What does SB 729 do?
SB 729 will require health plans to provide coverage for fertility care, including treatment for infertility and in vitro fertilization (IVF). The bill will also ensure that LGBTQ+ couples are not unfairly excluded from coverage. SB 729 is critical to achieving full-lived equality for LGBTQ+ people and advancing reproductive freedom for all Californians. Donate today to help pass SB729
How is current law discriminatory against LGBTQ+ families and unpartnered individuals?
The current law is particularly discriminatory towards the LGBTQ+ community and unpartnered individuals. It enforces standards of proof that are difficult, if not impossible, for same-sex couples and transgender individuals to meet. For example, current regulations require a year of “regular sexual relations without contraception” (unprotected penile-vaginal intercourse) to qualify as infertile, a standard that is irrelevant for LGBTQ+ couples. This essentially denies them access to fertility treatments. SB 729 proposes to correct this inequity by expanding the definition of infertility to include all individuals seeking to build a family, regardless of their sexual orientation or relationship status. This will help ensure that fertility care is accessible to everyone and that no one is unfairly excluded from the opportunity to have children.
Why is this bill of the essence at this time?
Despite the fact that 85 percent of Americans support access to IVF, the attack on this critical healthcare continues. The current legal landscape across the United States is increasingly hostile to fertility treatments like IVF, particularly as legislators in various states advance “personhood” bills–there have been more than 40 bills introduced at the state level that would impact IVF since the Dobbs decision. These bills seek to grant legal rights to embryos, which could significantly impact the availability of IVF. In Alabama, for example, a state Supreme Court ruling classified embryos as “extrauterine children,” causing some fertility clinics to suspend their services. As states move toward restricting reproductive rights, California must take a leadership role in protecting and expanding access to fertility care. Signing SB 729 into law will ensure that Californians can continue to access fertility treatments without fear of legal repercussions or service interruptions.
What is the current cost for families?
For many families, the cost of fertility treatments is the most significant barrier to having children. An IVF cycle can cost between $15,000 and $20,000, making it prohibitively expensive for many individuals, especially those without insurance coverage. While some argue that mandating fertility coverage would increase insurance premiums, data from states that have enacted similar laws shows that the cost is much lower than anticipated. For example, in Connecticut, the cost of infertility mandates was estimated to be less than $1.06 per member per month, significantly lower than initial projections.
An analysis of SB 729 by the industry leader in fertility data analytics, Fertility Dynamics, using actual data from fertility clinics throughout the country and benchmark data from other states that have implemented such an insurance mandate concludes that the increase in premiums would only total approximately $100 million per year in California, less than $1 per member per month to cover the 10 million insurance plan enrollees with insurance subject to the requirements.
In addition, a 2021 Mercer survey of more than 450 employers nationwide found that 97% of employers offering infertility coverage, even those that include IVF, have not experienced increases in their medical costs.
Furthermore, research shows that providing fertility benefits increases employee satisfaction and retention, making it a wise investment for employers. SB 729 would help ensure that infertility treatments are financially accessible, and that people don’t have to go into debt or abandon their hopes of becoming parents due to the high costs.
What is the state cost associated?
Furthermore, Fertility Dynamics analyzed the state cost for the mandate over the first two years. Fertility Dynamics estimates that the total cost for PERS, the only state agency subject to the mandate, would be $15 million over two years, whereas CHBRP estimated $80 million. Fertility Dynamics concludes that CHBRP overestimates the pace and rate of adoption by enrollees and the full and unit costs of fertility services. The final version of SB 729 delays the implementation for PERS until July 1, 2027, to avoid state costs beyond the projected state budget deficit window.
What will happen to Californians if this bill is not signed?
California, which has long prided itself on being a leader in reproductive rights, currently lags behind 14 states that already mandate insurance coverage for IVF. States like Connecticut, Massachusetts, and Rhode Island have had infertility coverage mandates since the 1980s. Most recently, states such as New York, Colorado, and Illinois have expanded their coverage mandates to include more people and comprehensive treatments.
It is estimated that if the Governor signs SB 729, 10M eligible Californians would benefit. By excluding IVF from insurance coverage, California denies thousands of residents access to the most effective treatment for infertility. When less expensive treatments are ineffective, IVF is often the standard of care for individuals facing infertility, and its exclusion from insurance plans means that many Californians must either pay out of pocket or forego treatment altogether.
Providing coverage for a full spectrum of fertility services, including IVF, will enable doctors to choose the most medically appropriate and least invasive treatments for their patients, leading to better health outcomes and higher success rates in conception.
Donate today to help pass SB729
ADDITIONAL BACKGROUND INFORMATION:
Current Law is Outdated and Inadequate
- California’s existing infertility coverage laws are based on legislation passed in 1989, now over three decades old. This law only mandates that insurers “offer” coverage for infertility treatment, excluding IVF, and leaving it up to employers to request the coverage and to the insurance companies to price it without regard to cost or co-payment limits. This approach is toothless. While infertility is recognized as a disease by medical authorities such as the World Health Organization and the American Medical Association, California law still allows insurance companies to exclude fertility treatment options. This disparity between the recognition of infertility as a disease and the failure to cover its treatment leaves many Californians without access to the full range of medical care they need. Paradoxically, diagnosis of infertility is typically covered by insurance, but treatment of the disease is not.
Time-Sensitive Nature of Fertility Treatments
- Fertility treatments, especially those involving IVF, are extremely time-sensitive. The longer individuals are forced to wait for treatment, the more their chances of successful conception decrease. Delays in accessing fertility care can mean the difference between being able to have a child and infertility becoming a permanent barrier. By passing SB 729, California would eliminate these unnecessary delays and ensure that individuals and couples can access the care they need when they need it most. This is especially crucial given that fertility naturally declines with age, and any delay in receiving treatment can significantly reduce a person’s chances of becoming a parent.
Fertility Preservation Patients Need IVF to Complete Family-building.
- CA SB 600 (Portantino) was signed into law in 2019. This law provides important coverage for millions of California residents who must find themselves diagnosed with life-threatening illnesses like cancer or sickle cell disease as children or young adults. It allows them to preserve their fertility by banking sperm, eggs, embryos, and other tissues prior to undergoing potentially sterilizing medical treatments including chemotherapy, radiation, certain surgeries, bone marrow transplants, and gene therapy. Once they are cured of their disease, these survivors will need access to IVF in order to use their banked tissues.
