Louisiana lawmakers kill insurance mandate to cover fertility preservation for cancer patients
A powerful Louisiana Senate committee has defeated 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 would make them sterile.
The Louisiana Senate Finance Committee estimated last week House Bill 537 too expensive for the state, which would have had to pay state workers and public school teachers for coverage. Louisiana would also have had to cover the additional costs of private health plans purchased from the state insurance exchange.
Many Louisiana health insurance plans currently do not cover egg and sperm retrieval of people who are 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 of having children.
The failed legislation, sponsored by Rep. Paula Davis, R-Baton Rouge, aimed to close that coverage gap for new health plans in 2023 and existing health plans in 2024.
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Davis had scaled down her proposal significantly in recent weeks in hopes of getting at least a select group of insurance-covered fertility services. An earlier version would have mandated coverage of a wider range of infertility treatments, including in vitro fertilization, for married couples who are not in same-sex relationships.
Davis’ original bill was based on a similar law in Texas, which requires private insurance plans to pay for in vitro fertilization in certain cases. Arkansas also requires health care plans to cover a portion of these treatments, according to proponents of the proposal.
The lawmakers are actually among the few people in Louisiana who have fertility treatment covered by their insurance plan. LSU first — which provides health care coverage to LSU employees, legislators and legislative staff — is the only plan provided by the state government that voluntarily pays for infertility services. A few private state insurance companies also cover it on a voluntary basis, but not some of the larger providers.
With her broader proposal, Davis faced opposition from insurance companies, Catholic bishops and Louisiana Right to Life, a leading anti-abortion organization. Insurance companies have said that providing in vitro fertilization coverage would be too expensive and would increase premiums by a few hundred dollars.
The 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 views embryos as human life, which makes their disposal problematic.
A handful of lawmakers have been infuriated by opposition from the Catholic Church and 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, despite being conceived with in vitro fertilization.
“If they were really against it, they shouldn’t take my money,” Magee told the House before a vote on the bill. “To sit here and tell me that my three beautiful daughters are unnatural is the most hurtful, ridiculous and weird thing.”
Nevertheless, in order to give the bill a better chance of passing 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 required cover for the extraction and freezing of eggs and sperm separately – not as a fertilized egg or embryo.
Members of the Senate Finance Committee were unwilling to pass the bill with its price tag for state government, and they also refused to approve it if state employees and teachers public schools were fired. Davis was willing to exempt health plans offered by the Office of Benefits — which provides insurance to most state employees and public school teachers — from the proposed fertility preservation requirement in order to reduce state costs, but committee members would not. go with this compromise.
Proponents of the bill have argued that the estimated cost to the state of providing fertility treatment is inflated.
Fiscal analysis of the impact of health plans on the state insurance exchange—estimated at $1.6 million to $4.9 million per year by mid-2026—is solely based on data provided by Blue Cross and Blue Shield of Louisiana, a company that lobbies against Davis’ legislation. This caused some lawmakers to question whether the state’s tax 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 counting on,” Sen. Gary Smith, D-Norco, told a hearing last week. “So this is all a scam.”
The Louisiana Department of Insurance told Smith that the federal government requires him 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 force us to accept it,” Frank Opelka, deputy commissioner at the Department of Insurance, said during a hearing last week. “I’m not telling you that I’m okay with that.”
Former State Representative Julie Stokes, a breast cancer survivor and cancer patient advocate, said she also believes the estimated cost to cover fertility preservation services for employees of the State and Teacher Benefits Office also seemed high.
Proponents estimate that only about 2,200 people a year, including those in the private sector, could have taken advantage of the fertility preservation coverage provided by Davis’s last bill. Still, the Office of Group Benefits estimated he would spend up to $1.8 million a year on the treatment. That’s a lot more than in other states, Davis said.
“Usually it’s one cent per member per month to five cents per member per month in other states,” she said.
Although his bill is dead for this year, Davis is expected to ask lawmakers to approve the study of the cost of imposing an insurance obligation to cover fertility treatmentsincluding in vitro fertilization, so that she can have more accurate cost estimates when preparing a proposal next year.
The fallout from the fight against infertility has spread to other legislative issues. The House has now set aside the legislation material to Senate Finance Committee Chairman Bodi White, R-Baton Rouge, in retaliation for killing Davis’ bill.
The House leadership refuses to move White’s controversial bill to redraw the boundaries of public schools in the city of Central to exclude a planned neighborhood with many black residents. Democratic and Republican lawmakers, particularly in the Baton Rouge area, had already opposed the legislation, which opponents called racist.