Advocates push for infertility benefit coverage in North Dakota
A draft bill before an interim committee of the North Dakota Legislature would increase infertility benefits for public employees to $50,000, with the hope the benefit later would be required for all private insurance.
BISMARCK — The problem of infertility is largely overlooked because it’s one of those subjects people don’t want to talk about.
But studies estimate that one of every eight couples is unable to conceive a child — a ratio that equates to about 20,000 North Dakota residents.
“It’s a lot of people,” said Tara Brandner, a nurse practitioner in Ashley. “They are invisible,” kept in the shadows by the stigma attached to infertility.
The cost of medical infertility treatments is high, averaging around $10,000 for many couples, yet is not covered by most health insurers, Brandner said.
Twice the North Dakota Legislature has been asked to require infertility coverage, and twice the proposals have been rejected, last year failing 31 to 63 in the North Dakota House of Representatives.
“We more than doubled our support from the first year to the second year,” Brander said Monday, June 20. “I feel more positive every year we move forward.”
So, she is back with a proposed bill introduced during the legislative interim and once again hopes to find a bipartisan slate of sponsors.
The interim draft bill will get its first test Tuesday when it will be considered by the interim Employee Benefits Programs Committee.
The bill seeks to increase infertility treatment coverage for public employees in the North Dakota Public Employee Retirement System from $20,000 to $50,000. If that succeeds, Brandner hopes after two years the benefit would be required for private insurance.
Although the cost of infertility treatments is typically $10,00 to $20,000, many pay more, and in rare cases the costs can exceed $200,000, Brandner said, making the treatments unaffordable to many.
Opposition stems from concerns that an infertility treatment benefit would drive up insurance costs. A recent study cited by Brander, however, found 91% of employers offering infertility treatment coverage have not experienced increases in their medical costs.
So far, 20 states require insurance coverage for infertility treatments, and another four are considering the requirement, according to Resolve , the national infertility association. Minnesota and South Dakota do not require coverage, but Montana does.
Blue Cross Blue Shield of North Dakota, the state’s largest private health insurer, encourages employees to advocate that their employers expand coverage to include in vitro fertilization treatments.
“We share in the belief that change needs to occur to address the incredible costs of infertility treatment,” Andrea Dineen, a spokeswoman for Blue Cross Blue Shield, said in a statement.
Instead of mandating infertility coverage by law, a better approach would be “working more broadly to better manage the costs of these services and treatments themselves. Mandates drive up the overall cost of health care," she said.
“Legislatively picking and choosing which medical services will receive mandated coverage is a slippery slope that prioritizes one person’s condition over another’s, such as insulin, cancer treatment, etc.," Dineen added.
The Centers for Medicare and Medicaid recently gave notice that states will be held financially responsible for any benefits beyond the essential health benefits, “which means the state of North Dakota will likely be responsible for the cost of this proposed mandate,” Dineen said.
Sanford Health Plan is “continuously evaluating its coverage options to ensure it is meeting members’ healthcare needs while keeping premiums affordable,” spokesman Nathan Aamodt said in a statement. “This includes looking into options to better manage premium costs for all plan members and evaluating the financial impact to those members undergoing fertility treatments.”
Brandner’s work as a nurse practitioner exposed her to the anguish of parents who are unable to conceive and moved her to form a nonprofit organization, Everlasting Hope, in 2019.
The charity’s fundraising has provided grants of $2,000 to $5,000 that have helped enable the births of five babies, with another four on the way, she said.
Studies have shown infertility benefits can help reduce multiple births because couples have financial support and are less likely to choose options that can result in multiple births, she said. In turn, that helps reduce neonatal intensive care costs, which are more likely in multiple births.
Brandner believes support for infertility insurance benefits is growing in North Dakota. She hopes more couples will come forward to tell their stories.