NCPA - National Center for Policy Analysis

Forcing Insurers to Cover Expensive Health Treatments

December 19, 2001

Most states leave it up to employers to decide what treatments to cover in their health insurance policies.

But 10 states now force employers to cover infertility treatments, for example -- which can run $10,000 or more a try. Other high-ticket therapies demanded by activists include those for mental illnesses, contraception and drugs such as the impotence pill, Viagra.

Such demands come as health inflation is rising at its fastest clip in a decade and employers are looking for ways to reduce spending and shift more costs to workers.

  • On one side, health-benefits advocates see no distinction between coverage for infertility treatments and chemotherapy -- and view parenthood as a right.
  • Others argue that infertility is not a life-threatening disease -- and point out that fertile couples should not have to subsidize those who are infertile through higher insurance premiums.
  • In addition to the 10 states that require coverage of at least some infertility treatments, four more -- New York, Connecticut, Texas and California -- require insurers to offer coverage, but don't require employers to include it in their health plans.
  • Fifteen states debated infertility coverage this year -- but New Jersey was the only one to adopt a requirement.

Among insurance policies offered by large employers, less than 20 percent cover in vitro fertilization and even fewer cover more advanced techniques, according to the benefits firm William M. Mercer. About half of policies cover an evaluation by a specialist and about one-third cover some type of drug therapy for infertility.

Source: Julie Appleby, "Pricey Infertility Care Sparks Insurance Clash," USA Today, December 19, 2001.


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