A legislative panel shied away from fully endorsing a request to add infertility to the list of diseases insurance companies must cover, leaving the fate of potential legislation uncertain.
Members of the Senate Finance Committee signaled a willingness December 17 to continue discussing the issue in the 2020 session, though they weren’t quite ready to endorse legislation after an emotionally grueling hour of testimony from would-be parents who have struggled with miscarriages, exorbitant medical costs and an insurance industry that tells them fertility treatment is considered a cosmetic vanity.
Uncertainty after the panel’s vote is another setback for Elizabeth Marshall, the Phoenix woman who has sought for more than three years to change state law. After five miscarriages and thousands of dollars spent on out-of-pocket medical bills, the Mesa accountant made advocating for insurance changes a second job.
“My husband and I want a baby, but I need medical coverage because I don’t want another miscarriage,” she said.
Seventeen other states now require insurance companies to cover fertility treatment for couples who have been diagnosed with infertility. In Arizona, a proposed mandate faces opposition from the insurance industry and a conservative Catholic advocacy group with considerable influence at the Capitol.
The insurance industry plans to bill the state for increased health care costs should a bill mandating insurance coverage of fertility treatment pass, said Marc Osborn, a lobbyist for Blue Cross Blue Shield. Federal law requires states to pick up the costs of mandates that apply to insurance plans sold on the state insurance marketplace.
“You can mandate it, we’ll price it, we’ll pass the costs on,” Osborn said. “We’re good at it. And for those on the individual market, we’ll send the state a bill if it passes.”
Osborn estimated costs would increase by 2% if a mandate passes. An actuarial study commissioned by supporters of the mandate had a more modest estimate of $1.37 in monthly premiums, about a 0.26% increase.
Supporters also argued that posted increases in health care premiums caused by the added coverage would be offset by decreased costs elsewhere. For one thing, they predicted insurance coverage would reduce the number of twins and triplets — pregnancies that are more expensive and complicated than single births — because couples who use in vitro fertilization will be less likely to implant multiple embryos to increase the odds that one will succeed if insurance makes in vitro fertilization more affordable.
Kathryn Fiore, a Gilbert lifestyle blogger who is now 13 weeks pregnant, told the committee she saw firsthand how a lack of insurance coverage makes couples take medically unnecessary risks. It took an extra $1,000 test to learn that she needed to transfer embryos at a different time in her cycle than standard; without that extra test, the in vitro fertilization treatment might not have worked.
“Every day, people with fertility struggles have to make gambles based on finances over their doctor’s recommendations,” Fiore said.
Hannah Israelsen, a photographer from Chandler, held her 2-year-old daughter, Greta, on her hip as she addressed lawmakers. Israelsen and her husband were diagnosed with unexplained infertility — the diagnosis given to roughly one-third of infertile couples, when doctors can’t find a specific problem with either partner — and emptied their savings account three years ago to pay for in vitro fertilization.
“She’s so worth the financial sacrifice, but I know that our life would look different if IVF had been covered,” Israelsen said. “Maybe my husband wouldn’t have had to take out a student loan to go back to graduate school. Maybe we would have been able to put a down payment on a house.”
Senate Finance Committee Chairman J.D. Mesnard, a 39-year-old first-time father to a six-month-old daughter, said he and his wife were fortunate not to face the same challenges as the women who testified, but they talked about the possibility when deciding to start their family.
But Mesnard said he still wasn’t comfortable either endorsing a mandate or giving the proposal a flat rejection.
“I can come up with a reason why each of the groups that come before us should have coverage with their issue, and then after a while we look back and we hear from another group that can’t afford coverage at all,” he said. “We have to be stewards of taxpayer money. We have to be stewards of the entire population.”
And Sen. Kate Brophy McGee, who as chair of the Senate Health and Human Services Committee holds what amounts to veto power over most health-related legislation, said she also isn’t convinced that a mandate is the right way to go. She said she’s interested in hearing more about what can be done in the way of a supplemental insurance policy, and pitches for how to pay for fertility coverage without raising health care costs or burdening the state.
“As far as just creating another mandate, I’m reluctant to do that,” said Brophy McGee, R-Phoenix.