As of August 1, 2019, hopeful parents in New Hampshire have reason to celebrate. That’s because Governor Chris Sununu signed into law SB279, a law expanding insurance coverage for fertility-related diagnosis, treatment, and preservation. Now not everyone has to work at Starbucks to get in vitro fertilization (IVF) benefits! Or at least not after the law’s effective date of January 1, 2020.
Twelve Years and Two Babies
I spoke to Catherine Tucker, a New Hampshire attorney specialized in assisted reproductive technology law. Tucker was one of the driving forces behind the new law. For her, Tucker explained, it all started 12 years ago when she herself hoped to have a child. She frustratingly underwent round after failed round of IVF. Ultimately, she was able to conceive (twins actually!). But she explained that she was one of the lucky ones. At the time, she was working for the State of New Hampshire and her health plan provided coverage for the multiple rounds of IVF. Tucker, however, was all too aware that the majority of the 1 in 6 couples in the state facing infertility were without insurance coverage that would have provided basic coverage for fertility diagnosis or treatment, much less IVF.
Tucker wanted to find a way to help others in this situation. She joined with individuals and organizations passionate about changing the law. These included fellow ART attorney Christine Hanisco, RESOLVE New England Executive Director Kate Weldon LeBlanc, and Fertility Within Reach’s Executive Director Davina Fankhauser, among others. Tucker then formed a working group to draft the bill and educate state legislators on the need for a law mandating that insurers provide fertility coverage as part of their plans. Tucker notes Boston IVF was also instrumental and deserves a special shout-out for all their efforts in helping get the word out about the bill.
While the group ultimately hoped that every New Hampshirite would have the coverage they needed, Tucker explained that certain compromises had to be made. The enacted law requires most employer-provided health insurance policies to provide coverage for infertility diagnosis, infertility treatments, and fertility preservation.
What Was Left On The Table?
The law, however, only applies to group insurance providers in the Granite State. It does not apply to individual policies offered through the marketplace. It also does not apply to “self-funded” health plans — only the federal government is entitled to make laws regulating self-funded plans. And while the group policy coverage includes IVF treatment that involves a couple’s own gametes or a donor’s, it does not include certain assisted reproductive technology protocols, most notably the transfer of an embryo to a gestational surrogate. Non-medical costs surrounding a donor or surrogacy arrangement are also not included.
Despite not including everyone or every treatment, Tucker reports that her working group is pleased with the ultimate content of the law.
Since When Did The “Live Free Or Die” State Go For Insurance Mandates?
Tucker explained that while perhaps counterintuitive, there is considerable evidence that a fertility mandate will save insurance companies, the state, and taxpayers money in the long run. Without the help of insurance, IVF can commonly run around $15,000 a round. That’s all out of pocket to a patient lacking coverage. Aside from being cost prohibitive for many, it has also been shown to lead infertility patients to make poor choices.
For example, when undergoing a round of IVF, patients are often faced with a decision as to how many embryos to transfer to achieve a successful pregnancy. Those without insurance coverage for IVF have a higher rate of choosing to transfer two or more embryos at once, with the hope that the greater number of embryos will increase the likelihood of pregnancy. Or, as some think of it, give them two (or more!) babies for the cost of one.
The problem is that twin and triplet pregnancies come with significant increased risks and increased costs, including high rates of pre-term births and associated complications. In fact, insurance carriers end up paying $105,000 on average for a twin pregnancy and almost half a million dollars (!) for a triplet pregnancy, versus approximately $20,000 for singleton pregnancy. The studies show that patients can make better choices (with better outcomes for everyone — including insurance carriers!) with fertility coverage.
Given the practical side of the law — saving money and supporting families — the bill received bipartisan support and passed the New Hampshire Senate unanimously.
The final result is that New Hampshire is the 17th state in the country to pass insurance mandates for fertility treatment. Insurance companies and policymakers in the other 33 states may want to take a look at the numbers…as well as consider whether it’s the right thing to do for the growing number of individuals and families battling infertility.
Ellen Trachman is the Managing Attorney of Trachman Law Center, LLC, a Denver-based law firm specializing in assisted reproductive technology law, and co-host of the podcast I Want To Put A Baby In You. You can reach her at babies@abovethelaw.com.