Amid political IVF debates, hopeful parents are struggling to afford fertility care in California

(Nate Kauffman)

Amid political IVF debates, hopeful parents are struggling to afford fertility care in California

California Politics

Mackenzie Mays

March 31, 2024

Between chemotherapy, a double mastectomy, and all the other medical appointments that come with a cancer diagnosis, Katie McKnight rushed to start the in vitro fertilization process in the hopes that she would one day be able to give birth once she recovered.

McKnight, 34, of Richmond,


was diagnosed with a rapidly spreading form of breast cancer in 2020. IVF can help increase the chances of pregnancy for cancer patients who are concerned about the impact of the disease and its treatment on fertility. The process involves collecting eggs from the ovaries and fertilizing them with sperm in a laboratory, then implanting them into a uterus.

But after that

have started

the process is being anesthetized to retrieve her eggs and hundreds of dollars a year to properly pay for the embryos created with her husband McKnight cannot currently afford to get

the embryo stem

from a freezer.

“You have to have access to a lot of money, or you just keep them there frozen and suspended. It’s such a strange place to be,” McKnight said earlier this month as she prepared for her fifth reconstructive breast surgery. “I’ve come this far, how am I going to finish this now? How am I going to actually achieve this dream?”

California, celebrated by women’s activists as a haven for reproductive health care, does not require insurance companies to cover IVF.

McKnight, a board member of Bay Area Young Survivors, a support group for young breast cancer patients, is among those lobbying for state legislation to change that. She and her husband hope to implant an embryo as early as this year, fearing time is of the essence as her cancer could potentially spread to her ovaries. McKnight has health insurance through her job at an environmental research nonprofit, but IVF is not covered.

According to the U.S. Department of Health and Human Services, IVF costs Californians an average of at least $24,000 out of pocket.

Costs vary depending on the treatment. Patients typically require multiple rounds of IVF to be successful and whether employers provide insurance coverage for the procedure. According to a 2021 survey, 27 percent of companies with more than 500 employees offered IVF insurance nationwide.

Under a bill signed by the Democratic Administration. Gavin Newsom in 2019,


was able to have her egg puncture, a first step in the IVF process, covered by insurance, prior to life-saving chemotherapy, which can cause infertility. Medical patients who experience infertility as a result of treatment are insured under that law, but that coverage no longer includes fertilization and embryo transfer.

A new bill was introduced in the state legislature this year that would require major insurance companies to provide comprehensive coverage for infertility treatment, including IVF.

But the bill could be costly and will face an uphill battle as the state grapples with a multi-billion dollar budget deficit. Similar proposals have failed in the past, including an effort last year that never made it to the governor’s desk, facing opposition from insurance companies that new mandates would result in higher premiums for everyone.

IVF is especially important to McKnight because it has allowed her through genetic testing to identify which embryos have the BRCA gene mutation, which is hereditary and significantly increases the risk of breast cancer. She has decided to discard those embryos because she is concerned about passing on cancer to her children.

McKnight wept as he spoke about recent political debates over IVF that took place nationwide after an Alabama court ruled in February that frozen embryos can be considered “children” and that those who destroy them could be liable for wrongful death.

The decision disrupted IVF appointments in Alabama, and state lawmakers there rushed to create legislation aimed at protecting the procedure. But uncertainty remains over access, amid outstanding legal questions.

More than a dozen states have passed fetal protection laws this year. These measures could potentially draw IVF into religious arguments opposing abortion rights and stoke fears about further reproductive health restrictions after the Supreme Court’s 2022 Dobbs decision rolled back a federal guarantee of abortion rights

to abortion


“It scares me. It’s unfathomable to me,” McKnight said. “I don’t want to bring a child into this world that has to go through all the hard things that I’ve been through, and I feel like that’s my choice.”

Infertility is common. According to the CDC, about 1 in 5 married women of childbearing age cannot become pregnant after a year of trying.

According to the U.S. Department of Health and Human Services, more than 11,000 babies were born in California in 2021 using assisted reproductive technology such as IVF, nearly 3% of all babies born in the state that year.

More than a dozen states, including New York, Arkansas and Connecticut, require health plans to provide some coverage for IVF.

The American Society for Reproductive Medicine said California, home to the nation’s most progressive abortion laws, is failing in its role as


state of ‘reproductive freedom’.

“California still has much work to do to ensure that all people can make personal decisions about their reproductive lives and futures. True reproductive freedom means that all people can decide if and when they want to start or grow a family.”

the ASRM group

said in a statement in support of SB 729.

In addition to expanding insurance coverage to IVF, SB 729, introduced by Senator Caroline Menjivar (D-

Panorama CitySan Fernando Valley

), would also redefine “infertility” in health plans, expanding services to LGBTQ+ couples who do not meet current standards

in order

to secure fertility services.

Most health insurance plans that do offer IVF coverage measure infertility based on whether a man and a woman do not become pregnant after a year of unprotected sex, with the exception of

out of cover

LGBTQ+ couples who want to use fertility services to start a family

out of cover


The new bill would broaden the definition of infertility to include “the inability of a person to reproduce, either as an individual or with their partner, without medical intervention.”

The issue is personal for Menjivar. She and her wife recently chose to postpone plans to start a family through fertility services such as IVF and instead buy a house, after weighing the costs. She said she has friends who have traveled to Mexico for cheaper fertility care.

“When we talk about Alabama…we have barriers like that in California. The physical barriers exist in California where people can’t afford this,” Menjivar said.

The bill has been opposed by the California Assn. of health plans and a

list number

from insurance companies warning that such single-issue mandates will lead to higher premiums for business owners and enrollees.

According to a legislative analysis of the potential costs conducted last year, the California Health Benefit Review Program estimated that employers and employees would spend a total of an additional $183 million in the first year of the bill’s implementation, and that the following year would almost double. According to that analysis, California could face tens of millions more in costs from premium increases for state workers.

“While this bill is well-intentioned, it will inadvertently worsen health care affordability,” the California Chamber of Commerce, which also opposed the bill, said in a statement.

The latest cost estimate reflects Democrats’ efforts to limit the bill and bring down the price by exempting small health care plans, religious employers and Medi-Cal, which provides insurance to low-income Californians, from the proposed mandate to to cover IVF.

New IVF policy debates have created a political quagmire for some Republicans who have used “personality” arguments to oppose abortion but do not want access to IVF to be affected.

Republicans in the California Assembly, some

from wiewie

oppose expanding access to abortion and last month introduced a resolution calling on the state to declare that it “recognizes and protects” access to IVF for women “struggling with fertility issues” and encourages the same at the federal level.

It’s the resolution

is also calling on Alabama to reverse its ruling.

“IVF has allowed so many families to actually have children, so we need to make sure we have access to it,” said Assembly Member Josh Hoover (R-Folsom), co-author of

Concurrent resolution of the ACR meeting

154. “We can’t go backwards with IVF.”

But several Republicans who support this resolution oppose last year’s effort to ensure IVF in California.

The insurance bill failed to pass the General Assembly last year, and Hoover said he’s not sure how he’ll vote if it comes to his house this year. He expressed skepticism about the costs to small business owners and taxpayers.

For Democrats like Menjivar, the Republican-led resolution, which specifies that IVF is for women struggling with fertility issues and makes no mention of LGBTQ+ families, is considered a farce.

“It’s all talk,” she said. “This does absolutely nothing, there’s no meat on it at all.”

Menjivar said she will not support that resolution without changes. She is angry about the “hypocrisy” she has seen among Republicans across the country, who she says voted for anti-abortion policies that have led to the IVF problems now occurring.

“They made their bed and tried to get out, but they got stuck,” she said.


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