Reproductive leader California lags when it comes to infertility treatment coverage | Opinion

For many families, an infertility diagnosis is not the largest barrier to becoming a parent. Sadly, the biggest barrier is cost. An average in vitro fertilization (IVF) cycle in the U.S. costs between $15,000 to $20,000 — roughly the same as arthroscopic knee surgery.

The difference is that knee surgery is covered by insurance, while infertility treatment — in California, at least — is not, placing it out of reach for many who must pay out of pocket for this healthcare.

Today, 14 states have insurance coverage for infertility that includes IVF. Connecticut, Maryland, Massachusetts and Rhode Island have mandated infertility benefits since the 1980s. In the last six years, 12 states have expanded existing fertility coverage mandates to cover more people or more procedures.

So why is California — a state that prides itself on being a leader in reproductive freedom — so far behind other states, with multiple failed legislative attempts to mandate infertility coverage?

The answer is that the myth of cost prevents employers from adding this benefit and stops lawmakers from enacting this coverage. The cost to provide this care is actually more affordable than employers and lawmakers realize and less costly than insurers want you to believe. This is proven by data from both employers that offer fertility benefits and states that have passed fertility insurance mandates.

For example, a 2021 study of employers by Mercer found that 97% of respondents who provide fertility benefits, including IVF, did not experience a significant increase in medical plan costs. Studies also show that employees with employer-provided IVF benefits have higher job satisfaction, miss less time from work for treatments, remain in their jobs longer and are more likely to recommend their employers as a place to work.

Similarly, cost projections for legislation to mandate fertility coverage are often inflated compared to actual utilization and cost data after a state mandate passes. A study out of Massachusetts, which has provided unlimited IVF coverage since 1987, found utilization increased after implementation and was not associated with excessive increases in consumer cost. Likewise, the Connecticut infertility mandate enacted in 1989 was estimated to cost $1.06 per member per month in 2016 — less than one-third of the original projection.

While the myth of cost has stalled prior fertility legislation in California, the Legislature is once again considering a bill, Senate Bill 729, that would mandate it for large group health plans.

SB 729, authored by state Sen. Caroline Menjivar, would require large group health plans to cover treatment of infertility, including IVF. It would also provide equitable access to the LGBTQ+ community and unpartnered individuals by updating the definition of “infertility” to include anyone seeking to build a family regardless of relationship status or sexual preference.

SB 729 passed the California State Senate by an overwhelming majority and advanced out of the Assembly Health Committee last year. It is now pending before the Assembly Appropriations Committee to determine if the bill moves forward. Cost will certainly be a deciding factor.

Unfortunately, the California Health Benefits Review Program’s analysis of SB 729 significantly overstates cost and utilization compared to other states with similar laws. An independent analysis of SB 729 by Fertility Dynamics, using data from other states’ post-mandate experience, estimates the actual cost increase for fertility services will be less than 10 cents per member per month in year one and approximately $1 in year five when the full impact is felt. Even if the indirect costs of maternity care are included, at full impact in year five the total cost would only be $2.15 per member per month.

Once again, patients and patient advocates in California are fighting the myth of cost.

At RESOLVE, the National Infertility Association, we work with countless Californians who have been forced to sell their homes, go into debt or, perhaps most tragic of all, abandon their hopes of becoming parents due to the cost of fertility treatments. The real cost is not in covering infertility treatments, but in continuing to overlook them. The financial, physical and emotional toll is profound for many Californians.

With SB 729, California’s legislature has lawmakers have the opportunity to update the state’s outdated 1989 infertility insurance law. As a “mandate to offer” rather than a “mandate to cover,” this archaic law is hardly a mandate at all (it does not require coverage and specifically excludes IVF, the standard of care for many patients).

Let’s ensure that the one in six Californians with the disease of infertility, as well as same-sex couples and unpartnered individuals, are not left to bear this burden alone.

This story was originally published January 23, 2024 at 5:00 AM.