A bill to require insurers to pay for expensive fertility treatments failed again this session, but that doesn’t mean the idea is going away.

The idea has been before the Legislature five times since 2021. It’s had strong backing from women’s health care providers and advocates, and it’s been championed by both Democratic and Republican lawmakers.

But no one has succeeded in getting it over the finish line.

This year it returned as House Bill 4155, for the first time led by a Republican lawmaker, House Minority Leader Lucetta Elmer. 

“I firmly believe that we should be doing everything we can in this building to help support our fellow Oregonians' ability to start and grow their families,” she told the House Health Care Committee

She also made a health care argument. 

“Infertility is classified as a disease by both the World Health Organization and the American Medical Association. When you have a disease, you seek treatment. I do not believe insurance companies should be denying treatment for a disease,” Elmer said

The bill would have required insurers to help families with fertility problems by paying for treatments to help them have a child. It said insurers must pay for the cost of retrieving three eggs and unlimited embryo transfers and specified the coverage would apply to everyone in the plan, including spouses and dependents.

An amendment would have established a Family Building Fund under the Treasury to pay for the coverage and exempted plans covering state employees and educators, unless they decided to offer coverage.

The bill had support from physicians, patients and health care advocates, including some who’d testified before.

“I come before you today as an infertility patient, heartbroken that I continue to have to testify year after year asking the Legislature to move mandates related to coverage, while Oregonians faced with infertility lose very precious and very finite time to build families ,” said Stacy Ochoa of Eugene.

That sentiment was echoed by Dr. Paula Amato, a fertility expert and OBGYN at Oregon Health & Science University and past president of the American Society for Reproductive Medicine.

She said during a hearing she almost didn’t sign up to testify.

“It's very disheartening to come back year after year and be disappointed,” Amato said. 

She said that 25 states, including some governed by Republicans, mandate some kind of infertility coverage and said she’s embarrassed that Oregon does not offer this coverage. Doing so is in the state’s interest, she added. 

“Barring any increases in migration, Oregon is likely to see a population decline in the next few decades, and that'll have huge socioeconomic impacts,” Amato said. “I'm not saying that infertility coverage will solve this problem, but this is very low-hanging proof. These are people who have already decided that they want to have children, and we have the opportunity to help them.”

Oregon has one of the lowest birth rates in the country, according to KFF, formerly known as the Kaiser Family Foundation. And that makes backing fertility treatments even more urgent, backers say.

Consistent opposition

As in  past years, religious groups and insurers opposed the idea. They included officials from the Archdiocese of Portland and Oregon Right to Life, who voiced religious and moral concerns, and representatives of PacificSource Health Plans, Regence BlueCross BlueShield and an industry trade group, who spoke about finances. 

Tom Holt, lobbyist for the Oregon chapter of the National Association of Benefits and Insurance Professionals, said fertility treatment is not offered by insurers selling plans to individuals or small companies because it’s so expensive. He said adding it as a mandate would have an impact.

“We're going to reach a point where the small group market is no longer sustainable as a market,” Holt warned.

Mary Anne Cooper, government affairs director for Regence BlueCross BlueShield of Oregon, said it would raise premiums by nearly $5 a month.

The bill died in the budget-writing Ways and Means Committee.

But that doesn’t mean that it’s dead for good. Rep. Rob Nosse, chair of the House Health Care Committee, told The Lund Report he expects it to come back next year. 

“I don't know who will bring it back, but someone will work on it again,” he said. “We'll keep trying.”