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 hopes that she would be able to give birth one day when she recovered.
McKnight, 34, of Richmond, Calif., was diagnosed in 2020 with a rapidly spreading form of breast cancer. IVF can help boost the chances of pregnancy for cancer patients who are concerned about the effects of the disease and its treatment on fertility. The process involves collecting eggs from the ovaries, fertilizing them with sperm in a laboratory, and then implanting them in the uterus.
But after beginning that process — where she was drugged to retrieve her eggs and paid hundreds of dollars a year to properly store the embryos she and her husband produced — McKnight can't now afford to take the embryos out of the freezer.
Katie McKnight, 34, from Richmond, California, takes a photo before retrieving her first egg for IVF after being diagnosed with breast cancer in 2020.
(Katie McKnight)
“You either have to have access to a lot of money, or you just have to keep it frozen and hang there. It's a weird place to be,” McKnight said earlier this month as she prepared to head into her fifth breast reconstructive surgery. Now how am I going to end this? How will I actually achieve this dream?
California — celebrated by feminists as a haven for reproductive health — does not require that insurance companies cover IVF.
McKnight, who serves on the board of Bay Area Young Survivors, a support group for young breast cancer patients, is among those pushing for state legislation to change that. She and her husband hope to implant an embryo as soon as this year, fearing time is of the essence because her cancer has the potential to spread to her ovaries. McKnight has health insurance through her job at an environmental research nonprofit, but it doesn't cover IVF.
On average, IVF costs Californians at least $24,000 out of pocket, according to the U.S. Department of Health and Human Services.
The cost varies depending on the treatment — patients typically need multiple rounds of IVF to be successful — and whether employers provide insurance coverage for the procedure. Twenty-seven percent of companies with more than 500 employees offer IVF insurance nationwide, according to a 2021 survey.
Under a bill signed by Democratic Gov. Gavin Newsom in 2019, McKnight was able to have her egg retrieval — a first step in the IVF process — covered by insurance before life-saving chemotherapy, which can cause infertility. Medical patients facing infertility due to treatment are insured under this law, but this coverage stops short of including fertilization and embryo transfer.
A new bill was introduced in the state Legislature this year that would require large insurance companies to provide comprehensive coverage for infertility treatment, including IVF.
But the bill could be costly and faces an uphill battle as the state faces a multibillion-dollar budget deficit. Similar proposals have failed in the past, including an attempt last year that never reached the governor's desk, facing opposition from insurers who said new mandates would lead to higher premiums for everyone.
IVF is particularly important to McKnight because it allowed her to do genetic testing to identify embryos that have the BRCA gene mutation, which is a hereditary mutation that greatly increases the chance of developing breast cancer. She decided to get rid of those embryos because of her fears of transmitting cancer to her children.
The embryologist works at the Virginia Center for Reproductive Medicine in Reston, Virginia in 2019.
(Mark Poster / Los Angeles Times)
McKnight cried when he spoke about the recent political debates over IVF taking place across the country after an Alabama court ruled last February that frozen embryos can be considered “children” and that those who destroy them can be held liable for wrongful death.
The decision disrupted in vitro fertilization appointments in Alabama, and lawmakers there rushed to create legislation aimed at protecting the procedure. But there is still uncertainty about access amid unresolved legal issues.
More than a dozen states have introduced laws protecting “fetal personhood” this year. These actions will likely push IVF to religious arguments that oppose abortion rights and raise concerns about further restrictions on reproductive health after the Supreme Court's 2022 Dobbs decision struck down a federal abortion rights guarantee.
“It scares me. It's unfathomable to me,” McKnight said. “I don't want to put a child into this world that has to go through all the hard things that I went 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 are unable to conceive after one year of trying.
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, according to the U.S. Department of Health and Human Services.
More than a dozen states, including New York, Arkansas and Connecticut, require health plans to provide some coverage for IVF.
California — home to the most progressive abortion laws in the country — is failing to live up to its role as a “reproductive freedom” state, the American Society for Reproductive Medicine said.
“California still has significant 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 whether to start a family,” the group said in a statement in support of SB 729. Or develop it and when.”
In addition to expanding insurance coverage to include in vitro fertilization, SB 729, introduced by state Sen. Carolyn Menjivar (D-Panorama City), would also redefine “infertility” in health plans, expanding services to include LGBTQ+ couples who do not meet current standards. To provide fertility services.
Most health plans that offer IVF coverage measure infertility based on whether a man and a woman fail to conceive after a year of unprotected sex, with the exception of LGBTQ+ couples seeking to use fertility services to start a family from coverage.
The new draft law would expand the definition of infertility to include “a person's inability to reproduce, either as an individual or with his partner, without medical intervention.”
The issue is personal for Menjívar. She and her wife recently chose to postpone their plans to start a family through fertility services such as IVF and instead buy a house, after weighing the costs. She said she had friends who traveled to Mexico for cheaper fertility care.
“When we talk about Alabama…we have barriers like we have in California. The physical barriers are there in California, where people can’t afford it,” Menjivar said.
California Sen. Carolyn Menjivar (D-Panorama City), left, and former Senate Leader Toni Atkins (D-San Diego) at the state Capitol.
(Fred Graves/For CalMatters)
The bill was opposed by the California Assn. Of health plans and a number of insurance companies warn that such single-issue mandates lead to increased premiums for employers and enrollees.
According to a legislative analysis of potential costs conducted last year, the California Health Benefits Review Program estimated that employers and enrollees would spend a total of $183 million more in the first year of the bill's implementation, and nearly twice that in the following year. California could face tens of millions more in separate costs, according to this analysis, due to increases in insurance premiums for state employees.
“Although this bill is well-intentioned, it will inadvertently exacerbate health care affordability issues,” the California Chamber of Commerce, which also opposed the bill, said in a statement.
The latest cost estimate reflects Democrats' attempts to narrow the bill's scope and lower the price, exempting small health plans, religious employers, and Medi-Cal — which provides insurance to low-income Californians — from the proposed mandate for IVF coverage.
New IVF policy debates have created a political quagmire for some Republicans who have used “personhood” arguments to oppose abortion but do not want access to IVF to be infringed.
Republicans in the California Assembly — some of whom oppose increased access to abortion — introduced a resolution last month calling on the state to declare that it “recognizes and protects” access to IVF for women “with fertility issues” and has encouraged the same at the federal level. level. The resolution also calls on the state of Alabama to rescind its ruling.
“IVF has already helped many families have children, so we need to make sure we protect access to it,” said Assemblyman Josh Hoover (R-Folsom), who co-authored Assembly Concurrent Resolution 154. Back in artificial insemination.
But many state Republicans who support the decision opposed last year's attempt to secure in vitro fertilization in California.
The insurance bill did not reach the Assembly last year, and Hoover said he was unsure how he would vote if it reached his house this year, expressing doubts about the costs to small business owners and taxpayers.
For Democrats like Menjívar, the Republican-led resolution — which specifies that IVF is reserved for women with fertility issues and does not mention LGBT families — is seen as a farce.
“It's all talk,” she said. “This does absolutely nothing. There's no meat in it at all.”
Menjivar said she would not support this decision without changes. She's angry at the “hypocrisy” she sees from Republicans across the country who she believes voted for the anti-abortion policies that have given rise to the IVF problems now.
“They've made their bed and are trying to get out of it and they're stuck,” she said.
