Reproductive autonomy is under threat across the U.S., affecting not just access to abortion but a host of other health services. A proposal by lawmakers has the potential to grant greater reproductive autonomy for federal workers.
Earlier this year, the Alabama state Supreme Court issued a ruling that jeopardized access to in-vitro fertilization (IVF), a service that the overwhelming majority of Americans (86%) support. Following state-level changes, Congress is now pushing to make IVF more affordable and accessible for those facing infertility. More than 175 House and Senate Democrats are urging the Biden administration to require IVF coverage in all Federal Employees Health Benefit (FEHB) insurance policies.
This effort comes at a time when more individuals than ever before need fertility assistance.
For individuals with cancer, restrictions on access to reproductive healthcare create additional barriers during a time of enormous distress. The American Cancer Society estimates more than 2 million people will be diagnosed with cancer in the U.S. in 2024. The alarming rise in early-onset cancers among individuals of reproductive age is cause for concern. An individual right to determining the number, timing, and spacing of children is an internationally recognized human right. Yet, infertility often occurs among people undergoing cancer treatments, creating a double burden: cancer diagnosis and potential fertility loss.
Oncofertility, the nexus of cancer care and reproductive health, offers expedited fertility counseling and preservation care prior to undergoing treatment. However, this model of care is often inaccessible to the majority of patients for a plethora of reasons, including cost. A single IVF cycle can cost upwards of $30,000 out of pocket.
With many insurers lacking comprehensive coverage of fertility preservation services, cost infringes on patients’ ability to make informed decisions about their survivorship. Faced with shouldering the expense of cancer care, many individuals forgo fertility preservation services, even if they are offered at a discounted rate.
Despite mandates in 21 states plus Washington, D.C. for some form of coverage, only 17 states extend coverage for fertility preservation in cases of medically induced infertility. This creates barriers for those living with cancer in states where fertility coverage policies have been crafted using traditional diagnostic criteria: people newly diagnosed with cancer are not immediately infertile. They face treatment-related infertility and must advocate for coverage, requiring patients and care teams to navigate administrative burdens such as producing letters of medical necessity and negotiating patchwork coverage in a matter of days. Furthermore, most of these laws only apply to certain insurers and for certain patients.
Ultimately, the current landscape of IVF coverage — particularly for those navigating cancer — undermines patients’ rights to informed decision-making and negatively impacts survivors’ quality of life.
Such restrictive and inadequate coverage requires immediate change. Recent actions across state legislatures in the U.S. have threatened access to IVF and concretized the real threat to fertility treatments. These and other pending bills require retroactive legislative fixes, and the Biden administration has the opportunity to lead efforts to further safeguard IVF access for 9 million federal employees, retirees, dependents, and survivors.
FEHB is one of the largest group health insurance programs in the U.S. market. A move by the Biden administration to expand coverage within the FEHB program will generate momentum toward addressing the need for fertility assistance nationwide. While some strides were made to increase access to IVF medication and services in 2024 benefit plans, inconsistencies remain across regions and plan types. Policymakers must acknowledge the growing need for fertility preservation services, as federal workers are among those impacted by these developments.
While legislative action guaranteeing the right to IVF treatment is the most straightforward way to protect access, it is critical that policymakers pursue all pathways to expand coverage. Members of Congress should continue to push for key bills such as: the Access to Infertility Treatment and Care Act, requiring all health plans to cover infertility treatment; the Access to Family Building Act, establishing federal protections for IVF access nationwide; and the Comprehensive Cancer Survivorship Act, ensuring Medicaid coverage of fertility preservation for individuals diagnosed with cancer.
By mandating IVF coverage in all FEHB plans, the Biden administration has the potential to galvanize reproductive health and rights coalitions nationwide. This action will not only usher in a new, more affordable reality within the health insurance market for Americans seeking access to fertility services, but also will send a powerful message to those grappling with the often arduous and solitary journey of infertility.
For those touched by cancer, expanded IVF coverage represents more than just critical medical care — it is a critical step toward equitable access to a human right.
Julia Strasser, DrPH, is the executive director of the Jacobs Institute of Women’s Health and an assistant research professor of health policy and management at the George Washington University Milken Institute School of Public Health. Bhakthi Sahgal is a doctor of public health student at the Milken Institute School of Public Health at the George Washington University, and served as a Women’s Congressional Policy Institute fellow focused on cancer and health equity. Bridget Kelly is a doctor of public health student at the Milken Institute School of Public Health at the George Washington University, with a background in sexual and reproductive health and rights research and advocacy.
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