The Biden administration is again putting pressure on the federal-employee health care system to protect and expand coverage for infertility treatments as reproductive care becomes increasingly politicized in states that question its use.

The Office of Personnel Management shapes priorities for the Federal Employee Health Benefits program, and this summer it will be negotiating final rates and terms with its providers for the 2025 plan year. Seeing an opportunity to voice their expectations, more than 100 Democratic lawmakers sent a letter to OPM on Monday urging it to require all FEHB carriers to cover IVF medical treatments and medications.

“President Biden would send a strong message that his administration, in word and deed, are true champions of safeguarding the right of families to decide if, when and how to build a family,” said lawmakers in the letter, first reported by Politico.

At OPM’s direction, a handful of plans have already expanded coverage for infertility medication in particular, and that step was applauded by advocates who said progress in this area has been slow, but steady. Still, lawmakers said it’s imperative the Biden administration keep the foot on the gas, especially as some states have wanted to explore enforcing personhood rights in treatments that deal with embryos.

Most recently, the Alabama Supreme Court ruled in a case that embryos created in a lab through in vitro fertilization, a popular and expensive method of conception, may be considered children for the purpose of qualifying under the Wrongful Death of a Minor Act.

While the state legislature followed up with a law clarifying protections for IVF providers, the ruling broke open new questions about whether IVF and other treatments that result in excess or unused embryos can be grounds for lawsuits, and it has had a chilling effect on providers and clinics in Alabama, said Sarah Raaii, an attorney focusing on employee benefits at McDermott Will & Emery, in an interview.

That case didn’t address insurance coverage of IVF, but if other states try to emulate Alabama’s court ruling and grant broader personhood rights to embryos, it could make providing IVF difficult, if not impossible, given multiple embryos are often used in the process. Advocates say moral or religious objections to IVF could mount pressure in states to interpret fetal personhood as applicable in infertility treatments. At least 14 states have introduced related bills, the Wall Street Journal reported.

“When you can’t receive the services within a state, obviously it doesn’t do you much good if your [insurance] plan still technically covers them,” said Raaii. “On the private employer plan side, we’ve already started having those conversations with employers who have covered individuals in Alabama.”

House and Senate democrats who signed the letter said OPM has an opportunity, as the administrator of the largest employee-sponsored health plan in the country, to be an exemplar for infertility coverage. They also said that reproductive challenges are more common than perhaps people realize; in the U.S., about 1 in 5 women are unable to conceive after one year of trying. There’s also more that can be done to cover intervention treatments needed by same-sex and solo individuals, they said.

“Simply put, at a time when seemingly every politician is loudly declaring their support for IVF — even when many of those same politicians support the personhood movement that has endangered IVF’s future — President Biden has an opportunity to demonstrate strong leadership by taking decisive action to make the scientific miracle that is IVF accessible to many more Americans, beginning with our dedicated Federal workforce,” according to the letter.

Some states have passed their own versions of laws that require providers to cover infertility. In January, New Jersey Gov. Phil Murphy signed a bill that requires coverage of intrauterine insemination, genetic testing and unlimited embryo transfers by health plans insuring more than 50 people.

“Anyone who relies on IVF or other assisted reproductive technology to start or grow their family should be able to access the healthcare they need, and that includes our nation’s federal employees,” Sen. Tammy Duckworth, one of the signatories and a former IVF patient herself, said in a statement to Federal Times.

Should other states take issue with aspects of IVF that deal with fertilized embryos, OPM is able to preempt state law since it’s a federal program.

For 2024, federal employees had 24 specific plans options for infertility treatments that vary by benefit and location. Notably, Blue Cross Blue Shield introduced a $25,000 annual maximum that employees have said has been helpful, though others pointed out in interviews with Federal Times that that allowance can be eaten up in just one or two cycles of treatment, assuming there are no other health complications.

Research published in JAMA, a peer-reviewed medical journal, has shown that the success rates of conceiving can double between the first and sixth IVF cycles for women under 40.

Twenty-five thousand dollars “doesn’t cover very much honestly,” said one federal employee who discussed her experience with obtaining federal insurance coverage. “I could go through a couple egg retrievals and I max out. [Then] I have to wait until the next year for an embryo transfer. It delays things even more.”

Correction: This story was updated to clarify attribution of research on IVF cycles to JAMA, a medical journal.

Molly Weisner is a staff reporter for Federal Times where she covers labor, policy and contracting pertaining to the government workforce. She made previous stops at USA Today and McClatchy as a digital producer, and worked at The New York Times as a copy editor. Molly majored in journalism at the University of North Carolina at Chapel Hill.

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