Senate GOP blocks bill to expand IVF access as advocates call for better FEHB coverage

A Democrat-led bill aiming to broadly expand IVF access has specific implications for feds through the Federal Employees Health Benefits (FEHB) program.

For federal employees, a bill pending in the Senate would bring expanded coverage of fertility treatments through the Federal Employees Health Benefits (FEHB) program.

But the Right to IVF Act, which Sens. Tammy Duckworth (D-Ill.), Patty Murray (D-Wash.) and Cory Booker (D-N.J.) introduced last week, did not garner the 60 votes needed to move forward with a floor vote Thursday afternoon. Almost all Republicans voted against the measure to advance the legislation, resulting in a 48-47 tally.

The legislation rolls together three previous bills all aiming to improve access and insurance coverage for in-vitro fertilization (IVF). In part, the bill would have impacts specifically on FEHB enrollees. One component of the Right to IVF Act aims to set higher requirements for FEHB carriers to offer IVF coverage.

The Office of Personnel Management increased FEHB carrier requirements for IVF treatments for plan year 2024. But the legislation looks to further extend the requirements of IVF to cover both treatments and medications, as well as expanding to more types of assisted reproductive technology (ART).

The Democrat-led bill currently has 48 cosponsors. Generally, it focuses on establishing broader access to IVF and ART and lowering treatment costs, which without insurance can add up to tens of thousands of dollars in costs.

“Federal workers — myself included — know how expensive paying for IVF out of pocket can be, and the cost has put it out of reach for far too many,” Stacey Young, president of the Department of Justice Gender Equality Network (DOJ GEN), a federal employee advocacy group, told Federal News Network.

The push for a vote on the IVF bill represents a mindset shift toward the presidential campaign now just five months away, the Associated Press reported. Duckworth and other co-sponsors of the bill have said the legislation is also a response to the overturning of Roe v. Wade in 2022, and other more recent efforts to limit access to fertility treatments and medications.

“Today, women and families … are worried about what comes next, including the erosion of reproductive freedoms nobody thought were at risk. This includes access to services like IVF,” Senate Majority Leader Chuck Schumer (D-N.Y.) said Tuesday on the Senate floor. “The Right to IVF Act establishes a nationwide right to IVF and eliminates barriers for the millions of families looking to use IVF to start and grow a family.”

The Biden administration also came out in support of the legislation and called for its passage.

“The administration looks forward to working with Congress … in order to protect access to fertility services, eliminate barriers for families in need of high-quality, affordable fertility services, and ensure that federal agencies have the resources to implement these benefits,” the Office of Management and Budget wrote in a statement of administrative policy Wednesday.

DOJ GEN has continually called for better federal health care coverage of infertility treatments. The group is one of many stakeholders that pushed for the advancement of the Right to IVF Act in the Senate.

“Supporting this bill should be a no-brainer,” Young told Federal News Network. “Our nation’s public servants should have affordable access to the full range of reproductive health care, including IVF and other forms of assisted reproductive technology.”

But some lawmakers, along with DOJ GEN, have said even without the legislation, OPM should still work to add more coverage for FEHB enrollees. For plan year 2024, OPM already expanded IVF coverage requirements for FEHB carriers to provide, at a minimum, coverage of the cost of drugs related to an IVF procedure for three cycles annually. OPM has also encouraged FEHB carriers to go beyond the minimum requirements — and so far, 24 carriers have done so.

DOJ GEN leaders said they’re grateful for the efforts OPM has made so far in the FEHB requirements. But the advocacy group wants OPM now to take things a step further. DOJ GEN is asking OPM to expand health carrier requirements to cover IVF treatments, on top of medications, for plan year 2025.

“OPM has the opportunity to break new ground again in 2025 by mandating not only coverage of IVF medications, but also medical treatments,” DOJ GEN wrote in a letter to OPM Acting Director Rob Shriver in May. “Medical treatments comprise the lion’s share of the cost of IVF. Many of our members can attest first-hand to the financial strains that paying out of pocket for IVF placed on them. Some had to drain their savings; borrow money from family members; or forgo treatments entirely. Others left DOJ for private-sector jobs that offered full IVF coverage, taking their invaluable skills and institutional knowledge with them.”

OPM declined to comment on whether there were any plans underway to further expand coverage requirements for IVF in the health insurance program. But some federal health experts have said with just a few months before Open Season, it’s likely too late to expand the coverage as early as plan year 2025 — though it would be possible in future health plan years.

Betsy Campbell, chief engagement officer at national infertility association RESOLVE, said the calls for better insurance coverage of fertility treatments have been growing.

“We know that hundreds of federal employees have been reaching out to OPM to request this coverage, and we’ve started to see some progress with OPM,” Campbell said in an interview with Federal News Network. “The next step is actually adding the medical procedure of IVF. So we’re hopeful that OPM will listen to their employees and add this highly desired benefit.”

RESOLVE has also been encouraging the adoption of a more inclusive definition of infertility that would help LGBTQ+ employees as well as unpartnered individuals access IVF and other fertility benefits through FEHB — but she said the efforts should go beyond simply updating the definition.

“There appears to still be some work, because donor sperm and donor eggs aren’t necessarily covered by all the plans,” Campbell said. “And that, of course, is needed by same-sex couples and non-partnered people when building their families. It’s one thing to have an inclusive definition, but you also have to cover the elements that are needed for these communities to build their families as well.”

A 2021 survey from Mercer, in partnership with RESOLVE, found that a vast majority of employers that increased fertility treatment coverage and benefits did not see a significant increase in medical plan costs.

Additionally, Campbell said, these types of benefit adjustments can significantly impact recruitment and retention of employees.

“You don’t want to provide yet another reason for them to leave federal employment to go to a private employer that is providing fertility benefits,” Campbell said. “Often employers don’t realize there’s a gap in this coverage until it’s pointed out. I think we’re seeing OPM trying to fill this gap piece by piece … Now it’s time to also cover these medically necessary procedures to help their employees build their families.”

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