House Bill 4155, which would have required Oregon health insurers, the Oregon Educators Benefit Board, and the Public Employees' Benefit Board to cover fertility treatments — including three egg retrievals and unlimited embryo transfers — died in the Ways and Means Committee during the 2026 short session. It marks the fifth time since 2021 that a fertility coverage mandate has failed in the Oregon Legislature. This year's effort was notable for crossing party lines: House Minority Leader Lucetta Elmer, a Republican, led the bill, declaring, "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."

Oregon remains one of the majority of states without a fertility insurance mandate. Currently, 21 states have enacted some form of fertility coverage law, with 14 requiring IVF coverage specifically. California's mandate, effective July 2025, requires fully-insured large group plans to cover three egg retrievals and unlimited embryo transfers — essentially the same framework HB 4155 proposed. The average cost of a single IVF cycle ranges from $15,000 to $35,000 depending on medications, genetic testing, and location, with most patients requiring an average of 2.5 cycles to achieve pregnancy. Dr. Paula Amato, an OHSU reproductive endocrinologist and longtime advocate, told The Lund Report: "It's very disheartening to come back year after year and be disappointed."

The opposition coalition remained formidable. PacificSource Health Plans, Regence BlueCross BlueShield, and an insurance industry trade group raised cost concerns — estimating an approximately $5 monthly premium increase per member. Tom Holt, speaking for the industry, warned: "We're going to reach a point where the small group market is no longer sustainable." Religious groups including the Archdiocese of Portland and Oregon Right to Life voiced moral objections. The bill's proposed amendment to establish a Family Building Fund under the state Treasury — an alternative funding mechanism — failed to gain traction in Ways and Means.

Watch for the bill's return in the 2027 long session. Rep. Rob Nosse, chair of the House Health Care Committee, told The Lund Report he expects it back: "I don't know who will bring it back, but someone will work on it again." The political dynamics are shifting — bipartisan leadership from Rep. Elmer signals broadening support, and the national trend toward fertility mandates (California, Colorado, New York, and others enacted laws in 2024-2025) adds momentum. The question is whether advocates can find a cost structure that neutralizes insurer opposition or identify an alternative funding mechanism that bypasses the premium impact debate entirely.