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How the Affordable Care Act Forgot About 7.3 Million Infertiles

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a blog by Jenn Nixon, October 2, 2013

October 1st marks the opening of the Health Insurance Marketplace, a vital element of the Affordable Care Act (ACA), which allows individuals, families, and even small businesses the opportunity to purchase health coverage. With the latest “Obamacare” overhaul of the insurance system, one might have assumed that our elected leaders considered adding provisions for their 7.3 million constituents who struggle with infertility.


Though the passing of the Affordable Care Act would have been the perfect opportunity to add in required mandates for infertility coverage, the bill went through without a single one.
Instead, the government made a list of 10 “essential health benefits” that must be included in every state-run healthcare exchange:

- Ambulatory patient services
- Emergency service
- Hospitalization
- Maternity and Newborn care
- Mental health and substance abuse disorder services
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services

The Department of Health and Human Services had the folks at the Institute of Medicine come up with this list, requesting that they not mention specific medical treatments, but instead leave room for interpretation. It is up to each individual state to decide what specific services it will include. As of now only 15 states have requirements for infertility coverage, and theirs are minimal at best.

Having to pay thousands of dollars for a chance at becoming pregnant comes with the territory of infertility. I am used to this being a reality. It’s fine elected leaders; just continue to ignore 2.3% of the population.

The real reason I am slightly frustrated at the Affordable Care Act is because of its impact on tax credits and flexible spending accounts; the two things Infertiles had going for them to help pay for treatment.

Beginning in January 2013, any non-reimbursable medical expenses that exceed 10% of your adjusted gross income can be deducted (this does include treatments for infertility, see Publication 502). That sounds great right? Except the percentage used to be 7.5% of your AGI; the Affordable Care Act raised that beginning this year.

2.5% doesn’t sound like a lot, but trust me it is. Let’s say your AGI was $100,000 in 2012 (the year before the change), then you could claim any medical expenses that exceed $7,500. In 2013, that amount is now raised to anything over $10,000. So this means you have to have more medical expenses to qualify for this tax deduction.

Another change that started in 2013, is the cap on Flexible Spending Accounts (FSA). If you have one, you know how it works: each month pre-taxed dollars are taken out of your paycheck to be set aside in an account which can be used toward any medical expenses you incur. Until this year, the IRS has not limited the amount which you could save, but with the ACA the cap is now at $2,500. Typically an employer determined how much could be set aside, so for many people this amount is less than what they were previously allowed.

Both of these savings have been utilized by many struggling to pay for fertility treatments, myself included. With infertility coverage not being specifically mentioned in the ACA, it is up to states to decide how to handle care. It is disappointing that with such a large reconstruction of our country’s healthcare system, legislators didn’t include fertility treatment coverage as part of their plan. Instead, they limited two of the very few ways we can save money on the thousands of dollars we pay out-of-pocket to become parents.

Comments (1)

Just this morning I was Googling the infertility coverage under the new healthcare reform and surprisingly couldn't find much... well, maybe not so surprisingly. Thank you for breaking this down into something that was much easier to understand.

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