Viewpoints

Infertility is a disease. This bill will require insurance companies to cover it

FILE - In this June 15, 2018 file photo, United Healthcare correspondence is seen in North Andover, Mass. UnitedHealth Group is reporting strong first-quarter driven by its main insurance business, as well as its pharmacy benefits division. The Minnetonka, Minn., company on Tuesday, April 16, 2019 reported net income of $3.47 billion, or $3.56 per share. Earnings, adjusted for amortization costs, were $3.73 per share, topping Wall Street estimates by 13 cents, according to a survey by Zacks Investment Research.
FILE - In this June 15, 2018 file photo, United Healthcare correspondence is seen in North Andover, Mass. UnitedHealth Group is reporting strong first-quarter driven by its main insurance business, as well as its pharmacy benefits division. The Minnetonka, Minn., company on Tuesday, April 16, 2019 reported net income of $3.47 billion, or $3.56 per share. Earnings, adjusted for amortization costs, were $3.73 per share, topping Wall Street estimates by 13 cents, according to a survey by Zacks Investment Research. AP

In my early 30s, I was head down, working 100-hour weeks to help reelect President Obama. Nevertheless, I visited a fertility doctor to understand my options and got the news – my follicle count was low for my age and I was diagnosed with “ovarian dysfunction.” Knowing that I was years away from wanting to start a family, my doctor recommended freezing my eggs.

Because I was living in Illinois, my insurance was required to cover this and I underwent three cycles. I was lucky. Not so for California. For thousands of Californians who suffer from infertility, options are limited or extremely expensive. I aim to change that.

Yes, infertility is a medical disease. It’s recognized as such by the American Medical Association, the American Society for Reproductive Medicine, the American Congress of Obstetricians and Gynecologists and the World Health Organization. But the insurance industry doesn’t see it that way, choosing to view childbearing as elective.

Current California law doesn’t provide clarity. Although state law requires medically necessary health care services to be covered by health insurance plans, it only requires health plans and insurers to “offer” group coverage for infertility treatment, but not necessarily “pay” for it. As a result, infertility treatment varies between insurers. Some companies provide no coverage, some pay for diagnostic testing to discover the reason for infertility and very few provide partial or full coverage.

Most insurers exclude in vitro fertilization entirely, even though the medical technology exists, is widely available and is much less likely than other infertility treatments to result in multiple births. Individuals needing IVF often face a painful choice: Pay for IVF themselves, often wiping out an entire savings account or dipping into what was once savings for their child, or go without treatment.

Opinion

That’s wrong – and it needs to be changed.

I have introduced legislation, Assembly Bill 767, to clarify that infertility is a disease and change the current infertility treatment mandate from a mandate to “offer” to a mandate to “cover” IVF and fertility preservation treatments. In the state Senate, my colleague state Sen. Portantino has introduced legislation, Senate Bill 600, that clarifies the requirement for insurance plans to cover fertility preservation when infertility arises as a result or side effect of medically necessary treatment.

Buffy Wicks.png
Buffy Wicks

A 2015 report from the American Society for Reproductive Medicine (ASRM) noted that low-income African-American and Hispanic patients are “underrepresented in the population of infertility patients.” Lack of coverage and prohibitively high out-of-pocket costs are almost certainly factors in that inequity. In fact, a recent study found that women aged 25-34 accrue an average of $30,000 in debt after undergoing fertility treatment. According to one estimate, there were an estimated 2,500 GoFundMe campaigns related to IVF and fertility treatment in 2017.

By removing cost barriers, AB 767 and SB 600 will also promote a healthier population. Women suffering with infertility and, often, their partners, struggle with low self-worth, crippling anxiety, depression and even suicidal ideation. The stress of the huge financial burden only exacerbates this.

Nine states already require insurance companies to cover IVF treatments. California, which prides itself in leading the nation when it comes to health equity, must become the tenth. AB 767 will be heard by the Assembly Health Committee today.

It’s my fervent hope that, when the bill is signed into law, the cost of infertility treatment will no longer be a barrier to family building and we can take steps as a state to reduce the stigma potential parents often face in their struggle to conceive.

I now have a two-year-old girl named Josephine, and I had her without IVF treatment. But at least I had options. Families come in all shapes and sizes - from blended families, to adopting children, to successful pregnancies from IVF and other fertility treatments. We should have all options on the table when it comes to creating families.

Assemblymember Buffy Wicks represents the 15th Assembly District, which encompasses the cities of Berkeley, Emeryville, Richmond and parts of the City of Oakland in the East Bay.
  Comments