The time is now for Washington state to require insurers to cover infertility care | Opinion
It is likely that we all know someone who struggles with the devastating impact of infertility. A disease affecting 1 in 8, infertility has no bounds of geography, gender, race, religion, or sexual orientation.
Further, young men and women diagnosed with cancer are often at risk for medically induced infertility, and only have a narrow time window to access fertility preservation before the start of their cancer treatments.
Twenty states today have insurance laws for infertility medical care. It may seem surprising given its reputation as a stalwart vanguard for protecting reproductive health access, but Washington state is not one of those states.
In the absence of a requirement by our state for health plans to cover infertility treatments, the ability to build a family for those facing an infertility diagnosis becomes a function of economic privilege. Washingtonians who pay in monthly premiums for their health insurance, but lack fertility coverage, shoulder the entire cost of their infertility medical care themselves, adding financial stress and debt on top of the already considerable emotional toll of infertility.
Many are simply unable to afford care. Others prematurely stop treatments when their savings run out.
The status quo in our state disproportionately impacts people of color, those who are less affluent, and those who provide essential services, such as schoolteachers, whose health plans do not cover infertility care. It discriminates against the LGTBQ community and others who require medical assistance to have children.
Lawmakers in Olympia are now advancing a much-needed legislative bill (HB 1151) to address the disparities, untreated disease burdens, and inequities that have persisted unchecked for far too long in our state. Widely supported across the state by patient advocates and health professional organizations, HB 1151 would require insurers to cover costs of infertility medical care as well as standard of care fertility preservation in patients facing a diagnosis of cancer or other medical condition that may impact fertility.
Studies make it clear that mandated insurance coverage not only improves access but results in better treatment outcomes. Most patients with the diagnosis of infertility do not require or undertake IVF medical treatments. For those who do need IVF and have insurance coverage, the rate of higher-risk, multiple-gestation pregnancies is lower because patients are more likely to choose single embryo transfer. This generates significant cost savings as well as better maternal and child health outcomes.
What HB 1151 will not do is significantly increase premiums for Washingtonians. Robust data and actuarial studies from multiple states show that mandated comprehensive coverage for infertility care only nominally increases premiums and administrative costs. Infertility care has the misperception of being expensive. It certainly can be, when paid out of pocket, and often prohibitively so, but when spread out across the payor group, increases to the group are small.
In Massachusetts, which has a mandate for unlimited coverage since 1987, a study funded by the state found that real-world increases in premiums were as little as 0.12 percent per member per month. IVF also was not overutilized. This is not surprising considering IVF is a difficult treatment that few want to undergo unless it is medically indicated.
For Washingtonians struggling with infertility or facing the prospect of infertility with a cancer diagnosis, the clock is ticking. HB 1151 is before our Legislature. The time is now for Washington state to be that vanguard of reproductive health access and join the growing number of states to hold insurers accountable to cover infertility care as with any other medical condition. Its passage will be transformative in the lives of those in the Evergreen State who struggle with infertility, and for those in years to come.
Dr. Christopher Herndon is an associate professor and medical director of the division of reproductive endocrinology and infertility at University of Washington School of Medicine.
