OPINION | It's Time for Washington Lawmakers to Pass an Infertility Treatment Mandate

by Nafkot Nurga, RN

The desire to have a child is one of the most fundamental aspects of being human. Infertility, which affects 1 in 8 couples in the United States, is a disease that robs us of this basic drive. Studies have confirmed that the stigma and psychological impact of suffering from infertility is comparable to that of suffering from cancer. Even though 90% of infertility cases can be overcome through medical treatments, fertility treatment — because of the high costs — is a privilege only affluent Americans can afford. To address this inequity, Washington State legislators should pass House Bill 1151 — currently being debated — which would require health plans sold in Washington to cover fertility services.

Twenty other states already have fertility mandates requiring health insurers to cover some form of fertility treatments. It has been over four decades since the first state, West Virginia, enacted a fertility insurance mandate. Colorado became the latest state to be added to the list after its fertility mandate took effect at the beginning of this year. It is unacceptable for our state, considered a leader on most progressive issues, to lag behind several states, including Montana and Utah, and not mandate insurers to cover fertility treatments.

In 2022, legislatures in our state attempted for the first time to pass a bill mandating coverage for fertility services. Twelve democrats, led by Rep. Monica Stonier, introduced House Bill 1730. However, the bill did not make it out of committee. A similar bill is being reintroduced in the 2023-2024 session (HB 1151 and companion Senate Bill 5204) by Rep. Stonier and her Democratic colleagues. The bill passed the House and is currently awaiting its fate in the Senate.

The House Health Care and Wellness Committee held its first public hearing of the current session on Jan. 18, 2023. Out of the four bills presented during the hearing, the fertility bill by far drew the most emotion from members of the public.

A mother testified about setting up a GoFundMe page to pay for cryopreservation (egg freezing) for her 5-year-old daughter diagnosed with cancer. After chemo and radiation removed her daughter's chances of having children naturally, the mother struggled to preserve her daughter's eggs for future use. Because our state does not mandate fertility preservation be covered by insurance, the mother had to raise funds on her own.

This family's story is a good example of the fertility mandate's additional benefits. Fertility mandate laws will not only help couples struggling to conceive, but also mandate coverage for standard fertility preservation when a medical treatment causes infertility.

During the hearing, several arguments were presented, both in support of and in opposition to the bill. Jennifer Ziegler, a lobbyist for the Association of Washington Healthcare Plans, warned that if the bill passes, insurance premiums will increase. However, studies have shown minimal effect on premiums. Other states' analyses show that adding fertility coverage to a plan costs less than 1% of the total premium. Furthermore, hundreds of employers offering fertility services in their health plans were surveyed, and 97% of them indicated that they have not experienced increased medical costs.

Having a fertility mandate will, in fact, have an opposite impact on the overall health care costs. Patients living in states without fertility mandates are more likely to choose multiple embryo transfer per cycle to maximize their chances of live birth and avoid another round of costly IVF (in vitro fertilization). Pregnancies with multiples lead to several health complications, including hypertension, prematurity, and gestational diabetes. The overall complications and risks associated with multiple pregnancies cost the American health care system billions of dollars per year.

Other opponents of the bill raised ethical and moral concerns. Angel Alvarado opposed the bill on behalf of Respect Life Ministry, arguing that the bill mandates insurers to pay for IVF, which will allow the destruction of millions of "embryonic children." However, linking fertility coverage with the broad debate on abortion is inappropriate, as the mandate's main goal is to assist people to build families, not destroy them.

Equitable access to fertility care is long overdue. Working families who pay their monthly insurance premiums should not be denied the opportunity to build a family because their insurance does not cover fertility care. Legislatures should intervene and create a fair playing field for all Washingtonians — regardless of wealth — to build families.

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