When and how women should be considered eligible for fertility treatments for insurance purposes is an issue before the state Legislature. Senate Democratic Majority Leader Loretta Weinberg says the current law is too restrictive in ascertaining eligibility and is invasive in how infertility is determined.
Weinberg is sponsoring a measure that she says addresses those issues. S-2867/A-4347 would expand access to in-vitro fertilization (IVF) to lesbian couples and women without partners. It would also change how infertility is defined in a way that the bill’s sponsors say would make the process less invasive.
But opponents of the measure say it amounts to a mandate that would increase the healthcare costs of both private insurers and the state. Insurance companies, business groups, and social-conservative organizations oppose it.
IVF involves joining a woman’s egg and a man’s sperm in a laboratory dish and transferring the resulting embryo to the woman’s womb. Women undergoing the process must first take a series of fertility drugs to boost their egg production.
Weinberg (D-Bergen) said she was shocked by language in the current state law that governs insurance requirements for IVF. The law’s definition of infertility includes women who are unable to “conceive after two years of unprotected intercourse if the female partner is under 35 years of age, or one year of unprotected intercourse if the female partner is 35 years of age or older.”
Weinberg said it was wrong to require a woman to demonstrate this for an insurance benefit “she paid for through her premium. And now she would be forced to produce a chart or a log of her sexual activity. What if she didn’t keep a log, like most people don’t? What if she’s a lesbian?”
The bill would remove that language from the law and replace it with a provision allowing a woman’s doctor to determine whether the woman is infertile.
“Ask yourself this one question,” Weinberg told the Senate Commerce Committee at a November 7 hearing. “If a woman could conceive without medical intervention, wouldn’t they? This bill respects all people and respects a woman’s right to manage her own body.”
But the bill would have implications beyond eliminating intrusive language, according to its opponents. It would also expand the health insurance mandate beyond the 2001 law requiring the IVF benefit for plans that cover at least 50 people.
New Jersey Association of Health Plans Vice President Sarah McLallen said the law’s infertility definition requires that a doctor’s diagnosis of infertility be based on “medical circumstances.” Changing the definition would undermine this requirement, she said.
She added that altering the provision is a significant departure from the more modest goal of expanding IVF coverage to women in same-sex relationships or who don’t have a partner.
McLallen also said that if the bill were to move forward, it should be amended so that only board-certified providers who specialize in the treatment of infertility — and not just any doctor — would be allowed to diagnose infertility.
McLallen focused on the cost implications of making it easier to have IVFs, noting that each process generally costs $10,000 to $15,000.
The bill “would expand the IVF mandate to new populations, but it also eliminates an important cost-control process that’s in place today for all people, heterosexuals included, who are seeking IVF,” McLallen said.
Christine Stearns, vice president of health and legal affairs for the New Jersey Business & Industry Association, voiced a separate concern about the bill. She noted that the 2010 Affordable Care Act requires that state’s that add insurance mandates beyond what the ACA defines as essential health benefits have to pay for those mandates.
“That is a concern that is important and something for the Legislature to be mindful of,” Stearns said.
Weinberg said she felt that the mandate is already in place and that the law’s current language is “extremely objectionable.”
“What we’re doing in this bill is removing the requirement that you have to somehow prove you’ve had two years of unprotected sex,” Weinberg said.
Sen. Raymond J. Lesniak (D-Union), who supports the bill, emphasized that IVF is not something that women would impose on themselves due to the potential side effects that women face when they take fertility drugs.
“No one is going to ask for this treatment if they don’t need it,” Lesniak said.
The New Jersey Food Council, League of American Families, and New Jersey Family First also oppose the bill.
The Commerce Committee released the bill on a 4-1 vote, with all four committee Democrats voting in favor, Sen. Gerald Cardinale (R-Bergen and Passaic) voting against it and Sen. Thomas H. Kean (R-Morris, Somerset and Union) abstaining.
Sen. Nia H. Gill (D-Essex and Passaic) also sponsored the Senate bill, while the Assembly version is sponsored by Assembly members Pamela R. Lampitt (D-Burlington and Camden), Valerie Vainieri Huttle (D-Bergen), former Assemblywoman Connie Wagner (D-Bergen and Passaic) and Reed Gusciora (D-Hunterdon and Mercer).
The Senate bill was referred to Senate Budget and Appropriations Committee, which could require an assessment of the fiscal impact of the bill on the state. The Assembly bill has been referred to the Assembly Financial Institutions and Insurance Committee.