CLEVELAND (WJW) — A same-sex married couple from Akron is suing their insurers, claiming they were denied the in vitro fertilization coverage they need to conceive a child, despite the procedure being covered for couples. heterosexuals.
Natalie Altizer and her wife “just want to start a family,” reads a press release from their attorney Mark Herron of Lyndhurst.
But IVF and related services could cost them more than $100,000 out of pocket, according to the couple’s federal discrimination lawsuit filed earlier this month against Atizer’s employer, the Summit County Board of Developmental Disabilities and others. They claim they are denied insurance coverage on the basis of gender, which is a violation of the Affordable Care Act.
This health care law was signed into law in 2010 during the administration of President Barack Obama. But legal analysts told FOX 8 that its definition of sex discrimination changed after President Donald Trump took office. That could change again under new federal regulations proposed by President Joe Biden’s administration that are currently underway.
Self-donor vs “other” donor
Altizer and her spouse are insured by the Stark County Board of School Governments, a large consortium of government agencies like the Summit County Board and other public entities like schools and libraries. The board contracts with Medical Mutual of Ohio and AultCare Insurance Company to administer the workers’ self-funded plan.
This plan covers infertility services like hormone injections and surgery, but only covers in vitro fertilization if the donated sperm comes from the insured person’s spouse – called a “self-donor” – rather than from a outside donor or “other”, as per a copy of the council’s benefits plan attached to the couple’s complaint.
Because Altizer’s wife is female, she needs sperm from someone other than her spouse to conceive, and that’s not covered by her plan, Herron said.
“If Natalie was married to a man, we wouldn’t have this problem,” he told FOX 8. “Political language is meant to discriminate against gay LGBTQ couples.”
At the heart of the lawsuit is the question: Does council policy unfairly exclude a same-sex couple in a way that a heterosexual couple would not?
“If it excludes coverage whenever the donor is not a spouse, it’s not necessarily discriminatory,” said Sharona Hoffman, professor of law and bioethics at Case Western Reserve, who reviewed the case at the FOX 8 asks. “There are a lot of cases where in a heterosexual couple the husband doesn’t have sperm.”
Hoffman said she thinks many insurance policies don’t cover IVF, largely because it’s expensive and has a low success rate — and those that do “try to restrict it.”
“Insurers aren’t eager to pay for this,” she said.
In such discrimination lawsuits, a plaintiff may need to prove why IVF is necessary in his case and to explain why he did not opt for a less expensive procedure, such as artificial insemination using sperm donated to a sperm bank, Hoffman said.
Consideration should also be given to the potential impact on other beneficiaries in the insurance group, she said.
“When an insurer pays for a very expensive treatment, it affects everyone in that group because they are likely to raise the rates,” she said. “There are also all sorts of hidden consequences for others.”
A spokesperson for the Summit County Board of Developmental Disabilities sent the following statement to FOX 8:
“Summit DD is one of more than 150 government entities that are members of the Stark County Council of Governments. The Agency has joined the consortium to provide comprehensive and affordable health care benefits to all employees, while remaining financially Accountable to the Ratepayers of Summit County This trial is in its early stages, where Summit DD is one of many named defendants, and we will not comment further except to reiterate our commitment to providing affordable health care to all employees, their spouses and dependents Summit DD’s mission is to break down the barriers of discrimination for people with disabilities who represent the diversity of the greater community, and we do no less for our employees.
Summit County Council for Developmental Disabilities
A spokesperson for Medical Mutual of Ohio declined to comment on the lawsuit against FOX 8 because it is the subject of active litigation. FOX 8 has also reached out to Guangzhou-based AultCare for a response.
Founding a family “is a fundamental right”
What’s unclear in the Summit County case is whether state law comes into play, since the ACA’s anti-discrimination rule only applies to programs that receive support. federal aid, Hoffman said. Ohio law also does not specifically protect against this type of discrimination.
Herron’s lawsuit argues that Altizer’s employer, insurance group and insurers all receive federal assistance — so they would fall under ACA rules.
The lawsuit also alleges that Altizer’s policy violates the 14th Amendment, which protects the rights of citizens, and that “the right to have children and raise a family is a fundamental right,” the lawsuit reads. Heron.
For insurance purposes, infertility is federally defined as the inability to conceive after at least one year of unprotected intercourse – but since cisgender and same-sex couples cannot conceive naturally, this definition does not does not apply directly.
Ohio law does not specifically define infertility in a way that could impact Altizer’s claim. But it’s one of more than a dozen states that require insurers to cover “basic health services,” including infertility treatments, according to the National Conference of State Legislatures.
Back in court in the Northern District of Ohio, records show that Medical Mutual and the Stark County Consortium received Altizer’s complaint. No hearing date has been set and none of the defendant agencies have filed a response.
“Natalie and her partner just want to start a family,” Herron wrote. “His government employer and the insurance companies they contracted with to administer his health insurance policy should not stand in the way.”
Insurance rules have changed
Altizer’s claim points to Section 1557 of the Affordable Care Act, which “prohibits discrimination based on race, color, national origin, sex, age, or disability” in programs federally funded health care. This includes sexual orientation. But the legal interpretation of sex discrimination has changed over the past two presidential administrations, Hoffman said.
In 2020, the Trump administration changed regulations to remove an Obama-era rule preventing insurers from varying benefits in a way that discriminates against certain groups, such as LGBTQ people, according to the Kaiser Family Foundation.
A new federal rule change proposed by the Biden administration would revise the ACA’s non-discrimination regulations to include sexual orientation, aligning it with a 2020 U.S. Supreme Court ruling on discrimination employers against homosexual or transgender workers.
The proposed regulations are currently open for public comment until October 3.
The Summit County lawsuit is now part of a growing number of legal challenges surrounding the issue of coverage discrimination since the Trump-era rule change. Herron said he modeled his costume on a recent case in New York.
In April, attorneys for Corey Briskin and Nicholas Maggipinto, a same-sex married couple receiving city benefits, filed a class action lawsuit against the city with the Equal Employment Opportunity Commission. use.
The couple had been looking forward to starting a family, but they allege the city flatly denies insurance coverage for IVF to same-sex couples, though it does provide coverage to straight and queer cisgender women.
New York City’s benefits policy differs from the Summit County case in that its IVF coverage is only granted to women deemed infertile, and “infertility” is defined to exclude gay men, according to a press release from the couples’ lawyers.
Briskin, a former Manhattan district attorney, said the city’s policy “is based on an archaic idea of the kinds of people who should be biological parents — an idea that’s inconsistent with modern values and the way our society understands equality in 2022”.