Louisiana lawmakers kill an insurance mandate to cover fertility preservation for cancer patients
A powerful Louisiana Senate committee scuttled a proposal that would have required insurance companies to cover fertility preservation procedures for cancer patients about to undergo radiation, chemotherapy and other treatments that will render them sterile.
The Louisiana Senate Finance Committee last week deemed House Bill 537 too expensive for the state, which would have had to pay for state workers and public school teachers to receive the coverage. Louisiana would also have had to cover additional costs to private health plans purchased on the state insurance exchange.
Many Louisiana health insurance plans don’t currently cover the extraction of eggs and sperm from people who have to undergo medical treatment that will result in infertility. This includes cancer patients, who are forced to pay out of pocket in order to preserve their chances to have children.
The failed legislation, sponsored by Rep. Paula Davis, R-Baton Rouge, was intended to close that coverage gap for new health plans in 2023 and existing health plans in 2024.
Davis had whittled down her proposal significantly over the last few weeks in the hopes of getting at least one narrow group of fertility services covered by insurance. An earlier version would have mandated coverage of a wider swath of infertility treatment, including in vitro fertilization, for married couples who are not in same-sex relationships.
Davis’ initial bill was based on a similar law in Texas, which requires private insurance plans to pay for in vitro fertilization in some cases. Arkansas also requires health care plans to cover portions of those treatments, according to proponents of the proposal.
Lawmakers are actually among the relatively few people in Louisiana that have some fertility treatment covered by their insurance plan. LSU First – which provides health care coverage to LSU employees, legislators and legislative staff – is the only state government-provided plan that voluntarily pays for infertility services. A few private insurance companies in the state also cover it on a voluntary basis, though not some of the larger providers.
With her broader proposal, Davis ran into opposition from insurance companies, Catholic bishops and Louisiana Right to Life, a leading anti-abortion organization. Insurance companies said providing in vitro fertilization coverage would be too expensive and drive up premiums by a few hundred dollars.
Catholic bishops and Louisiana Right to Life have a moral objection to in vitro fertilization, which often leads to the destruction of embryos. Ben Clapper, executive director of Louisiana Right to Life, said his organization considers embryos akin to human life, which makes their disposal problematic.
A handful of legislators were enraged by the opposition of the Catholic Church and anti-abortion advocates. House Speaker Pro Tempore Tanner Magee, R-Houma, said the church has always been willing to accept his tuition check for his triplet daughters to attend Catholic school, though they were conceived with in vitro fertilization.
“If they were really against it, they shouldn’t take my money,” Magee said on the House floor before a vote on the bill. “To sit here and tell me that my three beautiful girls are somehow not natural is the most hurtful, ridiculous and outlandish thing.”
Nevertheless, in order to give the bill a better chance of passing in the Senate, Davis removed the insurance coverage requirement for in vitro fertilization and several other fertility treatments. The most recent version of the legislation only mandated coverage for the extraction and freezing of eggs and sperm separately – not as a fertilized egg or embryo.
Senate Finance Committee members weren’t willing to pass the bill with its state government price tag, and they also refused to approve it if state workers and public school teachers were removed. Davis had been willing to exempt health plans offered by the Office of Group Benefits – which provides insurance to most state employees and public school teachers – from the proposed fertility preservation requirement in order to keep the state costs down, but the committee members wouldn’t go along with that compromise.
Proponents of the bill have argued that the estimated cost to the state of providing fertility treatment is inflated.
The fiscal analysis of the impact to health plans on the state insurance exchange – estimated to be between $1.6 million and $4.9 million per year by the middle of 2026 – is solely based on data provided by Blue Cross and Blue Shield of Louisiana, a company that lobbied against Davis’ legislation. That caused some lawmakers to question whether the state’s fiscal analysis was even accurate.
“The very people who don’t want to do this because it’s going to cost them more are putting together numbers that we thought we were relying on,” said Sen. Gary Smith, D-Norco, during a hearing last week. “So this whole thing is a scam.”
The Louisiana Department of Insurance told Smith the federal government requires it to use information from Blue Cross and Blue Shield when calculating the impact of insurance plan mandates.
“If they give us the wrong number, the feds require us to accept that,” said Frank Opelka, deputy commissioner at the insurance department in a hearing last week. “I’m not telling you I agree with it.”
Former state Rep. Julie Stokes, a breast cancer survivor and advocate for cancer patients, said she also believed the estimated cost to cover fertility preservation services for state workers and teachers in the Office of Group Benefits appeared to be high as well.
Advocates believe that only an estimated 2,200 people per year, including those in the private sector, would have been able to take advantage of the fertility preservation coverage Davis’ latest bill provided. Yet the Office of Group Benefits estimated that it would be spending between as much as $1.8 million per year on the treatment. That’s significantly more than seen in other states, Davis said.
“Usually, it is one cent per member per month to five cents per member per month in other states,” she said.
Though her bill is dead for this year, Davis is expected to ask legislators to approve the study of the cost of imposing an insurance requirement to cover fertility treatments, including in vitro fertilization, so she can have more accurate cost estimates when preparing a proposal next year.
The fallout from the infertility fight has spilled over into other legislative matters. The Househas now shelved legislation important to Senate Finance Committee chairman Bodi White, R-Baton Rouge, as retribution for killing Davis’ bill.
The House leadership is refusing to move White’s controversial bill to redraw public school boundaries for the city of Central to exclude a planned neighborhood with many Black residents. Democratic and Republican lawmakers, particularly from the Baton Rouge area, were already opposed to the legislation, which has been characterized by opponents as racist.