13 Jun 2023 California Poised to Pass a Bill Mandating IVF Insurance for Large-Group Health Plans
Last month the California Senate passed SB 729, a bill requiring the state’s large-group health insurance plans to cover a broad range of fertility treatments. After passing the Senate in a 31-3 floor vote, the legislation advanced to the Assembly Rules Committee for the very first time.
If passed into law, SB 729 would redefine infertility and require health plans to cover assisted reproductive technologies including in vitro fertilization (IVF), sperm testing/deposits, cryopreservation, egg retrievals, and embryo transfers (as long as any such embryo transfers are single-embryo transfers as recommended by the American Society for Reproductive Medicine (ASRM)). This is the farthest any bill mandating fertility coverage equality has gotten in California to date.
The current state mandate, which is more than 30 years old, requires group insurers to offer coverage for fertility treatment but excludes IVF. The current law allows employers to deny benefit coverage, allows religious exemptions, and codifies a hetero-normative definition of infertility that discriminates against non-traditional families and excludes the entire LGBTQ+ community and single intended parents from benefits provided to heterosexual beneficiaries. Outdated and narrow definitions of infertility based on unsuccessful heterosexual conception do not align with today’s diverse and evolving family models and often render same-sex married couples or single intended parents ineligible for fertility benefits--even though they pay into the same benefits plan. The current law also inhibits access to reproductive healthcare for low-income families and the Black and Hispanic Communities.
SB 729 stands to remove these exclusions and create more inclusive health coverage plans, regardless of relationship status, gender, race, sexual orientation, location, or income.
Bill Would Help Mitigate High Cost of Fertility Treatments
As we have reported in the past, the average cost of a round of IVF is over $12,000, which does not include related costs, such as time off of work to undergo treatment or yearly fees ($1,000+) to cryopreserve excess eggs, sperm, and/or embryos. The final cost of one round of IVF can easily reach well over $15,000. For many intended parents who may require more than one round of IVF, the dream of parenthood becomes even more of a strain and can even be unattainable given the financial burden.
If passed, SB 729 will expand access to reproductive healthcare for thousands of Californians and lessen disparities in access to fertility treatments, making assisted reproductive technology (ART) more affordable. In doing so, the measure acknowledges that family-building can be a complex process for the LGBTQ+ community and single parents, such as single men and professional women who choose to either parent alone or freeze their eggs/sperm for fertility preservation. Because these communities commonly rely on ART for family-building, the lack of insurance coverage can create heavy financial burdens and barriers. The bill also acknowledges that low-income families and individuals, as well as affluent ones, have a right to access reproductive technologies.
Global Fertility Rates Dropping
Over the past 50 years, the fertility rate has dropped drastically in both men and women worldwide. According to the New York Post, sperm counts have dropped more than 50 percent in Western countries since the 1970s, and the U.S. birth rate is currently 16 percent below replacement level.
On April 23, 2023, the World Health Organization (WHO) released a report on the prevalence of global infertility based on data from 1990-2021. Using 133 studies to gather data points, it found that one in six people will struggle with infertility at some point in their lives and that “infertility does not discriminate.” Rather, it affects all socioeconomic levels, ethnic backgrounds, religious affiliations, and sexual orientations. The report aims to give understanding to policymakers, civil society organizations, and health service providers to understand the magnitude of infertility and thereby address it in policy so that every intended parent has access to affordable quality reproductive healthcare. Yet, according to the United Nations Office of the High Commissioner on Human Rights (OHCHR), many countries are unclear on their responsibility to prevent infertility, ensure access to treatment, and end the harm suffered by individuals who are considered infertile. Responding to this uncertainty, in June 2023, the OHCHR issued a new research paper explaining countries’ legal obligations regarding infertility. Importantly, OHCHR underscores that the nations of the world must take steps to prevent infertility by addressing its root causes and ensuring access to treatment.
Presently, according to the report by the World Health Organization, infertility affects millions more intended parents than in the past, and yet research and financial support for high treatment costs remain underfunded. Assisted reproductive technologies remain inaccessible to a significant segment of the population due to high cost and availability. Even though WHO defines infertility as a “disease of the male or female reproductive system,” health plans continue to treat it differently than covered diseases such as cancer and diabetes. Instead, the need for infertility treatment has been put on the back burner by insurers, leaving intended parents to face enormous medical expenses and debt to have a child.
As a state that champions reproductive freedom, through SB 792, California seeks to join several other states already mandating reproductive healthcare coverage. According to RESOLVE: The National Infertility Association, 20 states have passed fertility mandates with 14 of those states already covering IVF, and 12 of them covering fertility preservation for medically induced infertility such as chemotherapy or surgery.
IFLG full-heartedly supports SB 729 and eagerly anticipates its passage into law, signaling California taking another step forward in supporting reproductive freedom as a basic human right, regardless of sexual orientation, gender, marital status, race, or wealth.
