RESOLVE: The National Infertility Association. 21 st Century Infertility Treatment & Access to Care

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1 RESOLVE: The National Infertility Association 21 st Century Infertility Treatment & Access to Care

2 What is Infertility? Infertility is a disease impacting 7.3 million Americans. 1 in 8 individuals or couples have trouble getting pregnant or sustaining a pregnancy. Infertility affects men and women equally. The American Medical Association, American Congress of Obstetricians and Gynecologists, American Society for Reproductive Medicine, and the World Health Organization all recognize infertility as a disease.

3 Infertility is a Disease Infertility is a disease, defined by the failure to achieve a successful pregnancy after 12 months or more of appropriate, timed unprotected intercourse or therapeutic donor insemination. Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months for women over age 35 years. -- American Society for Reproductive Medicine

4 Infertility is More than a Disease Having a family is fundamental to the lives of many American women and men. Being unable to have a child is life altering. The depression associated with infertility is as great as the depression that accompanies a cancer diagnosis. In 1998, the U.S. Supreme Court stated that reproduction is a major life activity and conditions that interfere with reproduction should be regarded as disabilities per the American Disabilities Act.

5 There are Multiple Ways to Resolve Infertility Medical/technical Most infertility cases are treated with drug therapy or surgical procedures. Less than 10% need advanced reproductive technologies like in vitro fertilization (IVF). Adoption More than 1.5 million children have been adopted in the U.S. Childfree A family of two.

6 RESOLVE s Mission Statement of Purpose: RESOLVE is dedicated to ensuring that all people challenged in their family building journey reach resolution through being empowered by knowledge, supported by community, united by advocacy, and inspired to act. RESOLVE exists to provide: Access to Care Access to Education Advocacy for Coverage Awareness of All Family Building Options Access to Support & Community 6

7 RESOLVE s Values We serve: o All people challenged in their family building journey We operate with: o Care and compassion o Integrity and without bias o Respect for all resolutions o Credibility and authority o A strong sense of community o The goal to drive positive change o A passionate belief that everyone deserves the right of family 7

8 Medical Treatment of Infertility Surgery Medication Intrauterine insemination (IUI) aka artificial insemination Sperm is placed directly into the uterus around the time of ovulation. Assisted reproductive technology (ART), which is the handling of sperm, egg, and/or embryos outside the body

9 ART and IVF In vitro fertilization (IVF) is the most common ART procedure. In IVF, eggs are removed from the ovaries and fertilized with sperm in a laboratory; the resulting embryo(s) are then transferred to a woman s uterus in the hopes that it results in a pregnancy.

10 Medical Treatment of Infertility First test tube baby born in U.S. in 1981 Since then, more than one million IVF babies born in U.S. (7 million worldwide). 1of every 100 births in U.S. is from IVF. IVF has advanced considerably over the years and is now considered the standard of care for many infertility cases. Success Rate: 30.7% for IVF; 7.6% to 9.8% for IUI Average Cost Per Cycle: $15,000 for IVF; $500- $3,000 for IUI

11 Access to Care Cost is the #1 barrier to care. 3 out of 4 never obtain needed treatment, often because they cannot afford it. 15* states have infertility insurance laws. Only 8* of those states cover IVF % of private insurance policies don t cover infertility treatment. A recent survey found women (25-34 years old) accrued $30,000 of debt on average after undergoing infertility treatment. *16 th state will sign infertility insurance law any day now, will be 9 th state to cover IVF

12 Access to Care States with Infertility Insurance Laws (IVF coverage in orange): Arkansas, California, Connecticut, Delaware (law to be signed by Governor any day now), Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, West Virginia State Fertility Scorecard: How Fertility Friendly is your State?

13 Access to Care What do physicians in states with IVF insurance say about Access to Care?

14 Infertility Insurance Coverage Infertility is a disease and should be covered by insurance like other diseases so patients can access the standard of care. Insurance Coverage for IVF = Lower Rates of Multiple Births Reducing multiple births results in healthier babies/moms and significantly lower costs. Requiring IVF coverage minimally impacts insurance premiums.

15 Impact on Insurance Premiums Connecticut: When Connecticut added infertility coverage, including IVF, premiums increased only slightly, less than 1% total, to cover both basic and advanced treatments. In 2015, revised estimates forward-looking were $1.06 per member per month. Massachusetts: The cost of infertility services as a percent of the total health care premium decreased after the 1987 Massachusetts law. The comprehensive coverage, which includes IVF, continues to have a minimal impact of <1% of the total premium cost as of Rhode Island: It is estimated that the infertility mandate costs $1.29 per member per month in Rhode Island. New York: A recent report determined that IVF coverage could be offered to every New Yorker with a fully insured health insurance policy for $0.55 per member per month.

16 Public Policy and Access to Care State Legislation Bills Introduced to Require or Improve Infertility Insurance Coverage (includes fertility preservation bills): Arizona, California, Connecticut, Delaware, Hawaii, Illinois, Indiana, Kentucky, Louisiana, Maryland, Mississippi, Missouri, Nebraska, New Jersey, New York, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont (Bills in orange passed.)

17 Public Policy and Access to Care Federal Legislation #IVF4Vets Funding for VA to offer IVF for wounded Vets in FY 2017/2018; Congress can make #IVF4Vets permanent through passage of the Women Veterans and Families Health Services Act. Access to Infertility Treatment and Care Act Requires private health insurance plans, as well as plans offered by the Federal Employees Health Benefits Program, TRICARE, and VA, to provide coverage for infertility treatment, including IVF and fertility preservation.

18 State Legislative Victories 2017 CT updates IVF law to be more inclusive, adds medically necessary fertility preservation. RI updates IVF law to add fertility preservation for iatrogenic infertility. NJ updates IVF law to provide coverage for same sex couples, single women, state/school employees and to reduce waiting period MD passes new fertility preservation law for iatrogenic infertility. IL passes new fertility preservation legislation for iatrogenic infertility (awaiting Governor s signature). DE passes new infertility insurance legislation, including IVF and fertility preservation for iatrogenic infertility (awaiting Governor s signature).

19 Delaware AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO INSURANCE COVERAGE FOR OBSTETRICAL AND GYNECOLOGICAL SERVICES The First State becomes the first state in 13 years to pass comprehensive infertility insurance legislation, including IVF and fertility preservation. Economic argument: Border states NJ and MD provide infertility coverage, which puts DE at a significant competitive disadvantage, as many reproductive age residents intentionally change employers and leave Delaware to gain more attractive fertility care benefits. State s Insurance Commissioner supported the bipartisan bill. Fiscal note not required: Act could increase the number of persons treated for infertility, but also increase the number of babies born in Delaware by per year, thus increasing the state s birth rate by 1-2% and providing a boost to the local economy, while also decreasing health care costs.

20 New York FAIR ACCESS TO FERTILITY TREATMENT ACT (FAFTA) Updates current infertility law to require coverage for IVF and for fertility preservation for iatrogenic infertility; codifies non-discrimination language into law to ensure all eligible individuals receive coverage. NY State employees already have IVF and fertility preservation coverage. Bipartisan bill with Democratic Assembly sponsor and Republican Senate sponsor Coalition to Help Families Struggling with Infertility: RESOLVE, Alliance for Fertility Preservation, American Society for Reproductive Medicine, cancer centers, fertility centers, pharmaceutical companies, and grassroots advocacy groups, including the Jewish community and breast cancer coalitions Recent report determined that IVF coverage could be offered to every New Yorker with a fully insured health insurance policy for $0.55 per member per month. Passed in Assembly, will it pass in Senate before June 20, 2018?

21 Why Care about Access to Care? All my life, I've believed that if you work hard enough for something, you will achieve your goal. However, infertility severely challenged that belief. I could work as hard as I wanted at trying to conceive, but ultimately, success was not up to me. I could invest tens of thousands of dollars, and not be guaranteed a positive outcome. I was not, and could never be, in control of the outcome. And that was very hard to accept almost two years into the process, IVF was the last option available. Feeling desperate, we grasped onto this last hope. We were living in Missouri at the time and fertility procedures were not covered by our insurance. At this point, we had spent close to $15,000 out of pocket. With the upcoming IVF cycle, that amount would double. But we found a way and tried. No success. The devastation of failure penetrated us deeply. The emotional exhaustion of the perpetual roller coaster of hope and despair had taken its toll. We took a time out. Went on a short vacation. Regrouped. And then something happened - my husband got a new job. He got a job in Connecticut. Connecticut has an insurance mandate for infertility treatment. Even before we moved, I set up an appointment with a clinic near our new home. As soon as we arrived, I met with the doctor and we did our second IVF a couple months later. We had a much better response all around, and the result was our beautiful, healthy son, Zachary. While we will never know for sure what made the difference, what we do know is that stress is never good for health, especially when trying to conceive. Because of the insurance mandate, the amount of out of pocket expenses for this second IVF cycle was nominal compared to the cycle in Missouri that was not covered. Although IVF is inherently stressful, not having the financial burden factored in relieves an enormous amount of stress. Having experienced this first hand, I hope to help advocate for others to access affordable fertility treatments - because building a family should not be a privilege afforded to few. Alyse S.

22 Why Care about Access to Care? Alyse and Zachary

23 Why Care about Access to Care? Hear from the 1 in 8:

24 Why Care about Access to Care?

25 Contact Information Betsy Campbell Director, Constituent Engagement