After multiple miscarriages and seven different fertility treatments, a Windsor woman is maintaining her hope to have her own child one day.
Rachael — whose last name is not included due to privacy reasons — and her husband have faced financial burdens from spending more than $25,000 on fertility services. The cost has forced the couple to halt their fertility journey as Rachael awaits transformational legislation that could make a positive difference in her life and the lives of other Coloradans.
The new state law requires insurance companies to cover fertility treatment, allowing more people to access services and reducing the stressful impacts of unaffordable care.
“Each time you go into infertility treatment … you want to hope that because you’re doing something medically supporting that it’s going to work,” Rachael said. “It’s very devastating, honestly, when you realize that you kind of put all your eggs in one basket, and still that didn’t work for you.”
House Bill 22-1008, Implementation Of Fertility Coverage, passed during the 2022 regular session and requires large employer plans of more than 100 employees issued or renewed in this state to cover fertility services on or after Jan. 1, 2023. The coverage must be implemented by the division of insurance in the department of regulatory agencies.
Pending a decision from the U.S. Department of Health and Human Services regarding the effects of coverage on costs for the state, the legislation also requires individual and small group policies and contracts issued or renewed in the state to cover fertility services.
The legislation extends coverage to more than 600,000 Coloradans — about an eighth of the state’s population, according to managing attorney Ellen Trachman at Trachman Law Center, LLC, who specializes in assisted reproductive technology law and co-founded a nonprofit called Colorado Fertility Advocates.
“So it’s not a huge coverage for everyone, but at least it’s something,” Trachman said. “It’s a victory that there is this population that will be having their insurance required to cover basic fertility care … but also this fight is still ongoing.”
Expected to take less of a toll on patients
As a board-certified reproductive specialist at Rocky Mountain Center for Reproductive Medicine in Fort Collins, Kevin Bachus has seen many effects, especially financial burdens, delay infertility testing and the fertility process.
The average cost of in vitro fertilization (IVF) in the United States is about $11,000 to $12,000, according to an Advanced Fertility Center of Chicago article. And in Colorado, the average cost for a standard cycle of IVF without medication is $10,000, Consider IVF indicated.
Expenses range from evaluating infertility to basic or advanced fertility treatments, which can add up to thousands of dollars based on which treatment is the best choice for a person. The national average of IVF with donor eggs is $28,000.
Rachael and her husband have been on their infertility journey for more than three years. She has been diagnosed with endometriosis and polycystic ovary syndrome — underlying conditions that cause infertility.
Having seen multiple doctors, Rachael has been billed three times for a diagnosis. At the last clinic she visited, she paid $3,500 to get her results.
Except for a small fee waiver, neither her treatments nor testing have been covered by her insurance — a common occurrence since most people seeking fertility treatment struggle with affordability and lack of insurance coverage.
While IVF is one of the more expensive options, Rachael has only stuck with the conservative, less invasive treatments like medications and intrauterine insemination (IUI) procedures, where the sperm is placed into the uterus using a small catheter.
That itself has cost the couple $25,000, but she hopes the fertility coverage bill can lead to their next step of affording IVF.
“When you’re paying all that money toward fertility, you’re not doing things like trips or going out with your friends, or doing things in relationships and things that are important for your own mental health,” Rachael said. “And so then there’s also been a mental health component of anxiety and depression.”
Emery Erhart, a counselor for Pregnancy, Postpartum, and Fertility Counseling of NOCO, explained financial barriers are a common hardship for her clients and expenses can lead to trauma, anxiety and depression. Rachael said infertility can also be hard on relationships and marriages since it takes up a couple’s conversations, decisions and finances.
“I went to a training last year that said infertility is just as devastating as a cancer diagnosis,” Erhart said. “A lot of times when couples come to see me, they’ve experienced not only loss of pregnancies or loss of even hope, but the idea that they can’t even move forward because it’s cost them so much. And that’s really tough.”
Erhart said lifting financial struggles off of someone’s shoulder while pursuing fertility services will switch the focus to other components that come along with treatment, including prioritizing mental and physical health.
“It all goes back to what they can focus on instead, right?” Erhart said. “If people aren’t worried about losing their home or having to pull double shifts, or having to up the number of hours in their workload every week, they can focus on their physical health.”
Accessibility will also alleviate stress, which is crucial for people trying to conceive. Many of Erhart’s clients have been told by doctors they need to decrease their stress, but that isn’t always possible with affordability concerns.
“There’s a lot of unknown and worry that accompanies fertility so even if it’s not wiped clean … something that just can be supportive, even that would be huge,” she said.
Personal or career choices are also a factor when people are looking at starting a family. As all these factors combine in the family planning process, it can lead to built-up frustration — sometimes occurring before people even visit a clinic.
“I certainly hope that the inclusion of the coverage will allow patients to seek care earlier in their trials of attempting to conceive,” Bachus said. “Thus, their frustration levels would be lower and their experience with going through the testing and treatment will be less stressful for them.
“I think that coverage is bound to be instrumental in helping … at least the financial pressures involved, and I think everything kind of falls down the hill in a positive direction from there in terms of not having the unwanted delays due to finances.”
LGBTQ people face an even higher barrier to accessing insurance-covered fertility care in the United States. In most cases, fertility treatment is the only option for LGBTQ couples to have children, which means most don’t meet the definitions of “infertility” that often would qualify them for coverage, according to a Women’s Health Policy report titled Coverage and Use of Fertility Services in the U.S.
Transgender people undergoing gender-affirming care are also usually excluded from coverage because they might not meet the criteria for “iatrogenic infertility,” the report said.
But data from a January 2019 Family Equality Council survey shows 63% of LGBTQ people ages 18-35 are planning to grow their families and more than 1.6 million LGBTQ millennials are considering biological paths — including insemination, IVF and surrogacy — to become parents.
As the number of LGBTQ people who want to pursue parenthood grows and a lack of care coverage remains present for those who fall into the community, Colorado’s new legislation will also open the door to more accessible coverage for LGBTQ people.
Republicans voted ‘no’ on fertility coverage bill
The bill won 45 votes with 20 Republican House representatives voting against the bill. Similarly, in the Senate, the legislation won 21 votes, with 11 Republicans against the bill.
State Rep. Richard Holtorf said he opposed the bill because was concerned about rising living costs, insurance premiums and inflation.
He believes the bill will add to self-employed or self-insured Coloradans experiencing insurance premiums as the highest costs on their monthly bills, with insurance companies covering those premiums and leading to employees having to pay a portion of those costs.
State Rep. Mark Baisley voted for the initial fertility coverage bill introduced by State Rep. Kerry Tipper in 2020, but this year, he voted no.
Baisley said there are some things, including ambulance rides, that insurance companies should be required to cover for competitive reasons. He explained if one company drops coverage for something and premiums go down, then other companies will follow their lead.
However, he felt fertility challenges should not receive the same type of coverage based on a resolution from Democratic representatives that upset Republicans.
“Is infertility or fertility challenges — is that something that is appropriate to require insurance companies to cover?” he asked. “I had quite an internal argument with myself about it … but I did so in support of Rep. Tipper until Rep. Tipper came out strong in her attack against the Republican Party.”
All Republicans voted “no” to the resolution, an election reform bill, that he found to be the “opposite of election integrity and its a centralization of power on Nancy Pelosi power grab.” He said Tipper attacked those on the right-wing.
“Rep. Tipper has always been a friend of mine that I’ve worked well with, but she really broke the trust with me with that one,” Baisley said. “She knows that, so I withdrew my support of her bill at that time.”
While Baisley’s decision on the bill was based on a conflict between political parties — rather than what the bill entails — Holtorf pulled his opinion from his experience on the Public Health Committee. After hearing testimony about fertility treatment on the committee, Holtorf said he learned that expenses range from $30,000 to $40,000 for one treatment and patients often need two or three treatments before becoming fertile.
“That’s over $100,000 … who’s going to have the burden of covering that cost for something that isn’t a life-threatening condition?” he asked.
Holtorf believes there is no realistic solution to his concerns about insurance coverage of fertility treatment.
“Is infertility a right? If you’re infertile, is it your right to have a baby?,” Holtorf asked. “Should the government be in the business of making sure that you can have that baby? Should they pay for it or should they pass the cost on as what I would call an unfunded mandate for insurance companies? I know insurance is regulated, but who should bear that responsibility? A private citizen? A couple that’s infertile?
“I don’t think there’s any good solution directly with this, other than, it’s expensive and who should pay for it?”
Baisley places blame on the Democrats’ influence on health care, arguing disengaging the government from health care will bring down costs.
“The best solution in my mind would be to disengage government from health care so that the natural forces of a free market would bring those costs down,” Baisley said. “Health care cannot enjoy free market forces because it’s so not a free market, because of the Democrats. They just can’t keep their hands off of health care and so they just make it more expensive and less available”
Rachael asks those who don’t support legislation such as the fertility bill to think about people who have wanted children and are unable to conceive due to reasons they have no control over, such as underlying conditions and diseases.
“I would really just encourage people to look at … people who have wanted to have families since they were young kids or a girl who dreamed of doing it since she was five and now 25 years later, not being able to,” Rachael said. “Just thinking about how that can help when we have other autoimmune diseases or underlying conditions that we really have no control over.”
How the legislation changed before passing
In the United States, about 9% of men and 11% of women of reproductive age have experienced fertility problems, the National Institute of Child Health and Human Development reported.
A few years ago, the need to make fertility more accessible statewide became apparent as people — including Trachman’s nonprofit Colorado Fertility Advocates — began advocating for legislation surrounding treatment coverage. The nonprofit is filled with professionals, advocates and people struggling with infertility to support one another and provide better education about infertility.
By 2020, the nonprofit began working with other organizations to endorse the movement to introduce the Colorado Building Families Act bill, which requires insurance under Colorado law to treat infertility like any other medical condition.
Initially, Trachman said many people were against fertility mandates and had concerns about premiums going up. After those involved in Trachman’s nonprofit testified at the House hearing, which included stories of a cancer survivor losing the chance to become a biological mother and people resorting to selling their homes to afford the cost of fertility care, the bill unanimously passed the house.
The bill’s mandate was originally expected to go into effect Jan. 1 of this year, but Gov. Jared Polis governor believed there needed to be additional language added relating to the American Care Act, according to Trachman. In particular, he required affirmative confirmation from Health and Human Services that the mandate would not make the state financially responsible for any increase in premiums.
Eventually lawmakers’ reintroduced a revised version of the legislation — the 2022 fertility coverage bill — which resolved previous issues involving the language.
A ways to go with fertility accessibility
“I want people to understand that there is more hope and this is a really positive step and there are 600,000 more Coloradans that will have coverage,” Trachman said. “I think that it’s a really positive thing and we should really celebrate it, but know that there’s so much more work to do.”
While this legislation only applies to a portion of the population, Erhart said it is important to get the word out that fertility coverage is a possibility for some people in the state. But as negative impacts including financial barriers and mental health problems continue to arise for people seeking fertility treatment, it becomes clear accessibility should be available to everyone, according to Erhart.
“I think that accessibility to family building is critical for everybody,” Erhart said. “When you look at trauma, questioning your identity, developing anxiety and depression, when barriers come down to money … If we can negate all of that stuff I just mentioned by increasing support and coverage, that’d be great.”
To help advocate for extended access to coverage, Trachman said there is still work to do on the federal level and within the state.
“Having this bill in law passed to where there are some measures in place, the tough financial burden would be obviously still there but so much less,” Rachael said. “It just makes it a lot more natural and equal in terms of people who aren’t able to have children naturally without any infertility support.”
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