WUNRN
Trading-Off
Reproductive Technology & Adoption: Does Subsidizing in Vitro
Fertilization Decrease Adoption Rates & Should it Matter?
I. Glenn Cohen
Harvard Law School
Daniel L. Chen
Duke University - School of Law
Minnesota
Law Review, Forthcoming
Abstract:
For those facing infertility, using
assisted reproductive technology to have genetically related children is a very
expensive proposition. In particular, to produce a live birth through in vitro fertilization
(IVF) will cost an individual (on average) between $66,667 and $114,286 in the
U.S. If forced to pay these prices out of pocket, many would be unable to
afford this technology. Given this reality, a number of states have attempted
to improve access to reproductive technology through state-level insurance
mandates that cover IVF. Several scholars, however, have worried that
increasing access in this way will cause a diminution in adoptions and have
argued against enactment of state mandates for that reason.
In this paper, which was selected for presentation at the 2010 Stanford-Yale
Junior Faculty Forum, we push against that conclusion on two fronts.
First, we interrogate the normative premises of the argument and expose its
contestable implicit assumptions about how the state should balance the
interests of existing children waiting for adoption and those seeking access to
reproductive technology in order to have genetically related children.
Second, we investigate the unexamined empirical question behind the conclusion:
does state subsidization of reproductive technologies through insurance
mandates actually reduce adoption; that is, is there a trade-off between
helping individuals conceive and helping children waiting to be adopted?
We call the claim that there is such
an effect the “substitution theory.” Using the differential timing of
introduction of state-level insurance mandates relating to IVF in some states
and differences in the forms these mandates take, we employ several different
econometric techniques (differences-in-differences, ordinary least squares,
two-stage least squares) to examine the effect of these mandates on IVF
utilization and adoption.
Contrary to the assumption of the
substitution theory, we find no strong evidence that state support of IVF
through these mandates crowds out either domestic or international adoption.