Yes, But...

I'll support it, but I'm actually really disappointed by it.

Resolve has revealed the Family Building Act of 2011, or Senate Bill 965, introduced by Senator Kirsten Gillibrand to create a tax credit for certain out of pocket costs associated with infertility.

Having spent nearly 50% of our gross income trying to start our family last year, since our insurance specifically excludes anything remotely related to infertility, I feel strongly that something needs to change. However this feels like a misguided attempt to 'fix' the problem, potentially creating a whole mess of additional problems for us infertile to have to deal with.

This plan will only cover costs associated with IVF. Only a fraction of the medical expenses that ML and I incurred last year would have qualified for this Family Building tax credit. Our diagnosis wasn't simple, and neither was our treatment plan.  Do we really want a tax code that handles medical credits and deductions on a case by case basis? It just doesn't feel right to me. It feels like we are leaving behind a huge segment of our ALI community. 

I think that most of us would agree that insurance mandates for infertility coverage would be an ideal place to start the discussions. Unfortunately I understand just how difficult that fight can be considering that I've been fighting unsuccessfully for California to simply require maternity coverage as a basic health benefit. In fact our governor vetoed such legislation at the urging of the (evil) insurance companies the past 4 years in a row.

Current federal tax law allows for a tax deduction for any medical costs over 7% of your income. In our case we  were able to deduct a significant portion of our medical expense, and will likely be in a similar situation again this year. Tax credits/deductions require that you spend the money first, then are able to play the tax game to hopefully recoup some percentage of your expenses. This is not an option for every family, nor is every family in a position to reach the 7% threshold in any given year. I assure you that it is a financially painful achievement.

If we really wanted to support hard working families, we'd start by making sure that they have access to comprehensive health insurance so that they don't incur huge medical costs in the first place. And if we can't do that, then then we should simply lower the 7% threshold so that they can deduct more of their costs. Its not a perfect solution, but it would be a step in the right direction.

I am not in favor of creating new, complicated tax rules that will only benefit certain individuals with certain conditions to receive certain treatments. This sounds to me like one more frustrating complexity that we will be left to figure out on our own, and it just rubs me the wrong way.

I'm also really put off by the idea that IVF is the only meaningful cost of infertility. We just spent a week busting myths, one being that IVF is the only treatment for infertility, that IVF is always successful, that IVF is the answer. It is just so disrespectful to our experience, and the experience of so many others, to suggest with this legislation that IVF is the only cost that really 'matters'.

Ideally, a Family Building Act would support public health goals that represent savings to the health care system. For example, insurance companies who do pay for IVF can restrict the number of embryos transferred resulting in more full term healthy babies born. The increased cost of IVF would be offset by the significant savings in NICU stays for preterm multiples. I'm not sure that I see the connection to public health in this legislation. In fact I perceive what might be perverse incentives in this legislation. IVF is not the best or first choice for every infertile couple, but when you start subsidizing one treatment option among many you start to disincentivize other potential more appropriate treatment options.

I do think it is commendable that RESOLVE is venturing into the political realm with this campaign, and I will of course support the Bill by contacting my US Senators and asking them to sign on a co-authors.

I understand only too well that in order to bring about change that we must stand together with one loud voice. I also understand that this is only one small first step toward the real changes that we know are necessary.

You can support it too by visiting http://www.resolve.org/family-building-options/insurance_coverage/federal-laws.html and following the links to contact your US Senators.

However I'm really disappointed that this is the best we could come up with.

Key provisions of the Fertility Act of 2011:

• The Family Act covers the out-of-pocket costs associated with in vitro fertilization (IVF) including diagnostic tests, laboratory charges, professional charges, and medications for IVF.
• The Family Act covers the out-of-pocket costs of fertility preservation procedures if the man or woman is diagnosed with cancer and the cancer treatment or disease itself may result in infertility.
• The Family Act has a cost sharing provision allowing 50% of all applicable medical expenses to be  covered up to a lifetime maximum of $13,360. You would need to have out-of-pocket costs totaling $26,720 to claim the entire credit in your lifetime.
• If you do not owe taxes in a particular year, do not owe enough taxes to use the whole credit, or do not reach the max amount in one tax year, it carries over to the next year for a max of five years after the first year you use the credit. 
• The Family Act is available to couples filing jointly with adjusted gross incomes of less than $222,520, but the credit is smaller for those earning between $182,500 and $222,520.