Should health insurers cover the cost of fertility treatment? | Lost Coast Outpost
Californians seeking to start a family using in vitro fertilization often have to pay the full cost of the treatment, in the tens of thousands of dollars. The cost could deter some people from having children, and it could leave others in exorbitant debt.
While 17 states have laws that require health insurers to cover fertility treatments, most of which include in vitro, California does not.
The debate over whether health insurance plans should provide fertility coverage isn’t new to Sacramento, but even in a state where Democrats like to brag about their fight to advance reproductive health, these efforts did not go very far. The main heist is money.
Assemblywoman Buffy Wicks, a Democrat from Oakland, is trying again this year. His 2029 Assembly Bill would require some health insurance plans to cover fertility treatments, including in vitro fertilization. The bill also expands the definition of infertility so that more people can be diagnosed and treated, including singles, same-sex couples and transgender people.
Wicks recently agreed to amendments in an effort to reduce the cost of his bill, which as originally drafted had a $715 million price tag for employers and health plan enrollees. The coverage mandate in his revised bill would only apply to large group health insurance, which covers about 9 million Californians. Small group and individual market plans would be exempt. Even as first drafted, the bill would not apply to Medi-Cal, the insurance program for low-income residents.
“This is the third time I’ve done this,” Wicks said. “We’re trying to get that adopted and that means making changes to reduce it.”
Wicks said the issue is personal to her — her second child is the product of in vitro fertilization. (In 2020, Wicks took her then a newborn to the Capitol to vote for a family leave bill.) The goal, she said, is to take a piecemeal approach and expand the benefits to more people over time.
California law currently requires insurance companies to offer fertility treatments, excluding in vitro treatments, but it is up to the employer or group to decide whether this is included in the covered benefits. This bill would make such coverage mandatory.
Annabel Adams, who recently testified in favor of Wicks’ bill, paid nearly $50,000 for three cycles of in vitro fertilization. Born with a chromosomal inversion that makes it difficult for her to sustain a pregnancy, she suffered six losses.
Her doctors recommended in vitro fertilization, or IVF, a process in which eggs are retrieved from ovaries and fertilized by sperm in a lab. The fertilized egg, or embryo, is then transferred to the uterus. For Adams, this process allows her doctors to test the embryos to make sure they are unaffected by her genetic condition, which increases her chances of having a lasting pregnancy.
Her first round of treatment, including the drugs, cost her $25,600, she said. His Kaiser insurance plan, offered by his employer at the University of California, did not cover him. Her husband’s insurance helped cover some of the costs for the second and third rounds.
“Every pregnancy is filled with terror. These are wanted pregnancies; these are children we envision and plan a future around,” said Adams, a Long Beach resident and founder of California Fertility Advocates. essentially the cure for my illness and knowing that it wasn’t readily available to me, it felt like an extra layer of evil.”
The health insurance lobby and business groups oppose Wicks’ bill, citing the cost. They say that, like other pieces of legislation that require new benefits to be covered, this bill would lead to higher health insurance premiums for employers and employees.
According to the California Association of Health Plans, it’s the most expensive bill the organization has opposed this year, and Wicks’ recent amendments don’t change its position.
“Every pregnancy is filled with terror. These are wanted pregnancies; these are children we envision.
— Annabel Adams, Founder of California Fertility Advocates
“As health plans, we need to be concerned about costs for everyone,” said association spokeswoman Mary Ellen Grant. “We don’t dispute the merits of this bill, but they increase healthcare costs for Californians. It’s just not something health plans can support.
Grant said lawmakers must consider the sum of all benefit mandates they choose to pass, not just a single bill. This year, the association is opposing 14 bills that would require new benefits to be covered — collectively, these bills could increase annual premiums by $1.5 billion, the association said.
The California Chamber of Commerce and various local chambers, representing business interests, have also expressed opposition to the bill because of its cost. The bill is then directed to the Assembly Appropriations Committee, which assesses the fiscal impact of a bill.
In 2019, California enacted a law specifying that insurers must cover the cost of storing eggs, sperm or embryos for patients undergoing treatment for conditions affecting their ability to have children. Of them previous bills introduced by Wicks in 2019 and 2020, targeting fertility coverage more broadly, have not moved forward. While much of the conversation around Wicks’ current bill focuses on in vitro fertilization, as it is the most expensive type of fertility treatment, the bill addresses the broader issue of overall fertility coverage, said Dr. Marcelle Cedars, a reproductive endocrinologist at the University of California, San Francisco. Not all infertile people need in vitro fertilization.
“It’s really about acknowledging infertility as a disease,” Cedars said. “As with any other disease, all evidence-based and medically valid treatment options should be available to patients.”
Cedars said it has patients whose diagnosis is covered by their insurance, but not their treatment. “You would never say, ‘Oh, by the way, you have diabetes, but we’re not going to give you insulin to treat it.’ I mean, that’s crazy, what other disease would you treat like that?”
It is estimated that infertility affects about one in eight couples, or about 15% of the population in the United States. . Treatment is often considered elective.
“Reproductive health is tricky in this country, as we’ve seen this week,” Cedars said, referring to news of a leaked draft opinion that showed the U.S. Supreme Court was on the hook. point to nullify Roe v. Wade. “Reproductive health is really a spectrum, it’s not about having kids when you don’t want them and being able to have them when you want them.”
In the abortion debate, California is positioning itself as a safe haven state for out-of-state people seeking to terminate a pregnancy. Democratic lawmakers have drafted a package of bills going through the Legislature to protect abortion access and affordability. Governor Gavin Newsom has already signed into law one such bill, eliminating out-of-pocket fees for abortions.
Wicks and supporters of his bill said that ultimately this bill is also about choice — allowing people to start families if and when they choose. “That’s why I’m working on bills for safe and legal abortion and making sure doulas are covered,” Wicks said. “All of these things for me are very intertwined.”
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