ReedyBear's Blog

Illinois ballot measure to extend IVF insurance coverage

In 6 days I will vote on this advisory ballot measure:

Should all medically appropriate assisted reproductive treatments, including, but not limited to, in vitro fertilization, be covered by any health insurance plan in Illinois that provides coverage for pregnancy benefits, without limitation on the number of treatments?"

I started by writing about where I'm at, but then I read a lot of stuff and took notes below and wrote my conclusions above it.

The question is advisory, so it will still be up to our representatives to actually pass a law or not.

For an inquiry into costs of IVF mandates, see https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/

Conclusions

(I wrote most of the below from memory. I did not fact check after writing my conclusions)

Illinois already has expansive reproductive coverage. We have an IVF mandate, but after a person has had 4 egg retrievals, that mandate ends, meaning somebody gets 4 attempts at IVF. If you have a baby, you get two more attempts. State government employees have additional coverage.

I have some concerns about eugenics. IVF can be used to select gender and traits, though my limited reading on the topic suggests that the selection process in IVF is mainly about getting healthy embryos that are likely to grow into babies. And it seems genetic-screening is a standard part of that selection, like to verify there is the correct number of chromosomes. If I saw evidence of widespread use of IVF for the purpose of gender and trait-selection, I would likely oppose IVF. I have not seen that evidence, but I also have not looked specifically for it.

I am highly interested in granting people access to health care they need. I realize infertility is a disease that can be treated, and IVF is a treatment for infertility. A fair (and advanced) society would provide health care to treat diseases for all people. Part of this is meeting individual needs, and part of this is gender equality, since IVF uniquely impacts women and AFAB folks. And if men/amab get access to freezing sperm, to fertility treatments, etc then women/afab deserve fertility care too.

I'm very concerned about the broader impact on healthcare costs. Expanding IVF access is likely to increase insurance premiums for all plans that cover pregnancy. IVF costs $18,000+ per-treatment, and successful birth from IVF costs around $60,000 on average. I am concerned that an increase in insurance premiums could price-out some poor people and cause them to lose healthcare all-together, or create financial hardships that limit other aspects of living a healthy life (like affording healthy food). I have more reading to do, but it sounds like increases in premiums are rather small ($1-$5 monthly).

There were 6,350,142 women in Illinois in 2020. 2% of that is 127,002. Less than 2% of women get IVF care, and seemingly less than 10% of those women (based on bad math of my own) require more than 4 treatments. Since Illinois already requires coverage of 4 IVF treatments, I just don't think the increased cost over-all would be that significant if unlimited IVF treatments are allowed.

Additionally, people who previously would save money and cover out-of-pocket expenses themselves would now be able to spend that money in consumer markets, or to save that money, pass it down to their kids, etc. It's pretty weird for me reading about people who saved up $20,000+ to get IVF treatments. I can't afford to fix a hole in my tire. I don't know.

I'm concerned about wealth/poverty discrimination. If wealthy people can access IVF, then poor people should be able to as well.

This ballot measure is not JUST about IVF, and I don't know what its implications are beyond the IVF component of it.

I read that Democrats put the IVF question on the ballot to motivate voters to go to the polls, which I didn't read into, but I'm inclined to believe it. Illinois only allows 3 advisory ballot measures on a ballot. I'm frankly rather upset that one of those questions is about IVF specifically.

I'd prefer a question about ranked choice voting, a question about state-run healthcare-for-all, a question about withholding military aid to Israel, or probably many other things.

I do care about meeting people's fertility needs. But I also live in a world that requires me to be pragmatic. My ideological views don't work in reality. There should maybe be 10 advisory ballot questions, idk. But there aren't and there can't be with how things are, so I have to value some things higher than others. We should address the greed of the healthcare system overall, but that's not the ballot question, so it's not the decision I get to make on Tuesday.

I need to read more of KFF's analysis, and their linked sources. I need to look into whether IVF is used for eugenics in Illinois (I don't think it is, but I want to know.).

I'm sympathetic to religious arguments, and my gut pulls that way a little bit, but this is not convincing for me. I'm concerned about the impact on adoption rates, but this isn't something I'm considering in my vote. I'm concerned about getting people the health care they need, and this is a dominating concern. I am concerned about eugenics, but I don't know enough yet and I'm opting to believe its not a problem based on my limited knowledge. I am extremely concerned about the money, how IVF care could compromise other more essential health care, and I am not knowledgeable enough on this topic yet, but what I have read suggests that increases in premiums would be quite small, so this concern is not dominating.

Altogether, I'm 93% sure that I'm a yes vote, primarily driven by my belief in a right to health care, and my belief in gender equality. My other concerns do not outweigh those two driving values. It is possible that my mind could be changed on cost or eugenics if I learn more and the facts are damning.

IVF Usage rates

"[KFF's analysis] of the 2015-2017 National Survey of Family Growth (NSFG) finds that 10% of women ages 18-49 say they or their partner have ever talked to a doctor about ways to help them become pregnant."

IVF treatments are higher in states with IVF mandates. White women are more likely to seek infertility care than black or hispanic women. 7% get advice, 2% get 'artificial insemination', 2% get 'other procedures'. 'Other procedures' includes IVF or surgery to clear blocked tubes. 55% of women under age 35 are successful on their first IVF treatment, whereas 47% of all treatments on women under 35 are successful. Overall success rate is 34% for ages 35-37, 22% for ages 38-40, and 7% for ages 40+. There were about 6,350,142 women in Illinois in 2020.

If 2% of all 6,350,142 women in Illinois had ever used IVF, then the number of women who would not have a successful pregnancy under illinois law would be as follows.

For simplicity, we'll use the 47% IVF success rate for all individuals, or 53% failure rate. 2% of 6,350,142 women is 127,002. Treatment Round 1 would leave 67,311 women not-pregnant. Round 2 leaves 35,764 not pregnant. Round 3 leaves 18,955 women not pregnant. Round 4 leaves 10,046 people not pregnant.

This is a gross oversimplification for so many reasons. But if we accept this highly flawed, 10,046 number, then this is the group that is actually impacted by this IVF question. The other ~117,000 IVF patients would be unaffected. (Note, the actual ballot question is very broad and does NOT just ask about IVF)

This number could be useful for considering how it would affect costs, but I'm not doing that deep of an analysis myself. It does suggest to me that the increased costs should be relatively small. For contrast, if 20% of all women required 10 rounds of IVF treatment in their lifetimes then costs would be significantly higher. Instead it's 2% who need IVF treatment at all (and actually less bc IVF is grouped in 'other procedures'), and probably less than 10% of people who use IVF need more than 4 treatments.

After 90 minutes of research, I've found nothing tangible about how this will affect insurance premiums. Basically all the arguments I'm running into are religious or emotional or about individual impact and individual rights to fertility treatments. (I wrote this before I found the KFF source)

The main thing I care about is: Will expanding IVF coverage cause an increase in premiums that will harm poor people in illinois? And I can't find an answer.

The best source i've found so far on the costs question is Coverage & use of fertility services and it doesn't sound like its that bad, bad cost wise. I need to do more reading.

My initial perspective and thoughts

I want medical treatments to be widely available to everybody who needs them. I do not believe that poverty should be a barrier to accessing available medical treatments, so my starting-point is a 'yes' vote.

IVF is a process whereby eggs are fertilized outside of the body, then implanted into the uterus. In this process, several embryos will be destroyed. The healthiest (most likely to survive) embryos will be implanted, and any unhealthy embryos are discarded. I find this selection process acceptable, and I'm only slightly bothered by the destruction of embryos - not enough to stop me from supporting IVF. (I read two articles a little while ago explaining this, and I'm satisfied with my understanding.)

IVF can be used to select for gender or other traits, based on genetic testing. I am strongly opposed to this on ... moral grounds? I'm concerned about eugenics, about master-races, about IVF babies having an advantage over traditionally-conceived babies thanks to genetic selection.

This concern does sway me a bit, but I don't know how much this gender-and-trait selection is actually practiced, if at all in Illinois. I also don't think this concern is enough to sway my vote to a 'no', but if it's extremely widely practiced, then maybe.

My biggest point of contention is the money. A news I watched today said that IVF treatments cost like $18,000 PER TREATMENT, that currently under IL law, 4 IVF treatments are covered by plans that include pregnancy coverage, and that lawmakers could remove this 4-treatment limit (that is the purpose of the ballot question, whether or not to remove the limit).

I am concerned that expanding IVF coverage will lead to an increase in insurance premiums, causing impoverished families to become financially harmed and less able to support their own needs.

If it were something like "Expanding IVF will cause 10,000 families to be unable to afford health insurance" then I would vote no. I would rather broader access to basic health insurance, and less financial burden, especially on poor people.

I do believe that IVF is a privilege, not a right. (Edit: I've changed my mind, I think. I think I believe it is a right.) Whereas I believe access to primary care doctors, hospitals for illnesses, and other treatments necessary for healthy life are a right. I do not want to support this IVF measure if it will erode these rights that I care more about.

There also comes the issue of gender equality, and the fact that I'm a bio-male who would never need IVF. I feel its not exactly my place to say "no, you can't access that treatment" to a woman who needs it in order to conceive. So is there a similar medical treatment for men & is it covered, unrestricted, by health insurance in Illinois?

If there were something LIKE ivf for men and they get 100% coverage of that, then it would be unfair for women to be denied that same access.

I'm also wondering if increasing IVF access will lead to fewer adoptions. I don't want this to sway my vote one way or the other, because looking at it that way is kind of ... using the government to manipulate people's behavior. I'm not super chill with that, but I am curious, and it would be a problem if more children were left without good homes.

Rambling over, what questions do I need answers to?

Questions I have

Notes and thoughts

Reading

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