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HONOLULU (AP) — When Piilani Smith was diagnosed with infertility at the doctor's office and chose to pursue fertility treatment, she was shocked by what she learned.
Smith found out she would not qualify for health insurance coverage for the fertility treatments that are a mandatory part of coverage under Hawaii law.
The reason: Smith is unmarried, and insurers are only required to provide fertility treatments to married women.
"I just could not believe in this day in age, with all of the intelligence and technology and political struggle that we've all gone through in history, that this level of discrimination ... is blatantly being exercised," Smith said.
Smith set out to change that law so that single women, divorcees, widows and women like her who wish to raise a child with the help of their extended family could have equal access to coverage for fertility treatments.
Hawaii lawmakers are weighing whether insurance companies should be required to cover more treatments for infertility and to update a law that some say discriminates against unmarried women. The resolution (SCR 35) calls on the state auditor to study the social and economic effects of the proposal.
"Women are starting their families later, which raises all sorts of concerns about access to procedures," said Rep. Della Au Belatti, chairwoman of the House Health committee, which advanced the resolution.
Hawaii already requires insurers to cover in vitro fertilization, but the law has limits. For example, under current Hawaii law insurers are only required to provide treatment to married women using sperm supplied by a woman's spouse. Those who don't meet the requirements have to pay $15,000 to $20,000 per procedure, which often has to be repeated.
That creates two classes of women, said Naunanikinau Kamalii, a lawyer with Case Lombardi.
"It's discriminatory that there are two classes of women sitting in the same office, paying the same premium, and the only distinction between the ones who get to do it and the ones who don't is that one is married," Kamalii said.
Smith, a Native Hawaiian hula practitioner at Halau O Na Maolitua, a school her family owns in Nuuanu, said she chose to start a family at age 44 with the help of her extended family. In Hawaiian culture, giving birth to a child is considered sacred, but joining in marriage is not, Smith said.
"We don't have that traditional cultural practice of marriage," Smith said. "We have a cultural practice of ohana and family. And it goes back to the fact that in our language, we don't have a word for illegitimacy. No child is born in our culture is ever viewed as illegitimate."
The Hawaii Catholic Conference has said that religious institutions should not be forced to provide services that go against the tenets of their faith. The fact that advanced procedures have been developed does not mean those procedures are morally acceptable, the group said.
"Infertility treatment for anybody, whether you're married or single, is not consistent with Catholic teaching," said Walter Yoshimitsu, executive director of the Hawaii Catholic Conference. "Our belief is that life begins at the moment that the egg is fertilized. And if you discard them, that is tantamount to abortion."
That's because the process of in vitro fertilization involves fertilizing eggs outside the womb and then choosing one to insert in a womb, Yoshimitsu said.
A bill that sought to mandate expanded treatment options (SB 2909) passed the Senate, but it died when it never got a hearing in the House. Smith, the author of that proposal, said a state must first conduct an audit before making this type of change to insurance law, so the resolution was pushed instead.
The Chamber of Commerce had opposed the bill, arguing that it would increase health care costs to businesses that would not be able to pass the costs on to consumers.
Kaiser Permanente had supported the intent of the bill but asked for the auditor to conduct a study of the proposal instead.
"Done correctly, health care reform can reduce costs while simultaneously improving the quality of care," the company said in comments to the Legislature. "However, this will not happen if the emphasis is shifted to costly mandates that inevitably drive up the price of health insurance, rather than emphasizing prevention."
The Hawaii House advanced the resolution to its finance committee Tuesday.
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