State lawmakers approve bill requiring insurance companies to cover fertility treatments

After half a dozen failed attempts over the years, the State House and Senate on Monday approved a bill that would require insurance companies selling policies in Maine to offer fertility care to their members.

Mainers struggling with infertility, which affects about 10% of the population, have defended the bill, but opponents say the high price tag will increase health care costs for everyone, including the state , which pays to insure state workers.

“As a midwife, I am able to witness the overwhelming joy of new parenthood, but also the deep pain of fertility challenges,” Sen. Stacy Brenner, D-Scarborough, said Monday. . “This not only has emotional implications, but also economic ones.”

Many young Mainers struggling to become parents have gone into deep debt trying to conceive, she said, and many are considering moving to a state that has fertility insurance laws. In New England, only Maine and Vermont do not require companies to offer fertility care.

“We are the oldest state in the country and we have to do something about it,” said Sen. Heather Sanborn, D-Cumberland. “It’s not just the right thing to do for those families struggling to have a child. It’s the right thing to do for Maine. We need these young families.

Opponents expressed sympathy, but said it was unfair to put the expensive needs of a few ahead of the many other members of the insured group who cannot afford to pay higher premiums. Some small employers might decide that fertility care makes insurance too expensive to offer, they said.

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“This is a tough case because I consider myself a pro-life lawmaker,” said Sen. Trey Stewart, R-Presque Isle. “I think that’s a wonderful thing, but I think we kind of have to measure twice and cut once on how we’re going to increase costs for the insurance pool in Maine.”

The law project, DL 1539passed the Senate 21-12 and the House 72-57 on Monday.

Nineteen states require some infertility coverage. Some require conception failure before insurers must cover care. Some set maximum benefit limits. Some cover drugs, but not in vitro fertilization, which can cost up to $25,000 including drugs.

The cost of providing this extended coverage would vary by health insurance plan. According to Stewart, market plan premiums would increase by about $5 to $6 per month, per person, to cover fertility care. The cost for state employees would not increase by more than $1.41 per month per person.

Initial cost estimates were much higher — Anthem Blue Cross Blue Shield, the health insurance provider for state employees, originally projected an increase of $8.28 per month per person — but that didn’t match. not to the experience of other states that prescribed fertility care.

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Upon review, lawmakers learned that Anthem included the cost of limited fertility care already available to state employees, which inflated the expected cost of expanded coverage, Sanborn told the Senate. He had also included the cost of insuring any additional babies that would be born.

“It’s very unorthodox,” Sanborn said. “I’ve certainly never seen a note that says, ‘oh, if we cover this treatment for Lyme disease, a person might live longer, and so we’ll have to cover them for these other things that might go wrong. This is not how health insurance costs are calculated.

To appease those concerned about costs, the Senate amended the bill and the House agreed to give the state Bureau of Insurance the right to pass technical rules that could give insurance companies some flexibility to reduce costs in their fertility coverage.

The original health and insurance coverage committee bill would have prohibited insurance companies from treating infertility differently than any other medical condition, requiring the same annual or lifetime deductibles and coverage limits as a heart attack. or a broken leg.

The amended bill still prohibits an insurance company from establishing a waiting period before a member can seek fertility care. Some states require couples to have tried to conceive for a certain period of time before insurance companies must cover fertility treatments.

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More than 50 people testified in favor of the bill at a public hearing last year, sharing heartbreaking stories of inability to conceive, indebtedness paying out of pocket for fertility treatment and abandonment of their childhood dreams when they lacked money. .

One was Rep. Colleen Madigan, D-Waterville, who shared her personal infertility challenges.

“When it was possible for me to have treatment and have a child, my insurance didn’t cover fertility treatment and I didn’t have the money to pay for it,” Madigan said. “I paid a lot of money for the health insurance I got from my employer and when I needed it it was not available.”

It’s too late for her now, Madigan said, but she didn’t want anyone else to have to endure such grief.

Some supporters have spoken of the genetic markers that put them at high risk of having a baby who would die a painful death after just a few days. Without coverage, they said, they would have to continue playing the genetic lottery in hopes that they and their unborn child could outsmart the odds.

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It’s unclear whether the bill would end up before the appropriations committee, which has about $12 million to fund bills not already included in Gov. Janet Mills’ budget, because it won’t. would enter into force only in January 2024. This means that they have no immediate tax impact.

That would likely increase the cost of the state employee health care plan in the future, though it’s hard to pinpoint exactly how much given the volatility in the health care market, Sanborn said. Currently, analysts predict Maine would pay $236,360 more per year for expanded coverage.

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Kristan F. Talley