FARGO — A bill that would mandate insurance companies cover infertility treatments failed on the floor of the North Dakota Senate this week, despite deeply personal testimony from the sponsor of the bill and its supporters.
State Sen. John Grabinger, D-Jamestown, sponsored the bill and testified Feb. 14 that his 23-year-old daughter was the state's first gestational surrogacy birth. His wife, unable to conceive, had a relative carry and deliver their child.
This inspired his political career, Grabinger said; he successfully pushed to make the birth form legal in 1995 just before his daughter was born, but he believes more work needs to be done to support families in these situations by requiring insurers to provide or offer coverage of infertility treatments.
Fifteen other states have similar legislation covering the costly procedures. The bill in North Dakota would cover the cost of up to three treatments and allow families to go beyond the typical $20,000 insurance cap, Grabinger said. It includes coverage for things like egg extraction and storage, medication, ultrasounds and lab tests.
That added up to $38,000 for nurse practitioner Tara Brandner, of Ashley, N.D., who had her first child Jan. 9, 2018, after months of in vitro fertilization. The proof is in her pregnancy announcement: hundreds of syringes surrounding her ultrasound photo.
Brandner was diagnosed with endometriosis that prevented her from conceiving, so she sought treatment at the region's only reproductive medicine clinic, Fargo's Sanford Health.
"It's a medical diagnosis, and therefore, insurance needs to cover it," she said. "It's unacceptable that they would not provide coverage overall for this illness and cancer preservation."
She said in working with Resolve, the national infertility association, she's heard of young cancer patients told that preserving their fertility to start a family in the future would cost thousands of dollars. People max out credit cards, sell houses, dip into life savings "just to build their family." An already emotional, stressful situation is made more difficult by the financial burden, she added.
The bill would include covering treatment for infertility caused by radiation and chemotherapy.
Dr. Kristen Cain, a reproductive endocrinologist at Sanford, said fertility preservation means that "young people with cancer have something to look forward to," and it can be "an important part of their recovery" to think about the possibility of having a family.
Sanford's reproductive clinic saw 700 patients last year for insemination, in vitro fertilization and cancer preservation. The cost per cycle of treatments can range from $500 to $15,000, with some patients needing several cycles to get a positive pregnancy test.
The inability to conceive is fairly common, Cain said, and is considered a medical illness. About 15 percent of people under the age of 35 have a fertility problem, and that number increases to 60 percent after the age of 40. She supports legislation that aims to assist families financially in these emotional situations.
"The stress associated with infertility diagnosis is the same that comes with the cancer diagnosis or HIV," she said.
Brandner said that she will continue fighting for the legislation because she believes "nobody should have to go through this." She wants to be the voice of families in the midst of infertility treatments unable to advocate for themselves. As for plans with her own family, she said they haven't talked about having another child and the "financial stress is a huge barrier."
Andrea Dinneen, a spokeswoman with Blue Cross Blue Shield North Dakota, said the insurance company has taken a neutral stance on the bill. In a statement, she wrote that "treatment for infertility is a covered benefit through our standard benefit plans, and self-funded employer groups have the option to provide benefits as well."
She added that "state mandates for the coverage of medical services add to the cost of health care and contribute to increased insurance premiums for our members."
Grabinger said that the senators opposing the bill — all Republicans — are against the mandate's potential to raise insurance rates. He said if he's back in the Senate again in two years, he will try passing the bill with Brandner again.