If Fiona M. Jardine had a husband, the expensive fertility treatments she's now undergoing would be covered by her health plan.
But Jardine, 29, is married to a woman, so she and her wife have to pay out of pocket.
A bill that would grant married lesbian couples the same fertility treatment benefits as husbands and wives is advancing in the Maryland General Assembly. The measure passed unanimously in a House subcommittee Tuesday, and full Senate and House committees are likely to vote this week.
Del. Terri L. Hill, the bill's House sponsor, said the measure is designed to bring consistency to state law, given Maryland voters' approval of same-sex marriage in 2012.
"We're concerned that we correct the law to reflect Maryland's state on marriage equality," said Hill, a Democrat who represents Howard and Baltimore counties. "It was about making sure all Marylanders are treated in an equitable fashion."
Maryland has required state-regulated health insurance plans that offer pregnancy-related benefits to cover the costs of in vitro fertilization since 2000. It is one of a dozen states that require coverage of the procedure, which involves fertilizing the egg outside the woman's body and implanting the embryo in the uterus.
That law includes a requirement that only the husband's sperm can be used in any covered in vitro procedure — a provision that excludes lesbians using donated sperm. Hill's bill, sponsored in the Senate by Montgomery County Democrat Cheryl Kagan, would remove that requirement for same-sex couples.
And if an insurer chooses to provide more extensive fertility coverage to heterosexual couples, same-sex couples would have to be offered the same.
"It's all about equality. It's all about updating our laws," Kagan said.
Jardine, a graduate assistant at the University of Maryland College Park, said she was dismayed to learn that her insurance carrier would not cover the costly form of artificial insemination she needs because of a medical condition. The sticking point was that she and her wife, Jo Arnone, 57, would be using donor sperm instead of a husband's sperm.
The cost of the procedure is $1,600 per attempt, Jardine said, and the couple is on their second try. If they have to move on to in vitro fertilization, the costs would escalate and still would not be covered under the 2000 law.
"We feel very passionately that this is just ... discrimination," Jardine said.
Carrie Evans, executive director of the gay rights advocacy group Equality Maryland, said the organization gets calls almost weekly from lesbian couples about being excluded from fertility benefits.
"This was such a big issue for a lot of couples. They were calling for years," she said.
Evans said the group delayed its push for parity while it threw its energies behind marriage equality and transgender rights bills, but this year the measure is one of Equality Maryland's priority issues.
The state's largest insurer, CareFirst BlueCross BlueShield, initially opposed the bill but entered into negotiations with supporters and now supports the compromise that resulted.
Mary Ellen Russell, executive director of the Maryland Catholic Conference, said her group is remaining neutral.
At a Senate hearing on the issue, Dr. Michael J. Levy, founder of Shady Grove Fertility Center, testified that about 5 percent of the 10,000 patients served by his large regional chain are lesbians. Levy said the cost of an in vitro treatment is roughly $8,000 to $10,000. He said the $500 to $600 cost of donated sperm is paid for by the patients whether lesbian or straight — something the bill would not change.
Levy said about two-thirds of the patients of his centers become pregnant without in vitro. Of the remaining third, he said, about half will become pregnant through in vitro per try.
Where current law considers a couple eligible for in vitro fertilization after two years of unprotected intercourse without conception — another provision written without lesbians in mind — the proposed legislation calls for six rounds of unsuccessful artificial insemination within two years before a lesbian couple would be eligible. Advocates for the bill said they were trying to create as level a playing field as possible without expanding the mandate to cover additional services.
Republican lawmakers on a House insurance subcommittee supported the bill even though most of the GOP caucus opposed marriage equality in 2012.
Del. Herb McMillan, an Anne Arundel County Republican, said he generally opposes same-sex marriage but might support this year's legislation because it's "about equity." He said he's also concerned that the state could face a costly lawsuit over the inequality, which he predicted Maryland would lose.
House Minority Leader Nic Kipke also voted for the bill in subcommittee. However, he said Wednesday that he plans to offer an amendment in the House Health and Government Operations Committee that would repeal the 2000 state requirement for in vitro coverage. If that isn't accepted, he said he plans to vote no.
Kipke said his concern has nothing to do with same-sex marriage but with a required benefit he believes is not essential.
"It's one of the components that drive up the cost of health care in Maryland entirely," the Anne Arundel County Republican said. "It's a nice luxury that's been provided, but unfortunately it's very costly."