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Wednesday, May 18, 2022

Should health insurers cover the cost of fertility treatments?

Ana B. Ibarra. By , CalMaters

Californians looking to start a family with the help of in vitro fertilization are often on the hook for the full cost of treatment in the range of thousands of dollars. The cost can deter some people from having children, and it can leave others in extreme debt.

While 17 states have laws that require health insurers to cover fertility treatments, most of which involve in vitro, California does not.

The debate over whether health insurance plans should provide fertility coverage isn’t new for Sacramento, but even in a state where Democrats can boast about their fight to advance reproductive health. Like, these efforts haven’t gone very far. The main hold-up is money.

Assembly member Buffy Wicks, an Oakland Democrat, is trying again this year. Her Assembly Bill 2029 would require certain health insurance plans to cover fertility treatments, including in vitro fertilization. The bill also expands the definition of infertility so that more people are eligible for diagnosis and treatment, including single individuals, same-sex couples and transgender people.

Wix recently accepted amendments in an effort to reduce the cost of its bill, as did a $715 million price tag for employers and health plan enrollments in the first draft. The coverage mandate in her amended bill would apply only to large group health insurance, which covers about 9 million Californians. Schemes in the small group and individual markets will be discounted. As previously written, the bill would not apply to Medi-Cal, an insurance program for low-income residents.

The bill would now limit an individual’s lifetime benefits to $75,000 and limit egg retrieval to three.

“This is my third time doing this,” Wicks said. “We’re trying to get it passed and that means amending it to reduce that.”

Wicks said the issue is personal to her — her second child is a product of in vitro fertilization. (In 2020, Wicks took her newborn to the capital to vote for the Family Leave bill.) The goal, she said, is to take a piecemeal approach and expand benefits to more people over time.

California law currently requires insurance companies to offer fertility treatment except in vitro, but it is up to the employer or group to decide whether it is included as a covered benefit. The bill would make that coverage mandatory.

Annabel Adams, who recently testified in support of Wicks’ bill, paid nearly $50,000 for three rounds of in vitro fertilization. Born with a chromosomal inversion, which makes it difficult for her to maintain a pregnancy, she has suffered six losses.

Her doctors recommended in vitro fertilization, or IVF, a procedure in which eggs are removed from the ovaries and fertilized by sperm in a laboratory. The fertilized egg, or embryo, is then transferred to the uterus. For Adams, this procedure allows her doctors to test fetuses to make sure they aren’t affected by her genetic issue, which increases her chances of a permanent pregnancy.

She said her first round of treatment, which also included medication, cost her $25,600. Her Kaiser insurance plan, as offered by her University of California employer, did not cover it. Her husband’s insurance helped cover some of the costs for the second and third rounds.

“Every pregnancy is full of terror. These are desired pregnancies; These are the kids we are imagining and planning for the future,” said Adams, a resident of Long Beach and founder of California Fertility Advocates. “Finding out that IVF was essentially the cure for my disease and knowing it wasn’t readily available to me, it felt like an extra layer of damage.”

Health insurance lobbies and business groups oppose Wix’s bill, citing the cost. He says that like other laws that require new benefits to be covered, this bill will increase health insurance premiums for employers and employees.

According to the California Association of Health Plans, it’s the most expensive bill the organization is opposing this year, and Wix’s recent amendments haven’t changed its stance.

“As health plans, we should be concerned about the costs for everyone,” said Mary Ellen Grant, a spokeswoman for the association. “We are not disputing the merits of this bill, but they do increase health care costs for Californians. It is not something that health plans can get behind.”

Grant said lawmakers need to take into account the sum of all the profit mandates they want to pass, not just one bill. This year, the association is opposing 14 bills that would require the new benefits to be covered — collectively, these bills could raise annual premiums by $1.5 billion, the association said.

The California Chamber of Commerce and various local chambers representing the interests of businesses have also voiced opposition to the bill because of the cost. The bill is next headed by the Assembly’s Appropriations Committee, which weighs the financial implications of a bill.

In 2019, California enacted a law clarifying that insurers must cover the cost of preserving eggs, sperm, or embryos for patients who are undergoing treatment for diseases that affect their ability to have children. affect capacity. The last two bills introduced by Wix in 2019 and 2020, targeting fertility coverage more broadly, did not move forward.

While much of the conversation around Wix’s current bill has focused on in vitro fertilization, as it is the most expensive type of fertility treatment, the bill gets at the broader issue of fertility coverage overall, Dr. Marcelle Cedar, a reproductive endocrinologist. University of California, San Francisco. Not everyone who is infertile needs in vitro fertilization.

“It’s really about the recognition of infertility as a disease,” Cedar said. “Like any other disease, all evidence-based, clinically validated treatment options should be available to patients.”

Cedar said he has patients whose diagnosis is covered by his insurance, but his treatment is not. “You’d never say, ‘Oh, by the way, you have diabetes, but we’re not going to give you insulin to treat it.’ I mean, he’s crazy, what else would you treat like this?”

Infertility is estimated to affect about one in eight couples, or about 15% of the population in the US. Cedar said infertility has been recognized as a disease socially and politically by the World Health Organization and the American Medical Association, but it is more questionable. , Treatment is often considered optional.

“Reproductive health is difficult in this country, as we saw this week,” Cedar said, referring to news of a leaked draft opinion that showed the US Supreme Court in Roe v. Wade is ready to strike. “Reproductive health is really a spectrum, it’s not having kids when you don’t want to and being able to have them when you do.”

In the abortion debate, California is positioning itself as a sanctuary state for out-of-state people seeking to terminate a pregnancy. Democratic legislators have written a package of bills making their way through the Legislature to protect abortion access and affordability. Governor Gavin Newsom has already signed into law one of the bills that eliminates out-of-pocket costs for abortions.

Wicks and supporters of his bill said that ultimately the bill is also about choice – allowing people to start families when they want. “That’s why I work on bills for safe and legal abortion and making sure doulas are covered,” Wicks said. “All these things are very much attached to me.”

CalMatters COVID and health care coverage is supported by grants from the Blue Shield of California Foundation, the California Health Care Foundation, and the California Wellness Foundation.

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