California legislators have joined a nationwide movement to expand insurance coverage for fertility treatment to LGBTQ individuals.
The Legislature on Thursday gave final approval to Senate Bill 729, which also requires insurers to cover in vitro fertilization for most women.
Introduced last year, the measure sailed through the Assembly Wednesday on a 46-0 vote and was then approved on a 30-8 vote by the state Senate. The bill now awaits action by Gov. Gavin Newsom.
Various organizations, including Equity California, support SB 729, saying it will help reduce inequities in health care coverage. Backers acknowledged the bill will increase insurance costs.
“Just like mandating coverage for other essential health care services, like gender-affirming care, substance use, and mental health services, there is always a cost associated with removing discrimination from health insurance,” supporters wrote, according to an analysis of SB 729.
They added there would be corresponding savings for people who currently have to pay out of pocket for such treatment. in vitro fertilization can costs tens of thousands of dollars.
The bill’s author, Sen. Caroline Menjivar, D-Van Nuys, wrote that the measure “is critical to achieving full lived equality for LGBTQ+ people, as well as advancing well-rounded and comprehensive health care for all Californians.”
The bill is targeted for large-group coverage while allowing exempting religious organizations and some employers who are self-insured.
The California Chamber of Commerce along with numerous organizations and businesses and the state Department of Finance expressed opposition on financial grounds.
Further, “to the extent this bill results in additional assessments on health plans and insurers, consumers may face increased health care premiums,” according to the bill analysis.
Conservative-leaning groups also have raised objections.
The Center for Bioethics and Culture Network maintained “that changing the definition of ‘infertility’ from a medical condition to allowing a person or couple with no infertility diagnosis or expanding medical care as a right for any human to utilize healthcare coverage does more harm than good.”
The California Family Council said “a range of fertility treatments — including those for same-sex couples and single individuals — has been a focal point of controversy for Christians who argue that it undermines the sanctity of life, religious freedom, and the traditional family structure.”
SB 729 followed a slow path toward a final vote, though it’s unclear why. The measure was first taken up in April 2023 by the Senate Health Committee, which passed it on to other committees. The full Senate sent it to the Assembly last year on a 31-3 vote, with Sen. Brian Jones, R-Santee, casting one of the opposing votes.
The measure was passed by the Assembly Health Committee in July 2023 and then seemed to disappear for more than a year. SB 729 was approved by the Assembly Appropriations Committee on Aug. 15 of this year. That put it in the bill deadline mosh pit, but it seemed to breeze through.
Efforts to expand insurance coverage of fertilization treatment, including IVF, are happening across the country, both legislatively and through lawsuits, though it seems incremental at this point.
“Only 14 states provide coverage on private insurance plans for fertility health care, (but) only three states have fertility insurance laws that inclusively cover LGBTQ people,” Polly Crozier, director of family advocacy, GLBTQ Legal Advocates & Defenders (GLAD), told ABC News.
More states are considering such coverage requirements, particularly after the American Society for Reproductive Medicine expanded the definition of infertility in October, which now includes:
- The inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
- The need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner.
“Nothing in this definition shall be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation,” the organization wrote.
Infertility had been defined as the inability of a heterosexual couple to conceive after a year of unprotected intercourse for women under 35, or six months for women over 35.
About 4 in 10 adults (42 percent) said they have used fertility treatments or personally know someone who has, up from 33 percent five years ago, according to a Pew Research Center survey in September.
Another Pew survey in March said 70 percent believed having access to IVF is a “good thing.” A CBS News/YouGov poll said 86 percent of those surveyed think IVF should be legal for women trying to get pregnant.
Fertility treatment wasn’t much of a public issue until the Alabama Supreme Court in February ruled frozen embryos should be legally defined as children — and that discarding them, as is common in the IVF process, would be equivalent to causing the death of a child.
That triggered a flurry of sometimes competing state and federal legislation to ensure IVF treatment remains legal. On Thursday, former President Donald Trump said if elected to a second term he would seek to have government or insurance companies cover IVF treatment costs, but gave few details.
For now, it seems the threat to IVF access has passed.
But the fight for insurers to cover broader fertility treatment, particularly IVF, and extend that to same-sex couples will continue.
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