With fertility rates declining and more women postponing childbearing into their 30s and 40s, many states are requiring private insurers to cover fertility treatments so people can start families without high out-of-pocket costs. Are considering.
Such a law would end with Miraya Gran of Bloomington, Minnesota, who spent $102,000 in vitro fertilization to give birth to her now two-year-old daughter, Ira, after trying other expensive options. and will help people like Andy Gran. Miraya Gran has since become an advocate for state legislation mandating insurance coverage for fertility treatments.
“In addition to the financial toll, I felt a lot of resentment and anger. I just thought it was wrong. said.
Twenty-one states mandate such compensation, but the proposed mandate is We’re screwed It is expected to pass the Minnesota legislature this year. Except in New York, the Medicaid program does not cover fertility treatments.
Minnesota was one of at least 16 states this year to introduce legislation aimed at creating or expanding fertility insurance. The District of Columbia recently approved the bill, and California, New Jersey, and Pennsylvania are still considering bills. Last year, Illinois enacted a new law that requires insurance companies to pay for treatment and employers to give paid time off to people recovering from failed treatments.
Some states have expanded mandates to cover more residents, including singles and same-sex couples. They are also expanding mandates to include coverage of fertility-sparing procedures for cancer patients and others who wish to preserve their sperm or eggs before undergoing potentially infertile treatments. .
Democratic Mayor Muriel Bowser signed into law the District of Columbia’s insurance coverage mandate in July, but Congress still needs to approve it, said councilor Christina Henderson, the bill’s sponsor.
henderson Said She’s heard from people who have taken on extra part-time jobs simply because their employer’s health insurance covers fertility treatments. The bill will come into force in 2025.
decades of history
Fertility coverage obligations have a long history, beginning with the first bill passed in West Virginia in 1977, requiring HMOs to cover unspecified “fertility services.”
The 1985 Maryland mandate was the first to specifically address in vitro fertilization, widely considered the most effective treatment for infertility.Approximate 50% chance of having a baby For women under the age of 35. But the cost of in vitro fertilization, the implantation of a fertilized egg into the uterus, can be prohibitively expensive without insurance.
It concludes, “The cost of in vitro fertilization remains the greatest barrier to fertility treatment in the United States.” Duke University Research The paper, published last year in the journal Reproductive Biology and Endocrinology, notes that each successful birth can cost $60,000. “State fertility insurance mandates are an important mechanism for expanding access to fertility treatment in the United States, which lacks federal law.”
West Virginia’s mandate predates the first IVF birth, and recent legislation has been introduced to add this procedure to the state’s mandate, including the proposed one. law I didn’t pass this year. According to RESOLVE, the National Infertility Association, which tracks state and federal law, 14 states include IVF as a requirement.
Limited mandates, such as those in Texas and California, require insurance companies to provide fertility coverage only if an employer requests it. California bill expand the mission A bill that would require all major insurance plans to provide coverage has passed the state Senate and is being debated in the state legislature.
California’s expanded mandate covers unlimited embryo transfers, but other states have limits. Maryland Coverage requirements are limited to three IVF attempts per birth, with a lifetime cap of $100,000. In Connecticut, lifetime limit Out of 4 embryo transfers.
religious opposition
Jessica Tincopa and her husband, Rob Tran, of Orange, Calif., have had six miscarriages since 2015. Before her pandemic, she had saved $20,000 to pay for IVF, but when her wedding photography business hit a dead end, she slashed the savings to keep her going. I had no choice but to take it. Up. They used IVF insurance to try and find work, but were unsuccessful.
“Our insurance company was charged $100,000 for the cost of the miscarriage. They should have covered the IVF trial round for $30,000,” Tincopa said.
Last year, a survey found that 61% of large employers had health insurance that covered fertility treatment, and 47% covered IVF. annual survey by consulting firm Mercer.
Even California’s new law wouldn’t cover Tincopa’s current small group policy. This is because the law only applies to large group policies. But at least she said the insurance available to Tincopa will increase her chances of finding a job.
but, California and other states, insurers have voiced opposition to basic or extended fertility insurance mandates.
For example, an insurance company in Oregon opposed To Infertility Insurance Obligation Bill It covers in vitro fertilization and claims that the operation violates Catholic doctrine. declare the method immoral.
Insurer Providence Health Plan, in written testimony to Congress, sought a waiver of IVF coverage. The Oregon bill did not pass, but fix Eliminate the requirement for in vitro fertilization.
Ann insurance companies in north dakota They said the process could create legal issues and uncertainties if people stopped paying for embryo storage because they changed jobs or for other reasons.
The Sanford Medical Plan, which provides coverage throughout the upper Midwest, also argued that costs would be higher because: state research It shows that plans with maximum benefits of $50,000 can increase premiums from $1.98 to $24.85 per insured per month. Due to an oddity in North Dakota law, before Congress can pass mandates for general fertility insurance, those mandates must first apply to retiree insurance.
Bills in Oregon and North Dakota failed to pass this year, as did Connecticut, Illinois, New Hampshire, New York, Vermont, Virginia, Washington, West Virginia and Wisconsin.
I wish my insurance benefits would make fertility treatment affordable and that my husband and I would have the opportunity to have at least one child.
In North Dakota, Republican Rep. Mike Brandenburg said it was the third attempt to get the bill through Congress.
“We will continue to work hard,” Brandenburg said. “We are moving forward. We are seeing more young people coming into[the legislature]and getting votes all the time. If so, why not?”
Parents in North Dakota, as well as the Grans in Minnesota, testified about the financial burden and emotional stress of fertility treatments.
Elizabeth Carter of West Fargo, January letter to Congresssaid she and her husband, who both have advanced degrees and have full-time jobs, began working in the moonlight to pay for their treatment.
“I wish I could have access to more affordable infertility treatment through insurance benefits, and that my husband and I could have the opportunity to have at least one child and be born into a stable family with both working parents. “It’s very difficult to get them out into the world,” Carter wrote.
In Wisconsin, Democratic Gov. Tony Evers added a mandate for fertility insurance to this year’s state budget, but the provision failed to pass the Republican-controlled Congress. Democratic state Sen. Kelda Royce told Stateline that she plans to introduce a separate bill later this year.
“Infertility is a common ailment and should be covered by insurance like any other health need,” says Royce.
A New Hampshire bill to consider the cost of extending fertility insurance requirements to singles and same-sex couples stalled on committee, but state senator Rebecca Perkins Kwoka said the Department of Health would consider it without the bill. He said he still wanted to persuade the possibility of doing so. .
postponement of childbirth
Some proponents say residents may postpone having children because of high housing and child support costs and the reality that more and more young women are working to build careers before raising children. points out that there is. However, such legislation is unlikely to have an impact. birthrate It has been below the replacement rate of two children per woman since 2010.
a study A professor at the University of California, Irvine, found a link between declining fertility rates and the state’s willingness to pass mandates, author Katherine Bogard says in her book: . video presentation “States are chasing each other,” he said last year as the issue gained more attention. Bogard told Stateline that he is preparing to publish more detailed findings.
Alison Jemil, a demographer and fertility expert at Johns Hopkins University, said the decline in fertility was associated with postponed births. Perhaps that, along with growing concerns about equality for groups such as single parents and same-sex couples, is driving new state legislation, she said.
“This means the state is open to messages and advocacy from fertility advocates, including many in the LBGTQ+ community,” Jemil said. But even with increased insurance, the overall fertility rate is likely to continue to decline, she said.
“The increased use of fertility treatments is not yet going to have a significant impact on U.S. fertility,” she says. “Assisted reproductive technology accounts for a small percentage of all births, 2% of all births.
