Following Alabama IVF ruling, CT lawmakers want infertility treatment coverage for all

In the face of Alabama’s ruling on in-vitro fertilization and continued legislative attacks on the LGBTQ+ community, Connecticut lawmakers are considering legislation that would expand health insurance coverage for infertility treatments to same-sex couples and individuals who wish to have a child on their own.

At a public hearing Tuesday, supporters of House Bill 5378 said the proposal would “provide equal access” to coverage for all individual and group policyholders seeking infertility treatment, regardless of their gender, sexual orientation or relationship status.

Opponents expressed concern that the bill would require heterosexual couples to jump through more hoops to receive coverage for infertility treatments than individuals or couples who identify as LGBTQ+.

H.B. 5378, which was introduced by the Insurance and Real Estate Committee last week, would broaden the state’s definition of infertility to include “the inability, as an individual or with a partner, to conceive or produce conception because the individual or couple does not have the necessary gametes to conceive or produce conception.” (Gametes are egg cells and sperm, the reproductive cells required for conception.)

Currently, the state defines infertility as “the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period.”

H.B. 5378’s definition would remove the requirement that individuals, LGBTQ+ couples or heterosexual couples who lack gametes wait one year to prove their inability to conceive a child before they can access infertility coverage.

As written, H.B. 5378 would only apply to individual and group health insurance policies, but a separate bill in the Human Services Committee would expand infertility coverage to patients on Medicaid.

“Everybody in this state who wants to have a child should be able to do so regardless of who they love and who they want to have that child with,” Connecticut State Comptroller Sean Scanlon said.

Scanlon said that he amended the state employee health insurance policy last year to include infertility coverage for LGBTQ+ couples and individuals after an employee alerted him that the former health plan discriminated against her and her wife “who, like so many other young couples recently got married and decide that they wanted to have a child.”

“The problem that we were experiencing was that people who were on our plan were having to be deemed by a doctor to be infertile. And there was a period of time through which that they had to have sexual intercourse that was not resulting in a pregnancy,” Scanlon said. “No matter how much her and her partner had sex, they were never going to have a baby in the way that a man and a woman would.”

Scanlon said that under the state employee plan, and H.B. 5378, same-sex couples would “not need to be deemed infertile by a physician in order to access the insurance … given that, no amount of fertility in a same-sex couple would ever result in a baby.”

Scanlon said that for those who lack insurance coverage, the cost of infertility treatment is “quite prohibitive to people in our state right now who would love nothing more than to have that child and experience that gift.”

Under current state laws, private insurers are required to “provide coverage for the medically necessary expenses for the diagnosis and treatment of infertility, including, but not limited to, ovulation induction, intrauterine insemination, in-vitro fertilization, uterine embryo lavage, embryo transfer, gamete intra-fallopian transfer, zygote intra-fallopian transfer and low tubal ovum transfer.”

Dr. Mark Leondires, a board-certified obstetrician, gynecologist and reproductive endocrinologist, who is the founder and medical director of Illume Fertility and Gay Parents To Be, said that the majority of LGBTQ+ patients at his fertility clinic lack coverage.

Leondires said that a pregnancy via intrauterine insemination could cost a couple $5,000 to $20,000 out of pocket. For individuals or couples who require an egg donor and a surrogate, Leondires said the costs could reach $150,000.

Leondires said it is not uncommon for patients to stop reproductive health care due to cost barriers.

“(H.B. 5378) would often give them access to a benefit that allows them to have enough money to be able to complete a treatment course and have an opportunity for pregnancy,” Leondires said.

“Nobody’s asking for coverage for additional services, but the same services,” Leondires added. “Why should they be denied the ability to have a child if they are paying into the same taxes and health care options as everybody else in the state?”

As a member of the LGBTQ+ community, Leondires said he faced this same reality when it was time to start his own family.

“I did not have access to coverage,” Leondires said. “Thankfully, 12 years ago I went on and had a successful pregnancy. But on a regular basis, we see patients who are single, who are LGBTQ+, and need the help of fertility therapy to be a parent.”

Leondires emphasized that “the desire to be a parent is independent of sexuality or gender (or) gender identification. It’s just something that’s kind of innate within our humanity.”

Additionally, Leondires said the definition in H.B. 5378 would bring Connecticut in line with the American Society for Reproductive Medicine, which updated its definition of infertility to include “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.”

Rep. Cara Pavalock-D’Amato, a ranking member of the Insurance and Real Estate Committee, voiced concerns over the proposed expansion to the state’s definition of infertility and its application.

“Most insurance coverage for treatment, you have to be sick,” Pavalock-D’Amato said. “There’s, there’s infertility, whether you are straight or gay, that, up to this point, has been a requirement.”

“Under this bill as written, it would require heterosexual couples to be deemed infertile, but same-sex couples and individuals would not have that same requirement,” Pavalock-D’Amato added. “I’m wondering how this, the equal protection of the law, is applied here if it’s requiring one thing of one person and not of the other.”

Pavalock-D’Amato expressed confusion over why doctors would not need to diagnose any patient infertile before fertility coverage kicks in. She also questioned whether an 80-year-old woman who wanted to become pregnant would be able to seek coverage under the law.

Pavalock-D’Amato also drew a distinction between coverage for elective vs. mandatory treatment.

“I suffered from infertility, so I understand that infertility isn’t necessarily elective, but having a baby is,” Pavalock-D’Amato said. “I understand there are many individuals who want to conceive, but again, this is for insurance coverage. It’s not that those couples are stopped from going through trying IUI or IVF, but as far as requiring insurance coverage for something that’s elective, again, that’s different.”

Representatives from the Connecticut Business and Industry Association and the Connecticut Association of Health Plans, said H.B. 5738 could raise insurance premium costs.

“With every new mandate, it’s just an increased cost to the policyholders,” Wyatt Bosworth, associate counsel of the CBIA, said.

Bosworth encouraged the committee to have the proposal first undergo a health benefit review process, “Not just to make recommendations on whether the mandate is good or bad, but (to) also help broaden the mandate to cover more people and then take into consideration the costs and benefits that come along with that.”

Rep. Kerry Wood a chair of the committee, said that many private insurance carriers are already providing infertility coverage to individuals and LGBTQ+ couples.

“I wouldn’t really look at it as a mandate per se, but really just a fairness issue,” Wood said.

She said this proposal was originally a goal of the committee last year.

“I think we were a little light on the language, which really just said you can’t discriminate, but we wanted to make sure that the benefits were there for people that are looking to start a family,” Wood said.

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