Insurance coverage

Proposal to require insurance coverage for advances in assisted reproduction in the Legislature – Oregon Capital Chronicle

Insurers would be required to cover infertility services under a proposal put forward by Oregon lawmakers, which moved after a similar bill failed last session.

The plan aims to make assisted reproduction affordable for thousands of Oregonians. Assisted reproduction is expensive, costing around $15,000 per attempt and usually three attempts are required.

It is estimated that one in eight couples is affected by infertility, according to experts. Fifteen states, including Arkansas, Texas and Utah, require insurers to cover assisted reproduction.

Senate Bill 1530 aims to make insurance coverage for in vitro fertilization possible for the nearly 150,000 consumers who insure themselves in the market. This would not apply to Medicaid or company plans and would allow companies to claim a religious exemption.

“Reproductive health services are essential health services,” Sen. Deb Patterson, D-Salem, said during a hearing on the bill last week. “And it’s not just a problem that affects only a few people.”

Infertility is classified as a disease by the World Health Organization, the American Medical Association, the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine, according to Dr. Paula Amato, a specialist in infertility at Oregon Health & Science University. Testifying at the hearing, Amato said the disease causes considerable emotional distress and the lack of insurance coverage creates inequities.

She said the cost can lead couples to pursue more aggressive treatments, such as transferring more embryos to increase their chances of success.

“This leads to a higher risk of multiple pregnancies, which is associated with a higher rate of pregnancy complications and a substantial increase in health care costs,” Amato said.

Reproductive health services are essential health services, and it is not just a problem that concerns only a few people.

– Senator Deb Patterson, D-Salem

The bill passed the Senate Health Care Committee last week on partisan lines, with three Democrats voting in favor and two Republicans opposing. He is now awaiting a hearing at the Senate Rules Committee.

Sen. Lee Beyer, D-Springfield, proposed the bill after a previous attempt last year failed. He said he had been pushing the proposal since 2019, but Oregon officials were concerned about rising premium costs for AHR coverage for state-insured employees, he said. he declares.

Beyer noted that was now a moot point: The Public Employees Benefits Commission has approved AHR coverage. Beyer said he was a longtime supporter of a woman’s right to choose and this proposal was one of them.

“Having a family is one of the basic tenets of human existence,” Beyer said.

Dozens of women filed written testimonials in support of the bill, recounting their difficult attempts at conception. Eugene’s Nicci Schaefer-Limbach, who gave evidence and spoke at the hearing, said the first time she became pregnant in 2017, she had to undergo emergency surgery because the fertilized egg was pushing out of the main cavity of the uterus. Ectopic pregnancies can be life-threatening.

“I ended up with a fallopian tube and medical and emotional trauma. It took us years to heal and find the courage to try again,” Schaefer-Limbach said.

She had a second ectopic pregnancy, forcing more operations. She said she ran up a ‘significant debt’ from trying in vitro fertilization, and pointed out that her insurance company would have saved money if she had paid for assisted reproduction instead of paying for more surgeries .

Providing commercial coverage without a defined pathway to establish coverage for low-income Oregonians will exacerbate existing health inequities and further entrench an unequal two-tier health care system.

– Samaritan Health Plans, Cambia Health Solutions, Kaiser Permanente, Moda, America’s Health Insurance Plans and PacificSource

“Because of my infertility, my ectopic and surgical operations cost over $150,000 in insurance versus $15,000 to $30,000” for in vitro fertilization, Schaefer-Limbach said.

“After my first ectopic, I would have taken that option in a heartbeat, but since we didn’t have that option, we naturally tried again, which risked my life and led to two more surgeries. because of my infertility,” Schaefer-Limbach mentioned. “Paying for an IVF cycle meant taking out a loan against our mortgage. It meant sucking up our pride and making a GoFundMe. This meant exhausting all of our savings and resources.

Others wrote that they were spending tens of thousands of dollars on assisted reproduction even though they had insurance.

“I pay insurance premiums every month to cover treatment for illnesses I will probably never be diagnosed with or need treatment for,” Ashley Morrow wrote. “Infertility is a disease that should be added.”

Six insurers – Samaritan Health Plans, Cambia Health Solutions, Kaiser Permanente; Moda, America’s Health Insurance Plans and PacificSource – oppose the proposal. They said in written testimony that the move would increase premiums, jeopardize the tax status of members’ health savings accounts, and make assisted human reproduction coverage unfair.

The proposal would not apply to Medicaid, which covers 1.3 million people in Oregon, or to uninsured people, they said.

That’s why advocates and a union are against the proposal. Planned Parenthood, the Service Employees International Union, and several advocacy groups including the Oregon Latino Health Coalition, Forward Together, Basic Rights Oregon, Family Forward, Pro-Choice Oregon, and the Asian Pacific American Network of Oregon favored an amendment that would have included everyone. , including insurers who can claim a religious exemption.

“Providing commercial coverage without a defined pathway to establishing coverage for low-income Oregonians will exacerbate existing health inequities and further entrench an unequal two-tiered health care system,” they said in written testimony.