OPM urged to commit to protecting IVF in federal health insurance

of Biden administration The federal government is once again putting pressure on federal employee health care systems to protect and expand coverage of infertility treatments, as states question access to reproductive health care and become increasingly politicized.

The Office of Personnel Management is developing priorities for the Federal Employee Health Benefits Program, and this summer Negotiate final rates and terms Strengthen collaboration with providers for plan year 2025. Seeing the opportunity to express their expectations, More than 100 Democratic Party members sent a letter to OPM on Monday requesting that all FEHB carriers be required to pay for IVF treatment and medication.

In a letter first reported by Politico, the lawmakers said, “President Biden is committed to ensuring that his administration uses words and actions to truly protect families’ rights to decide whether, when, and how to start a family.” “It will send a strong message that we are advocates for the United States.”

OPM’s direction has already expanded coverage in some plans, particularly for fertility drugs, a step advocates say is slow but steady progress in the field. praised. Still, lawmakers said it’s imperative the Biden administration keeps its foot on the gas, especially as some states want to consider enforcing moral rights in embryo-based treatments.

Very recently, The Alabama Supreme Court ruled For example, embryos created in a laboratory through in vitro fertilization, a common and expensive method of conception, may be considered children for purposes of eligibility under the Wrongful Death of a Minor Act.

Although the state Legislature has since enacted legislation clarifying protections for IVF donors, this ruling raises new questions about whether IVF and other treatments that result in surplus or unused embryos can be grounds for litigation. This raised many questions and had a chilling effect on providers and physicians. Sarah Rye, an employee benefits attorney at McDermott Will & Emery, said of the Alabama clinic in an interview:

The case did not address insurance coverage for IVF, but if other states follow the Alabama court’s decision and grant broader personality rights to embryos, multiple IVF delivery may be difficult, if not impossible, given that embryos are often used. Advocates say moral or religious objections to IVF could increase pressure on states to interpret fetal personhood as applicable to infertility treatments. At least 14 states have introduced related legislation. The Wall Street Journal reported.

“Obviously it doesn’t help if you can’t get services in your state. [insurance] The plan still technically covers them,” Raayi said. “On the private employer plan side, we have already begun conversations with employers who are targeting individuals in Alabama.”

House and Senate Democrats who signed the letter said OPM, as administrator of the nation’s largest employee-run health plan, has an opportunity to lead by example in fertility coverage. They also said that reproductive problems are probably more common than people realize. In the United States, about 1 in 5 women are unable to conceive even after trying for a year. They said more could be done to cover the intervention treatments needed by same-sex and single individuals.

“Simply put, at a time when seemingly every politician is loudly proclaiming their support for IVF, even if many of those same politicians are putting the future of IVF in jeopardy, a personality movement President Biden has an opportunity to demonstrate strong leadership by making the following decisions,” the letter said. Make it available to more Americans, including dedicated federal employees. ”

Some states have passed their own laws requiring health care providers to cover infertility. January, New Jersey Governor Phil Murphy signs the bill This would require coverage for intrauterine insemination, genetic testing, and unlimited embryo transfer by health insurance that insures 50 or more people.

“Anyone who relies on IVF or other assisted reproductive technologies to start or grow a family should have access to the medical care they need,” said Sen. Tammy Duckworth, one of the signatories. That includes our federal employees.” I am also a former IVF patient, said in a statement to the Federal Times.

If other states raise questions about aspects of IVF that involve fertilized eggs, OPM can override state law because it is a federal program.

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In 2024, federal officials created 24 specific planning options for infertility treatment, varying by benefit and location. Notably, Blue Cross Blue Shield has implemented a cap of up to $25,000 per year, which employees say has been helpful, but assuming no other health conditions, the benefits are modest. Some noted in an interview with the Federal Times that it could be used up after one or two cycles of treatment. complications.

A study published in the National Library of Medicine shows the following success rates: Pregnancy rates can double between the first and sixth IVF cycles For women under 40.

$25,000 “honestly doesn’t cover much,” said one federal employee who spoke about his experience with federal insurance. “After several egg retrievals, we were able to reach our limit. [Then] Embryo transfer will have to wait until next year. That would delay things further. ”