WA proposal would require fertility treatment insurance coverage

Washington lawmakers are debating whether to require coverage of fertility treatments under group health plans and Medicaid in an attempt to help more people start families. Though concerns have been raised about the costs around the mandate. 

Data from the National Institutes of Health show about 9% of men and 11% of women have experienced fertility problems, while treatments can cost tens of thousands of dollars. 

"There’s nothing more personal than the choice to build a family," said sponsor State Sen. Noel Frame (D-Seattle). "And not everyone gets to do that without the help of a little medical intervention." 

Big picture view:

Senate Bill 5121 would require all group health plans to cover fertility perseveration services, like freezing eggs and sperm, starting in 2026. In 2027, group plans would have to cover the diagnosis and treatment of infertility – whether that be medications or procedures like in-vitro fertilization. However, Medicaid would only have to cover fertility preservation services. 

At a committee hearing Friday morning, Frame told senators about how she and her husband needed fertility treatments as they started their family later in life. 

She described how after they were "really lucky" to have their first child, they needed to turn to fertility treatment for a second child. But they were initially hesitant because they did not want to "bankrupt our family." However, they proceeded when her husband got a job offering fertility treatment as a benefit. 

"You shouldn’t have to work for one of the largest corporations in the world to have the privilege of getting to build a family," she said. "I am so grateful to those employers for setting a good example, but that’s not the way it should be." 

Local perspective:

Maranatha Hay of Grays Harbor and her partner Michael Truong testified about their struggles in starting a family. 

Hay said an ectopic pregnancy made her no longer able to have children without IVF. However, the treatment has been too expensive for the couple to go through with it. 

Truong said infertility also has an impact on men, not just women directly experiencing it. He said even as a veteran, he does not have fertility treatment as a benefit. 

"The ability to have kids based on who your employer is or what pathway you choose in life, in terms of your career or occupation, makes absolutely no sense," Truong said. 

While other states have required some sort of fertility coverage, Hay is worried help is coming too late, if not at all. 

"Grains of sand are like slipping out of this hourglass. Every night I think about it," she said. "I think that it’s one more day past the point that we’re going to be able to have a family, and that’s the reality." 

The other side:

Opponents of the bill raised moral concerns around the embryos discarded during IVF processes. Representatives of insurance companies said mandating fertility treatments could increase coverage costs for everyone. 

"This proposal for us is projected with a 1.4% premium increase, which is a $7.68 per member, per month cost impact for the first year," said Christine Brewer with Premera Blue Cross. "The primary driver of the higher cost is the increased likelihood of high-risk maternity and newborn care associated with fertility service." 

Hay and Truong said they pay insurance for things resulting from other people’s lifestyles and choices, like treatments for smoking, so why must they pay out of pocket for a condition they did not choose? 

"What’s more tragic about this is that I am missing out on such an important piece of what it means to be a human being," Hay said. "I will never know what it means to be a mother." 

Companion legislation in the House passed out of committee Friday morning, but was amended to exempt small group health plans. 

A spokesperson for Frame said while she has not seen the amended House bill, "she doesn’t expect there to be any problems with getting both chambers on the same page for whatever the final details of the bill end up being." 

Albert James is a television reporter covering state government as part of the Murrow News Fellowship program – a collaborative effort between news outlets statewide and Washington State University.

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