The Times is midway through a really great series on the financial, physical, and emotional wreckage often left in the wake of extreme fertility treatments. What hasn't been addressed -- at least, so far -- is how health reform would alter this landscape. As I reported in a piece for Double X, other countries highly regulate fertility clinics in order to tamp down on dangerous multiple births.
Britain’s National Health Service pays for every infertile woman to undergo three IVF cycles. And, sure enough, in the United Kingdom, single embryo transfers are the norm, and preimplantation genetic diagnosis (PGD) is generally used only when the parents’ medical history suggests an increased risk for fetal genetic abnormalities.
In the United States, however, we have a classic divide between haves and have-nots. For the poor, even basic prenatal genetic testing can be out of reach. Medicaid pays for 40 percent of American pregnancies—1.6 million annually. But while 46 states and the District of Columbia provide some Medicaid coverage for prenatal genetic testing, the reimbursement rates are low, and parents often can’t afford to pay the rest of the bill.
The health-reform bills in front of Congress don't address these issues -- they leave it up to the Department of Health and Human Services, after reform passes, to decide what specific procedures should be covered and regulated. If fertility treatments and genetic testing were defined as part of a basic care package, though, it would allow for increased government regulation of this industry, which, as the Times reports, is currently driven both by its own profit margins and by patients' inability to pay for multiple rounds of IVF, which leads couples to demand that several fetuses be transferred at once into the woman's uterus.
It all serves as a reminder that there will be a lot of controversial health policy-making to be done after a reform bill makes it through Congress. In many ways, we're just beginning this process.