Editor’s Note: This article is part of a series looking at the language of Ohio Issue 1 and the reproductive rights it would impact. The full language of the amendment can be found here.
When Roe v. Wade was overturned in June 2022, the physicians at Ohio Reproductive Medicine took to their website, hoping to reassure patients that their care would still be available.
“It is truly hard to fathom that in 2022, our reproductive freedom, a fundamental human right, is now at risk,” the statement on the website read.
Though the Columbus business said it strongly opposed the overturning of Roe as a whole, the focus of their statement was on those undergoing or considering fertility treatments.
“We ardently stand alongside our current and past patients — as well as anyone who wishes to build a family in the future with the help of fertility treatments,” according to the statement.
The effects that repealing nationwide abortion access would have on fertility treatments like in-vitro fertilization (IVF) weren’t clearly spelled out by the U.S. Supreme Court in its Dobbs decision, but physicians have worried about what various bans mean when it comes to fertilized embryos and the definition of the start of life.
A hard-fought battle
Infertility can happen for 10% to 15% of couples, according to the American Society for Reproductive Medicine, and CDC data found 1 in 5 women in the U.S. couldn’t get pregnant after a year of trying.
For those who have insurance and/or can afford fertility treatments, the process is long, arduous, and often involves disappointment along the way if an implanted embryo fails to turn into a pregnancy, or becomes a medical complication.
Ohioans have expressed worry that they won’t be able to utilize fertility treatments in the same way if abortion is banned in the state, whether that be at six-weeks under current law (though that law is held up in court and not currently being enforced), or if other regulations fall into place keeping physicians from treating life-threatening ectopic pregnancies or miscarriages, which are considered “spontaneous abortions” by the medical community.
After the Dobbs v. Jackson Women’s Health Organization ruling from the U.S. Supreme Court overturning nationwide abortion rights, the fears regarding fertility treatments came closer to home, as state Rep. Gary Click, R-Vickery, introduced a bill that would have considered the start of “personhood” to be the moment of conception.
That, physicians said, could include fertilized embryos sitting in cryogenic chambers at their facilities.
The “life begins at conception” message has been used by anti-abortion groups nationwide for many years, though the medical community does not universally agree on the beginning of life, or if there’s one certain point when cardiac activity begins in a fetus.
At a rally one year ago to support anti-abortion causes, state Rep. Jena Powell, R-Arcanum, spoke of ways to “abolish abortion” in the state, making the claim that the “science is crystal clear” that “life begins at conception.”
Powell urged support for the “personhood” bill.
“The shackles are no longer holding us back as state legislators, and we can and we must be a voice for the unborn child in Ohio,” Powell said at the time.
The cost of access
Fertility treatments and the freezing of embryos has become a common practice, but that doesn’t mean it’s available to everyone, because it’s a costly endeavor with complicated insurance regulations.
The Center for Reproductive Rights says barriers to access include “limited information, restrictive laws and policies, stigma, high costs and more.”
“Issues surrounding assisted reproduction implicate core human rights — including the rights to health, sexual and reproductive health, decision making about reproductive life (such as if and when to have children), benefit from scientific progress, equality and non-discrimination and informed consent,” the center said in a statement.
The center’s research on infertility and IVF access in the United States showed that in 2020, clinical infertility impacted about 12% of women ages 15-44, but only 24% of people in the U.S. seeking care for infertility could access it.
“The limited number of private insurance markets and public programs covering infertility services, combined with high out-of-pocket expenses, result in significant economic barriers to needed infertility treatment,” the CRR stated in the report.
Self-pay packages at the University Hospitals Fertility Center in Northeast Ohio, for example, price IVF, including lab work and one embryo transfer at $12,775.
An egg donor package runs $14,030 for self-pay patients, and a surrogate (also called a “gestational carrier”) is priced at more than $15,000.
Ohio law mandates that private health insurance cover basic services, including “medically necessary” services that could fall under fertility treatment. The Ohio Revised Code includes “infertility services” under “preventative health care services.”
Though this could include the diagnosis of infertility and treatment of reproductive system problems, other services involved in the process may not be included.
“Many procedures fall into a gray zone, including IVF, which leaves much interpretation and denial of claims,” according to Ohio Reproductive Medicine.
In 2021, Ohio added “reproductive health services” into the Ohio Administrative Code, allowing Medicaid-eligible individuals access to “pregnancy prevention services,” including “contraceptive management,” pregnancy testing and “fertility awareness.”
What is not covered under Medicaid is infertility treatment, including IVF, “assisted reproductive technologies,” artificial insemination, or surgery to “promote or restore fertility.”
Ohio is not alone in keeping Medicaid recipients out of the fertility treatment landscape, as very few states nationally extend those services through Medicaid.
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