Do you want to get fertility treatments in Hawaii? If you’re married, there’s a good chance that the treatments will be covered by insurance.
But if you’re not married, you’re probably out of luck.
Insurance companies in Hawaii are required to cover fertility treatment only for married women, not for their single counterparts. And in vitro fertilization treatments must use sperm from the patient’s spouse.
A push in the state Legislature to expand coverage for fertility treatments to unmarried women died Thursday with the end of the session.
Piilani Smith, a Native Hawaiian hula practitioner who also happens to be single, sought to change that law, saying it discriminates against all varieties of unmarried women including Native Hawaiians, who historically did not observe marriage in the traditional Western sense.
"In Hawaiian culture there’s nothing sacred about the institution of marriage," Smith said. "It doesn’t exist. What exists is the respect for family and, ultimately, ancestral genealogy."
Before Western missionaries and colonists arrived in Hawaii, marriage in the legal sense was not practiced, said Doug Askman, associate professor of history at Hawaii Pacific University.
"The concept of marriage was very different," Askman said. "Many of the alii (royalty) had numerous wives. In the traditional culture that was certainly acceptable, especially among the ruling class."
But the arrival of Westerners brought Christian values that infused the state’s laws.
Hawaii, which is one of 15 states that have insurance mandates for fertility treatments, also is not the only state that excludes single women from the benefit. Maryland and Texas also have laws that require that the patient’s eggs are fertilized using the spouse’s sperm, according to Resolve, an organization that tracks fertility policies.
Hawaii’s fertility law excludes all men with fertility problems because it offers only one method of treatment: in vitro fertilization, which is designed for women. It also excludes lesbian couples because, although married, neither partner can provide the required sperm.
Smith found out about Hawaii’s law when she decided to have a baby. She planned to raise her child with the help of her extended family, which runs Halau o na Maolitua, a school that teaches about Hawaiian traditions.
Smith was diagnosed with infertility and sought treatment from her doctor. When she asked about insurance coverage, she was met with a question: "Are you married?" When Smith said no, she was told she was out of luck.
"The goal here is to not cover people," said Barbara Collura, president and CEO of Resolve. "The goal here is to exclude as many people as possible so that your actual coverage is pretty minimal."
Smith helped craft legislation during the 2014 session that sought to require coverage beyond married women, but both proposals died.
The Hawaii Medical Service Association, one of the state’s largest insurers, had told the Legislature it was open to expanding coverage beyond single women, spokesman Floyd Takeuchi said. The association provides coverage for some patients who are in civil unions, depending on the patient’s employer group plan, he said.
The insurance company Kaiser Permanente had told the Legislature that it supports the idea of the proposal, but it warned against the high cost of insurance mandates and requested a study instead to determine the potential cost increases.
Then Smith pushed for a resolution to ask the state auditor to conduct an impact study on the possibility of expanding the insurance mandate. But that proposal also failed when it languished in the House finance committee. Rep. Sylvia Luke, chairwoman of that committee, did not return telephone calls for comment.
"If it can’t be offered to everybody in a nondiscriminatory manner, than repeal it," Smith said, "because it’s a bad law, and it’s the wrong message to be sending to families."
Cathy Bussewitz, Associated Press