Arkansas Legislature

My Most Recent Failure (Updated!)

(Guest post from occasional Arkansas Project contributor Rep. Dan Greenberg)

My most recent failure—my proposal to reduce health insurance costs in Arkansas by removing the state’s mandated coverage for in vitro fertilization (IVF) treatment—is the topic of a story in this week’s Arkansas Times. You can get a taste of the Times’s customary cool-headedness and even-handedness from the headline: “Greenberg: Let Women Pay To Get Pregnant.”

I decided a while back not to proceed with this bill. (If the Arkansas Times had called me more recently than 24 days ago, at which point reporter Leslie Newell Peacock informed me breathlessly that “my deadline looms,” their just-published story might have included that relevant fact.)

When the costs of health care are hidden by the system we have today, where the employer pays for it and the recipient has little or no idea how much it costs, and the beneficiaries of the mandate have a disproportionate incentive to keep it as it is, it is just about impossible politically to lower health care costs by removing mandates. That is because even though the public might benefit greatly from ending a mandate, a relatively small beneficiary group is going to work much harder to preserve it.

The IVF mandate raises health insurance costs for every American citizen by about three to five percent (link opens as PDF file). That’s a nationwide figure, and I don’t know if Arkansas’ costs are any different. That’s one reason I prefiled the bill – to find out those kinds of questions, and to try to determine whether it would be in the interest of the people of Arkansas to end the mandate.

The price of that, I guess, is to endure Leslie Peacock’s vaguely conspiratorial innuendoes about my religious motivations (“Though he claims not to be inspired by religious activists,” she writes, “Greenberg’s proposal would sit well with the Vatican”). Despite her paraphrase, I said nothing whatsoever to Peacock about religious activists. (This, at any rate, is what I claim.) Furthermore, the suggestion in Peacock’s article that people with cancer are at fault for their illness (at the fourth paragraph from the bottom) is more than a little creepy.

I have great sympathy for people who want to, but can’t, conceive. But I am not as uncritical as Leslie Peacock is of the idea that infertility is just a disease, like cancer. There are plenty of people who just physically can’t do something they want to do: that does not mean that they are sick.

For instance, there have been plenty of people who would like to serve in the military who, for a variety of reasons, lack the capacity to do so. Military service is a really important thing and a commendable career goal. But if you don’t qualify to serve—if you just can’t run fast enough, for instance—I am not sure that demonstrates that you have a disease. It just means you aren’t physically capable of doing what you want to do. That’s true no matter how important your goal is to you, and it’s true whether your goal is professional or familial.

Here’s a reason that headlines like “Greenberg: Let Women Pay to Get Pregnant” are so lacking in seriousness: a moment’s thought will reveal that, whether we have the mandate or not, lots of women (and men) will pay to get pregnant. The mandate doesn’t make IVF treatments free: it just makes their costs hidden. I think it would be a step forward if we knew how much IVF treatments were costing everybody with health insurance; regrettably, the forces of reaction at the Arkansas Times think that it’s very dangerous to discuss this kind of thing publicly. Of course removing the mandate wouldn’t block health insurance companies from providing IVF coverage, and the Arkansas Times story is silly to pretend otherwise.

When I say that introducing this bill was my most recent failure, I’m not kidding. I got a couple of angry e-mails and phone calls from people who felt I was trying to abolish IVF treatments. And I certainly could have explained my thoughts better when discussing insurance mandates, and the way they raise costs and block access to health care for everyone, publicly.

But I can live with failure, and I will do my best to learn the right lessons from it. I am grateful to the people who took the time to explain to me how very important and personal an issue fertility treatments are to them. In their own way, they are a powerful force and their case has some merit. I will take measures next week to ensure that the bill doesn’t go anywhere, and I will explore other alternatives that might lower the cost of health insurance.

Update: I see Max Brantley at the Times blog has responded to my post, noting (or, as Leslie Peacock would say, “claiming”) that the article “debunked some of Greenberg’s operating assumptions.” Max, as usual, is very attentive to sportscasting; it’s just that he’s not so good at scoring goals. The only substantive criticism he makes of my post is clearly wrong.

Here’s the closest Max comes to actually making an argument: “Still missing after all the verbiage is an explanation for why he singled this particular mandate out for attention. There are many in the law, including more costly ones.”

The problem for Max is that complaining about the verbiage of others while at the same time misrepresenting it is rarely a powerful argument. If he had bothered to read my post before responding to it, he might have noticed these two paragraphs:

“I have great sympathy for people who want to, but can’t, conceive. But I am not as uncritical as Leslie Peacock is of the idea that infertility is just a disease, like cancer. There are plenty of people who just physically can’t do something they want to do: that does not mean that they are sick.

For instance, there have been plenty of people who would like to serve in the military who, for a variety of reasons, lack the capacity to do so. Military service is a really important thing and a commendable career goal. But if you don’t qualify to serve—if you just can’t run fast enough, for instance—I am not sure that demonstrates that you have a disease. It just means you aren’t physically capable of doing what you want to do. That’s true no matter how important your goal is to you, and it’s true whether your goal is professional or familial.”

Now, you may not like that explanation of why the IVF mandate is different than the others. Maybe you’d say it’s a really bad explanation. But the one thing that you cannot say is that it’s a missing explanation.

Of course, as Max says, there are many mandates in Arkansas law. But almost all of them are not nearly as costly, and almost every one responds to what is uncontroversially a medical problem. If Max had read the report I linked to, he would have found that it mentions 41 mandates in Arkansas. The IVF mandate is the second or third most expensive of all of them; only mental health parity and (possibly) dental benefits are more expensive.

In a world where people are denied access to health care because of the cost of health insurance, sometimes we need to think about the way that the cost of big-ticket items can increase the cost of health care for everyone. I’d like to minimize the problem of needy people being denied access; the attitude of the Arkansas Times is, as far as I can tell, that the problem doesn’t exist.

In short, the explanation whose absence Max complains about was right there in the original post. The IVF mandate is significantly different both in kind and in cost from just about every other mandate in Arkansas, as is evident from the report Max ignored. To sum up, Max gives us a post with a high sneer content but very little nutritional value.

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27 thoughts on “My Most Recent Failure (Updated!)

  • Bill from Sheridan

    Rep. Greenberg,

    There is no reason why health insurance providers in Arkansas ought to be required to provide IVF for their customers. People who want to have IVF insurance coverage ought be able to get it, but there is no reason that every other insurance consumer ought to subsidize IVF for those who want it.

    I wish I lived in your dist, Rep. Greenberg. I’d be proud to vote for you. My daughter lives in Bryant and she wants you to run for State Senate over there. I hope you do.

  • spankmonkey

    I thought Leslie was a dude. Am I wrong?

  • a fertility patient

    Bill from Sheridan,

    I can give you a compelling reason “why health insurance providers in Arkansas ought to be required to provide IVF for their customers”.

    There are ample studies (NEJM) that show that in states where mandates are NOT in affect, multiple births are higher. A single digit % of insurance plans offer IVF. I challenge you to find one. When couples pay for IVF out of pocket, they take greater risks transferring more embryos, that result in more multiple births.

    Multiple births almost always spend time in neo natal intensive care units. The insurance costs for this are 100 of 1000s times greater than IVF.

  • spankmonkey, ru serious???? no wonder my blind date with Leslie went so weird. I may not even ask Leslie out again after this!!

  • Bill from Sheridan

    Fertility Patient,

    I can understand your desire to have children, and I also understand that neo-natal care can be extremely expensive. If you want to go through with having IVF you should, but YOU should be the one to pay for it with YOUR insurance premiums or out of your own pocket. Requiring everyone else to pay higher premiums for your IVF coverage isn’t right.

  • constituent

    Bill from Sheridan:

    Let’s see… great logic. Let’s not pay for any number of medical conditions. I propose anything caused by smoking, for one. Or injuries from car accidents where someone was speeding. OH — or obesity, if the person ate a lot of fatty food.

    Seriously, you need a better understanding of insurance. We all subsidize other’s conditions. Infertility is a medical condition.

  • constituent

    Bill, again your ignorance shows with each passing comment. IVF does not lead to higher order multiples the same way other infertility treatments does, as the number of embryoes transferred back to a woman is controlled by the ASRM guidelines. IUI or Clomid is what cheaper, but results in the litters you see on Discovery Channel.

    Banning IVF would actually increase health care costs vis a vis NICU stays.

    Please, keep your ignorance to yourself.

  • Caroline

    Greenberg still had this bill on the calendar as of a few days ago, so I’m not buying his line that he decided to drop it a while ago.

  • Caroline,

    You are welcome to buy any line that you like, but as I understand it, once a bill is prefiled, it must stay on the calendar until the session begins. There is no way to change that. In this case, I will be able to remove the bill from the calendar starting January 12 (this coming Monday), but nobody can do anything before then.

  • Bill from Sheridan


    Did you actually read what I wrote? The state ought not mandate that insurance companies provide any services to their customers. People and employers ought to negotiate with insurance companies for what services will be provided. The same goes for people that don’t want to subsidize smokers or anyone else.

    I never said that IVF ought to be banned, nor did I say it should be unavailable. I just said people ought have to pay for it.

  • a fertility patient


    I still challenge you to find a plans that offer IVF coverage.

  • constituent


    If one medical condition is covered, they all should be. Or, none at all. Your choice.

    Your proposed “hey, let’s pick and choose and let everyone negotiate on their own behalf” if a nightmare in discrimination waiting to happen.

  • I wear prescription eye glasses and they are not covered. This a medical condition that I HAVE to treat or else I can’t see past my hand. Why is the condition that requires treatment not mandated to be coverage but a conditional that is optional to treat is not?

    But what do I know, according the Blake Rutherford I’m anti-health! Of course, I prefer pro-illness!

  • Caroline

    “As I understand it”? Dan, aren’t you elected *to* understand how to pass legislation? Given the comments you left on a woman’s blog just a few days ago, however, via your own words I don’t believe that you decided to drop this legislation a long time ago. Sorry, but I think you were listening to an insurance lobby, and the facts were against you.

  • Anesthesia Girl

    Dan, are you serious? You are truly ignorant on this issue. I am very pleased that you are pulling this bill on Monday, but you seem to miss the “I was wrong” bandwagon. You are like the child who finds out they are wrong to hit their sister, and says, “I was wrong….but she deserved it and I did it for good reason, etc…..”.

    I have been in the Medical field for 19 years and you are WRONG. Infertility is an actual medical diagnosis with its own ICD9 code. It is, in many cases, a treatable medical condition. Your comparison to joining the military is ridiculous. It is very easy for you to judge this diagnosis as you had no problems conceiving you two sons. Congratulations.

    Do you REALLY believe that insurance companies would decrease healthcare costs for all of us if you repeal this mandate?? Or that by covering the few hundred people who use this coverage in AR that, as you stated, mandates would “block access to health care for everyone, publicly.” Do you really believe that? If you TRULY would like to decrease health care costs, get off you witch hunt and go after what is REALLY increasing the costs of healthcare. Smoking and Obesity. Without these two, I would be out of a job in a New York minute! Ask ANY healthcare provider and you will get the same answer. So why don’t you introduce some legislation to decrease smoking, especially in our youth. Or find a way to clean up the food in our schools and make it healthier OR increase the amount of excercise our kids get in schools. Do something, ANYTHING, that will HELP and NOT HURT your fellow man.
    I thought that was what public service was all about.

  • Cameron Bluff

    Are small breasts considered a medical condition?

  • David Kinkade

    Only if they’re dangerously small, Cameron. I may need you to form a commission to study this critical question.

  • Dorothy Dortin

    “Failure”, something IF couples are all to familiar with.
    Yes Dan, it would have been a ‘step forward’ to know what mandated IVF treatments cost, in real dollars, to the insured of Arkansas and specifically who and how many are blocked or denied access to health care as you state in your response.

    Your ‘real failure’ was lack of due diligence before filing HB1017.

    Here is one ‘alternative’ for you to explore: list the insurance companies where you can purchase IVF coverage.

    There may be a small number of families who can afford 20K or more, out of pocket, to hopefully have just one child. They would not have been affected by repealing the mandate.

    When the Arkansas Times asked Mr. Weiske if lifting the mandate would drop insurance rates 3-5% his answer was “I don’t know.” Yet he’ll “estimate” insurers would have to ADD 3-5%, an estimate not based on ‘actual’ Arkansas figures. Huh????

    Taking measures to insure the bill goes no further smells like someone trying to save their political bacon, so to speak.

  • Virginia

    The study Dan keeps referring to was conducted by the Coucil for Affordable Health Insurance. CAHI are lobbyists for the insurance industry. (see CAHI called President Bush’s Plan “Vital to Curing Ills of America’s Health Care” and call President Elect Obama’s health care plan “A Recipe for Doom”. They are uniformly against mandates. Whether you agree with their positions or not, you must agree, they are not an independent source

  • Cameron Bluff

    There must be more intellectuality in this thread.

    Mr ARPro Guy, I accept your task and am announcing the formation of a group to study whether or not small breasts should be considered a medical condition.

    Effective on Monday, January 12, 2009, the Group Research About Breast Enlargement Merits (GRABEM) will meet to assign study topics to a variety of yet-to-be named committees.

    In the meantime, I am soliciting membership in GRABEM. To be considered for full voting membership, join us at Hooters at 6:00 PM. Shortly after Happy Hour, uh, rather, the opening reception, Mr. ARPro Guy will deliver the “Membership Code of Research Ethics” presentation. This will be followed up with a short slide show entitled “Small Breasts, To Enhance Or Not To Enhance, That Is The Question.”

    GRABEM is an equal opportunity offending entity and does not offend on the basis of race, gender, or religion.

  • Virginia


    Rep Greenberg,

    Thank you for withdrawing the bill.

  • No one choses to have their dream of a family become a nightmare when fertility problems arise.
    This is a womens’ (in most cases a couples) right to choose the option of persuring their dream to have a family!
    My Greenberg, you obviously didn’t have to take the same long drawn out road of seeking help to start a family, but having the science and technology makes those of us in fertility treatment feel fortunate to have had the chance to have a baby.

    Thank you for having the courage to list to your voters.

  • Whew

    glad you pulled this and find your explaination well considerd and well written. thank you for the clarification. I have two friends who are now wonderful parents thanks to IVF. They could not have afforded it without insurance assistance. Injury in one case and illness in another directly impacted conception. I guess Bill from SHeridan is one of those people who dont want to pay taxes because they do not have kids in school. We all benefit from good people raising good children who become good citizens. Thank you for dropping this bill.

  • jamie

    I guess you’ve never heard the term “Walk a mile in my shoes” because if you had walked in my shoes you wouldn’t think infertility is an option. MY taxes pay for people who can conceive. MY taxes pay for welfare so they can pump out more. HOWEVER MY taxes don’t help me ONE bit when you can’t get pregnant. They only care when you can. Ironic huh? The same can be said for insurance.

    Insurance would increase by $20 A YEAR if IVF was mandated across the nation. My premium just went up $144 for next year in Texas, and guess what?? I STILL don’t have IVF covered. HOWEVER, the SAME insurance fertile people pay to get vasectomy’s, birth control, tubal ligations and maternity services is the SAME insurance I pay for. Not having IVF covered has devestated my husband and I as it is the only thing keeping us from having a family. Time is crucial in the infertility world and while I am in my late 20’s my husband and I have diseases that prevent us from conceiving. The cost is a lot to come up with even for wealthier families. Not to mention when something is covered by insurance it costs CONSIDERABLY less. I wish I was as ignorant to infertility as fertile people are. Yes, you are mistaken “infertility” is considered a disease and has been for some time. I do thank you that you did recend on your bill as it was brought forth in ignorance. Comparing having a child to joining the military is comical. How LUCKY you are to remain oblivous to infertility. I wish I was so lucky to be sitting on the pedastal you are sitting on now.

  • You made some good points there. I did a search on the topic and found most people will agree with your blog.

  • hopefulmom

    Wow!!! I am amazed at some of the negative things I am reading…my husband and I are “forced” to undergo IVF if we want to have a child. You see a doctor, someone that I trusted, removed both of my fallopian tubes, on accident. My world was shattered when I found out, day in and day out all I think about is why and how could he have done this and not told me. Now here is the kicker, Arkansas is a state that mandates IVF coverage, which I agree with, however we have a self insured policy through our company so therefore the company is exempt from covering this procedure. As stated before our taxes pay for all these “ladies” who have several children and are living on food stamps, welfare, and any other hand out that they can get. No one seems to mind that sort of lifestyle, but when you have two people in a marriage and are tax payers and hard workers and the only thing they desire is a child……this too somehow gets taken from them. Nothing makes me more angry than to hear a girl who gets pregnant from some guy she’s had a few fun nights with then she decides to call her child a “miracle”…walk a mile in my shoes and you’ll see just how much of a miracle a child can be.


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