Infertility Insurance Coverage in Washington State

by | Jan 4, 2022 | Fertility Preservation, In the News, Infertility, IVF Services, News at PNWF

How to support an infertility insurance mandate

We have an update on important legislation regarding infertility insurance coverage in Washington. PNWF’s co-founder and medical director, Dr. Lorna Marshall, has been working with a local coalition to present an insurance mandate to the Washington state legislation. This mandate would require insurance plans to cover fertility treatments, including IVF and fertility preservation, for all individuals. We believe this bill will address systemic inequity and help all Washingtonian access needed fertility treatments to build their families. We’ve provided a guide to the legislation below, as well as resources if you would like to get involved.

Background on the Proposed Washington State Infertility Insurance Mandate

The Washington Building Families Coalition (WBFC) has presented the proposed legislation, HB 1730. The WBFC was started in 2019 by a diverse group of fertility doctors from WA clinics, fertility support workers from RESOLVE and other fertility advocacy groups, representatives from the American Society for Reproductive Medicine (ASRM), and Washington residents who have experienced infertility and fertility treatments. The WBFC met biweekly for two years to put together the proposed infertility coverage mandate, and submitted it to the state Department of Health for review in May 2021. The bill was filed on January 3rd, and will be introduced to state legislation soon.

Why Is Health Insurance Coverage For Fertility Important?

Approximately 1 in 8 couples struggles with infertility. That number doesn’t include LGBTQ couples or single parents who also require medical intervention to have biological children. It also doesn’t include cancer patients, whose life-saving treatments can cause infertility. For all these individuals, in vitro fertilization (IVF) and related fertility treatments can be the only option to starting a biological family.

However, IVF can be very expensive, averaging $15,000 per cycle in the US. If a patient doesn’t have insurance coverage for infertility, they must pay out of pocket, often going tens of thousands of dollars in debt. When it comes to insurance, there is a huge equity issue with access to coverage and fertility services. Some companies, mostly in tech, offer their employees coverage for IVF or fertility preservation, along with higher salaries that offset the costs of fertility treatment in general. Individuals with lower income, BIPOC, and people in the LGBTQ+ community are significantly less likely to have insurance coverage for fertility, and are less likely to be able to afford fertility treatments. Even when insurance companies cover infertility treatment, they often define infertility through heterosexual, cisgender, and partnered standards, excluding LGBTQ+ individuals and single parents from coverage.

How Does the Infertility Insurance Mandate Solve This Problem?

The proposed legislation aims to reduce the inequity in access to fertility treatments by increasing affordability for everyone. Mandating infertility coverage significantly reduces the costs to the patient – up to 75%. This cost reduction lowers the very real burden of stress associated with infertility, and increases access to previously underserved communities. In addition, the proposed bill defines infertility as “a person’s inability to reproduce either as a single individual or with the person’s partner without medical intervention.” This definition will extend coverage to LGBTQ+ and single individuals.

Infertility is linked with high levels of depression, anxiety, and emotional distress. The financial burdens of paying for fertility treatments out of pocket significantly add to this stress. Mandating coverage for quality fertility care reduces financial stress and may reduce the associated mental health burdens as well.

Why Does Infertility Treatment Cost So Much?

There is a common misconception that fertility care costs significantly more than other medical procedures. In fact, most fertility centers keep treatment charges very close to the actual costs of the care, in order to provide as much accessibility as possible to patients paying out-of-pocket. IVF is an extremely complex service involving multiple medications, regular monitoring and testing, surgery, and sophisticated laboratory procedures to conceive a new life. Even with that, the patient’s charges are much closer to the fundamental costs than, say, a kidney surgery or other significant operation.

Will A Mandate Affect Insurance Premiums?

Studies have shown that including infertility coverage has a minimal effect on premiums. Comprehensive reviews from Connecticut, Maryland, Massachusetts, and Rhode Island, which have all mandated infertility coverage for years, show that the cost of infertility coverage is less than 1% of the total premium costs. A 2016 study of Massachusetts estimated that infertility coverage increased premiums by only 0.12%-0.96%.

Additionally, mandating infertility insurance coverage may reduce other medical expenses, offsetting the costs of IVF. Studies have shown that states mandating infertility insurance have significantly lower rates of multiple births (twins, triplets, or more). Without insurance coverage, patients undergoing fertility treatments are more likely to transfer multiple embryos at once in the hopes of increasing the chance of pregnancy, or resort to less expensive treatments with higher rates of multiple pregnancies. With coverage, patients can make decisions about fertility treatments with their doctors based on medical necessity, rather than finances. This leads to more single embryo transfers, avoiding the considerable health risks and financial costs associated with multiple births. One study estimates that national savings from fewer multiple births could be over $6 billion dollars. That estimate doesn’t include long-term care costs associated with multiple pregnancies and premature births.

How Can I Support the Infertility Insurance Mandate?

Community support for the bill is extremely important and very welcome. The WBFC presented the bill for Sunrise Review with the state Department of Health in August 2021. At the hearing, 37 individuals testified in person about their struggles with accessing infertility treatments, along with 90 written testimonies. If you would like to add your voice, you can comment on the bill here. Join the WBFC group on Facebook to stay up to date on more upcoming opportunities to support the bill. ASRM and RESOLVE are also offering a virtual training session on local advocacy in January 2022.

As fertility care providers at PNWF, we fully support the bill and hope it will pass this year. The bill will help the more than 200,000 Washingtonians living with the disease of infertility and other residents who face barriers building their families in the Evergreen State.

This article was sourced from the Applicant Report to the Sunrise Review Committee on May 26, 2021.