Health & Science

Could Health Care Reform Prevent Another Octomom?

How Obama’s plan could affect genetic testing and fertility treatment.

The various health care bills in front of Congress don’t specify which procedures insurance plans must provide upon passage of the legislation. That will probably be up to the Department of Health and Human Services, after President Obama signs the final bill into law. But what’s certain is that for the first time, insurers will be regulated. The result will be a basic package of care all insurers must provide.

Advocates on both sides are up in arms over whether abortion will be covered in that basic plan. But assisted reproduction, a field that has grown exponentially over the past decade, has so far been ignored. That’s shortsighted. Infertility treatments and prenatal genetic testing are becoming some of the most expensive and ethically controversial parts of our health care system. As the Octomom debacle demonstrated, the field is crying out for regulation. Done right, President Obama’s universal-health-care push could accomplish that. But first, policymakers will have to mediate some uncomfortable debates between advocates for reproductive rights and disability rights.

As couples are increasingly able to overcome infertility, and then learn about the DNA of their fetuses, two major concerns are emerging that affect the health reform debate. First, patients who can’t afford to pay out of pocket don’t have the same access to infertility treatments and prenatal genetic testing as patients who can. In addition, there is evidence that regardless of whether patients have insurance or can pay, they aren’t receiving accurate information about the failure rates of prenatal genetic tests or about what life is like for people who have genetic diseases. That could be contributing both to more abortions and to a greater stigma associated with raising a disabled child.

The menu for assisted reproduction and prenatal testing grows longer each year. For about $1,000, doctors can now screen prenatally not only for Down syndrome but also for cystic fibrosis, Huntington’s Disease, hemophilia, and sickle cell anemia. Expensive new technology is coming down the pike that will offer parents the option of getting a definitive prenatal Down syndrome diagnosis as early as the first trimester, through a blood test that isolates fetal DNA from maternal DNA. And in the near future, it may be possible to identify, in utero, a gene for autism.

With preimplantation genetic diagnosis, or PGD—which costs up to $5,000 and is rarely covered by insurance—even an embryo conceived in a Petri dish via IVF (up to $15,000 out of pocket) can be tested for genetic abnormalities. Selected embryos can be implanted in the uterus, often two, three, or even more at a time.

Who should get each of these services and tests, and how much should patients pay? Which procedures should Obama’s health care plan require insurance plans to cover—state-of-the-art testing and treatment, or a more basic and modest package? And what about the expense posed by pregnancies with multiple fetuses, because of the high health risks for both moms and babies—who bears it?

It’s no wonder that American couples battling infertility often opt for the combination of PGD and multiple implantation, which they believe will increase their chances of giving birth to a healthy baby without the travails of additional rounds of IVF. But luxury fertility treatments open up a tricky debate about the rationing of care. Remember President Obama’s vow to “bend the cost curve” by tamping down on unnecessary medical procedures? Many experts see PGD and multiple implantations as prime culprits for unaffordable spending. Exhibit A through G, of course, is Octomom Nadya Suleman, whose doctor ignored professional guidelines by implanting six embryos, two of which split into twins, in her uterus. Also to blame is the trend of for-profit clinics advertising elective PGD to couples who want to choose their baby’s sex or even eye and hair color. “Clinics are in this totally out-of-pocket, for-profit environment,” says Susannah Baruch, a Washington-based lawyer and policy consultant specializing in reproductive genetics.

Tags: genetic testing, in vitro fertilization, nadya suleman, Octomom, pre-implantation diagnosis

Dana Goldstein Dana Goldstein is an associate editor at the American Prospect, where she covers politics, women's issues, and education.

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