someone hasn't been able to get pregnant, we should provide that same sort of coverage to people who are not married that still want a child," Hettleman said.

"Having a child is a really difficult process and an enormous decision … this is an equity issue."

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