Michelle Andrews | KFF Health News (TNS)
Companies are increasingly offering generous fertility benefits to attract and retain top workers. Today, the federal government is getting involved. Starting this year, federal employees can choose plans that cover several fertility services, including up to $25,000 per year for in vitro fertilization procedures and up to three artificial insemination cycles each year.
With approximately 2.1 million civilian employees, the federal government is the nation’s largest employer. Today, as companies of all stripes prioritize fertility benefits, in vitro fertilization – a procedure used for more than 40 years – has become a sore subject for some anti-abortion Republican members of Congress and even for presidential candidates.
It was inevitable that disagreements over IVF among abortion opponents would eventually come to light, said Mary Ziegler, a legal historian and reproductive health expert.
“The anti-abortion movement since the 1960s has been a pro-fetal personhood movement,” said Ziegler, a law professor at the University of California-Davis. Since the U.S. Supreme Court’s Dobbs decision removed the constitutional right to abortion, anti-abortion groups and the Republican Party have debated what “fetal personhood” means and how it fits into their position about IVF and other technologies that help people have babies.
The Alabama Supreme Court cleared the way for the recent brouhaha by ruling last month that frozen embryos created through IVF are children under state law. Two Democratic senators have proposed legislation that would override state laws by establishing a statutory right to access IVF and other similar technologies. The bill was blocked in the Senate by a Republican opponent.
These events highlight the difficult situation Republicans find themselves in. Many support IVF and are well aware that it is extremely popular: 86 percent of adults in a recent CBS News-YouGov poll said IVF should be legal. The outcry over Alabama’s decision and Republicans’ failure to unite around a federal response, however, have highlighted fault lines within the party.
Some anti-abortion groups have vigorously opposed measures such as this Senate bill, arguing that lawmakers must balance IVF with the responsibility to respect life.
Republicans are “trying to fine-tune things, which is very difficult,” Ziegler said.
About 10 percent of women and men face fertility problems, according to the National Institute of Child Health and Human Development. IVF, a process in which an egg is fertilized in the laboratory and then implanted in the uterus, is one of the most expensive fertility treatments, costing around $20,000 for a cycle. Even with insurance coverage, the procedure is expensive, but for some people it is the only way to conceive.
In recent years, the number of companies offering fertility services to their employees has continued to grow. In the early 2000s, fewer than a quarter of employers with at least 500 workers covered IVF, according to benefits consultant Mercer’s annual employer survey. By 2023, this figure had roughly doubled, to 45%. Employers generally cap IVF benefits. In 2023, employers had a median lifetime maximum benefit of $20,000 for IVF, according to the Mercer survey.
IVF benefits from the federal government – up to $25,000 per year – are more generous than those from a typical employer. Coverage is available through the standard option of Blue Cross and Blue Shield’s popular federal employee program. In total, two dozen 2024 health plans for federal workers offer enhanced IVF coverage, with varying benefits and cost sharing, according to the Federal Office of Personnel Management, which manages federal health plans.
“OPM’s mission is to attract and retain the workforce of the future,” Viet Tran, OPM press secretary, said in written responses to questions. He noted that surveys have found that federal health benefits influenced employees’ decisions to stay with the federal government.
Starting this year, plans offered to federal employees must offer fertility benefits, according to OPM.
But it’s unclear how the emerging political debate around IVF and other reproductive health issues might affect national trends in benefits and coverage.
Last month, after the Alabama Supreme Court ruled that frozen embryos left after IVF procedures are considered children under state law, the state legislature quickly passed and Republican Gov. Kay Ivey signed a bill that grants immunity to patients and providers who participate in IVF services. . During the ensuing brawl, a coalition of more than a dozen anti-abortion groups signed a letter drawing a clear line in the sand. “Science and logic have clearly shown that embryos must benefit from the same human rights” as other human beings, we can read. Alabama law did not address the underlying issue of “personhood” of embryos, leaving open the door to further litigation and possible restrictions on IVF in Alabama and other states, say some legal analysts.
More than a third of states have laws that classify fetuses as being in a certain stage of pregnancy, according to a Politico analysis.
It is unclear whether the turmoil surrounding the Alabama case will have long-term impacts on employee benefits in that state or other states.
“If this were to happen in multiple states, employers would have to find a way around it,” said Jim Winkler, director of strategy for the Business Group on Health, a nonprofit that represents the interests of large employers . At this point, employers will want to keep a watchful eye on the issue but likely won’t plan any changes, Winkler said.
A Mercer blog post advised businesses with employees in Alabama to review health plan policies related to medical travel and leave benefits. Additionally, “employers should monitor other states that broadly define fetal personhood and restrict reproductive health care,” the blog advises.
The situation is reminiscent of what happened with abortion coverage following the Supreme Court’s Dobbs ruling in 2022. As states imposed restrictions on access to abortion, many companies have started to cover the travel costs of their employees to have it.
But what happened with abortion may not be a good indicator of what will happen with IVF, said Dorianne Mason, director of health equity at the National Women’s Law Center.
Following the Alabama judge’s ruling, “the Alabama legislature moved very quickly to respond to the outcry,” Mason said. “When we look at the legislative response to IVF, it’s moving in a markedly different direction in terms of access to care” compared to other types of reproductive care.
(KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF – the independent source for health policy research, polling and journalism.)
©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.
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