Voters across Illinois are being asked this election season to weigh in with their ballots on reproductive rights.
The question: “Should all medically appropriate assisted reproductive treatments, including, but not limited to, in vitro fertilization, be covered by any health insurance plan in Illinois that provides coverage for pregnancy benefits, without limitation on the number of treatments?”
In other words, should any health insurance plan that already covers pregnancy also cover in vitro fertilization, or IVF, and other assisted reproductive treatments to help families have children — with unlimited treatments?
IVF in particular is a time-consuming, expensive procedure that has become the only way for some families to have children on their own. The process typically involves women taking medication to help produce multiple eggs inside their bodies; those eggs are retrieved in a doctor’s office and mixed with sperm. One or more fertilized eggs are then placed inside a woman’s uterus, potentially developing into embryos. One full cycle can take several weeks, and for some people, it can take years to become pregnant.
But IVF is controversial for people who morally oppose the destruction of embryos that aren’t used. The procedure was thrust into the spotlight earlier this year when the Alabama Supreme Court ruled that embryos created through IVF should be considered children. Some fertility clinics in Alabama quickly paused treatments, concerned about the liability they could face if embryos were damaged or destroyed. Treatments resumed after the Alabama state legislature stepped in, granting civil and criminal immunity to providers and patients.
In Illinois, state law requires private group health insurance policies for more than 25 employees to cover IVF. People typically get group plans through their jobs. But the state’s Medicaid health insurance plan for people who are low income or disabled does not cover IVF. The state does cover expenses for people who become infertile through medical treatment, like a person who has cancer and needs to freeze their eggs before starting chemotherapy.
The lack of IVF coverage in Medicaid plans is common across the U.S., but it creates a big barrier to access for people who can least afford to pay, said Katie Watson, a professor at Northwestern University’s Feinberg School of Medicine who specializes in reproductive rights.
“It is a violation of reproductive justice, the right to have a child, to allow medical treatments to be divvied up based on income,” Watson said.
The price tag for states to cover IVF would be steep. The procedure on average costs up to $14,000 per round, and many people need multiple rounds, according to KFF, a nonprofit health policy research organization formerly known as the Kaiser Family Foundation. Cost is the leading reason why women say they could not get the treatment, and that frustration is most common among low-income women, KFF research shows.
The referendum question on the Illinois ballot is advisory, meaning if voters approve it, nothing changes. But a majority voting yes could signal to Illinois lawmakers that expanding health insurance coverage for IVF and other assisted reproductive treatments is what many Illinoisans want, potentially leading to new laws.
WBEZ analyzed birth data from the U.S. Centers for Disease Control and Prevention to highlight the current state of fertility treatment usage in Illinois. Treatments include IVF, fertility drugs, artificial insemination and gamete intrafallopian transfer, when a mix of sperm and eggs is placed directly into a woman’s fallopian tubes.
Almost all births involving fertility treatment in Illinois were likely paid for with private insurance
The share of births involving fertility treatments differs greatly by mothers’ socioeconomic status
Use of fertility treatment in Illinois increased slightly after a dip in 2020
DuPage County had the highest fertility treatment rate out of all Chicago-area counties in 2023
Fertility treatment is more common in Illinois than in a majority of states
Lindsay Allen, a health economist at Northwestern, said she’s not surprised by WBEZ’s findings. A majority of people who have Medicaid in Illinois are either Black or Latino, groups reporting some of the lowest rates of fertility treatments, WBEZ found.
Accessing fertility treatments like IVF isn’t just about having health insurance cover the cost, Allen said. It’s also about how easily patients can get to a provider depending on where they live, or if they have a flexible job that allows them to leave work to race to a doctor’s visit.
“IVF is such a complicated process, and it requires an awful lot of self-advocacy on the part of the patient,” Allen said.