PORTLAND, Ore. (KOIN) — Advocates are pushing the state to expand reproductive health services to include fertility treatments as a requirement that health benefits plans in Oregon must cover.

Senate Bill 168, introduced by state Sen. Lee Beyer, D-Springfield, would amend Oregon’s Reproductive Health Equity Act to include coverage of fertility and reproductive endocrinology services. 

“My interest was parity for people who wish to have a family,” Beyer said via email about why he sponsored the bill, which is currently awaiting assignment to a subcommittee in the Oregon Senate to move forward. “What the bill addresses is helping those who can’t have children for medical reasons and may not have the money to afford alternative medical means. The bill simply says that insurance policies cover these procedures the same as they would a normal birth. I see that as an equity issue.”

The bill was drafted at the request of Eugene resident Stacy Habr Ochoa, who said she began advocacy work surrounding fertility issues after she was personally impacted by infertility for almost 10 years.

“We didn’t seek medical help for about four of those. And then once we finally jumped in to getting help, we had a diagnosis of male factor infertility. And we just didn’t have access to great care through our insurance,“ she said.

Stacy Ochoa is a co-founder of Oregon Fertility Advocates based in Eugene (undated photo courtesy Stacy Ochoa).

After trying unsuccessfully with intrauterine inseminations (IUI) for a long time, Ochoa said the couple finally moved on two years ago to in vitro fertilization (IVF), which has a higher rate of success than IUI, according to the Carolinas Fertility Institute. IVF can also be quite a bit more expensive than IUI.

“We sold a vehicle, we borrowed money from family, we took out a credit card, we did all of those things coupled together to pay for a package of two IVF cycles. And our first IVF cycle got us nothing, $24,000 plus medication, and we had no embryos to work with,” Ochoa said. “So then we went to cycle number two and out of that, we only got one. We haven’t transferred it yet. We’re still in treatment ourselves, getting ready to do another IVF cycle here in a couple of weeks. So it can be a really long, drawn out process.”

IVF, a medical procedure whereby an egg is fertilized by sperm in a test tube or elsewhere outside the body and then the embryo is transferred to a uterus, is a type of treatment that would be covered under the bill, in addition to fertility preservation for cancer patients and others at risk of infertility as a result of a medical condition or treatment.

According to a fact sheet provided by Oregon Fertility Advocates, a group Ochoa co-founded, LGBTQ+ couples who need assisted reproduction technology would be covered by the legislation. The coverage would be applicable whether the infertility is diagnosed as female factor, male factor, or a combination. 

“Oregon is kind of behind the curve on this. There’s actually 19 other states that have some sort of mandate for fertility coverage. So another reason why there’s no time like the present to take care of this and do it now,” Ochoa said.

Currently, about 1 in 8 couples have trouble getting pregnant nationally, with the condition affecting about 116,000 women who have physical difficulty getting pregnant or carrying a pregnancy to live birth, according to RESOLVE The National Infertility Association

“The message is simple: everyone has the right to build their family and if they need medical intervention to reach their goal, it should be available to all. SB 168 will make greater access to care a reality in Oregon.”

Betsy Campbell, Chief Engagement Officer for RESOLVE 

Advocates also point out that infertility is widely recognized as a disease by groups like the American Medical Association in 2017. 

Ochoa said the bill had an initial hearing in the Senate Healthcare Committee. It was then referred to the Ways and Means Committee with bipartisan support. The next steps in the legislature are to get the bill assigned to a subcommittee within Ways and Means. After that, the bill can be eligible for another hearing and moved to the floor for a vote.

Grassroots organizing has resulted in a lot of support for SB 168, with over 3,000 letters being sent to legislators asking for the bill to be passed this session, Ochoa said. She hopes that momentum and bipartisan interest can see the bill through to completion, as opposed to losing steam like a similar, previous bill did in a prior legislative session. 

“Where in years past when we’ve presented this bill, a few years ago, it moved to Ways and Means as well, but it paused. But this time we’ve definitely heard more from Oregonians than we’ve ever heard in the past, here locally,” said Mollie Huyck, a Wilsonville-based advocate with Oregon Fertility Advocates.

Huyck said she’s been advocating for those with infertility for 10 years after her and her husband experienced infertility as well.  

Nationally, Oregon’s SB 168 has been endorsed by both RESOLVE and the American Society for Reproductive Medicine.

“The common-sense updates this legislation makes would ensure that all Oregonians diagnosed with the disease of infertility – including cancer patients whose infertility is a result of related treatment – can keep their dream of building a family alive. Oregon shouldn’t miss this chance to join the growing list of states that has demonstrated it supports equitable, affordable access to family-building options,” said American Society for Reproductive Medicine’s President Elect, Marcelle I. Cedars, M.D. in a written statement to KOIN 6 News

In addition, a proclamation raising awareness about infertility and its accompanying challenges was signed by Governor Kate Brown back in April, declaring April 18-24 to be National Infertility Awareness Week. 

In terms of the projected financial impact, the Legislative Fiscal Office released a Fiscal Impact Statement for SB 168, saying the expenditure impact for the 2021-23 biennium would be $26,626,100. For the 2023-25 biennium, the projected funds totaled $44,838,252. There was a notice of “no revenue impact” projected from the Legislative Revenue Office on the measure. 

In addition, Moda, a medical plan provider, submitted public testimony against SB 168, saying fertility and reproductive endocrinology treatments are expensive, and urged lawmakers to “consider the impact of this additional cost on all Oregonians who pay for their coverage, many of whom struggle to afford the current cost.”

Mollie Hyuck is a Wilsonville-based advocate with Oregon Fertility Advocates. May 27, 2021 (KOIN).

The letter was signed by Dave Nesseler-Cass, Moda Health’s Chief Compliance Officer and Director of Regulatory Affairs and went on to state that consumers buying individual coverage, paying for any unsubsidized costs of their coverage, would be “directly exposed to the cost of each expansion in the type of services covered under their plans.” According to Nesseler-Cass, the addition of fertility coverage, per federal law, would not be covered by the federal Affordable Care Act’s relatively inexpensive Essential Health Benefits packages, meaning the cost “would likely be put directly on the State of Oregon.” 

The Fiscal Impact Statement from April 2 said the Oregon Health Authority estimated that under the measure, premiums for plans would increase by 1.2% for both Public Employees’ Benefit Board (PEBB) and the Oregon Educators Benefit Board (OEBB). 

It was announced on May 27 that some fertility coverage would be extended for PEBB members at no additional health care costs to PEBB members–that is, no increases to co-pays or deductibles. The coverage applies for people requiring assisted reproductive technologies (ARTs) and available at in-network and out-of-network facilities and will apply to both full-time and part-time employees. The PEBB board approved $35,000 annual maximum for ARTs, including coverage of artificial insemination, like IUI,  and with no member cost share related to the ARTs being due for basic treatment of fertility, including diagnostic testing to determine underlying cause. 

Philip Schmidt, a communications officer with Health Policy and Analytics Division of the Oregon Health Authority told KOIN 6 News via email that, to promote health equity, PEBB is removing the requirement to have an infertility diagnosis in order to receive infertility and fertility services, allowing same-sex couples and single people the opportunity to receive treatment.

Schmidt said SB 168’s requirement of covering “fertility and reproductive endocrinology services for men and women” is an aspect of the bill that will need to be clarified in the rule-making process to define what those services will include, should the measure pass. But an assessment by healthcare and investment consulting firm Mercer about the changes in PEBB and OEBB coverage assumes the bill’s areas of coverage are similar to what PEBB is now providing.

While PEBB’s fertility coverage is capped at $35,000 per year, meaning members will have to pay out-of-pocket for any costs above that cap, SB 168 does not provide such a cap, Schmidt said.

Schmidt said it’s important to recognize that PEBB’s recent coverage expansion of fertility treatments will have an impact on premiums, as would the passage of SB 168.

“PEBB’s premiums are expected to increase 0.6% due to the expansion of the fertility benefits. Subsequently, members will pay a commensurate share of the premium increase within their payroll deductions,” Schmidt said.

But Schmidt clarified that all fertility services provided under PEBB’s $35k cap are free to the member. If a member needs these services within that cap, they will be covered at 100% by PEBB. That is what was meant by the announcement saying “no increase in cost to the members.”

“At the point of service (when members are receiving care), there will be no cost to members. Even with covering these services without member cost share, PEBB was able to maintain an overall composite rate increase of 3.3%, below the legislatively mandated cap of 3.4%,” Schmidt said.

According to the National Library of Medicine, a study from 2016 indicates that states with mandated insurance coverage for IVF is associated with decreased odds of multiple births because insurance coverage encourages single embryo IVF cycles . Multiple births happen when people transfer multiple embryos during a single IVF cycle in order to increase the chances of getting pregnant in just one cycle. Multiple births raise health risks and health care costs for both the mother and babies, according to a 2021 report on fertility benefits conducted by Mercer and commissioned by RESOLVE. 

The report also surveyed 459 national employers. Of those respondents, 254 said they offered coverage of reproductive endocrinologist and/or various fertility treatments. 97% of the employees that covered infertility benefits said doing so did not result in a measurable, significant increase in medical plan costs. 

“The message is simple: everyone has the right to build their family and if they need medical intervention to reach their goal, it should be available to all. SB 168 will make greater access to care a reality in Oregon,” said Betsy Campbell, Chief Engagement Officer for RESOLVE, via email. 

Editor’s note: this story was updated on June 8, 2021 to include more in-depth information about OHA’s expanded fertility benefits coverage for PEBB members.