Minnesota Democrats want to mandate insurance coverage for IVF, but price tag concerns loom
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Cost concerns could curtail — or derail — an effort to guarantee coverage for fertility treatments for more Minnesotans.
The big picture: Top state Democrats, including Gov. Tim Walz, pledged to do more to protect access to in-vitro fertilization (IVF) following a February Alabama Supreme Court ruling that prompted some providers to pause procedures there.
State of play: Supporters of the insurance bill say removing cost barriers for prospective parents is central to that goal, as a single round of IVF can reach $30,000 or more out of pocket.
Yes, but: The move comes at a cost for the state, and DFL leaders say they might not have the cash.
- "I'm not sure that we'll be able to afford that this year," House Speaker Melissa Hortman told reporters recently. She's heard estimates as high as $130 million.
What we're hearing: DFL Sen. Erin Maye Quade, one of the authors of the IVF bill, disputes higher cost projections, which she says are based on assumptions that more people will seek more expensive and physically invasive treatment options.
- But Maye Quade, who spent about $12,000 on her own treatment, made changes to rein in the cost in hopes of getting something passed this year.
The latest: In an amendment adopted in March, Maye Quade agreed to authorize the human services commissioner to set a lifetime coverage cap of $30,000 for people on public insurance programs — the same limit currently in effect for state workers.
- Her current bill assumes the state would spend roughly $15 million a year to cover the public and private plan costs, though the projections aren't final.
Between the lines: The price tag for such state mandates goes beyond the impact on government-run insurance programs. That's because the federal Affordable Care Act requires states to help cover private insurers' costs.
- That aspect alone could cost the state millions each year.
What to expect: In other states with similar policies, premiums rose by 1% or less.
What we're watching: Exempting some smaller private plans from the requirement— at least to start — could also be on the table, Maye Quade told Axios this week.
- "I'm trying to be the most flexible person I can possibly be to get anything done to make sure that any [additional] population of people in Minnesota have treatment for infertility," she said. "I don't want the answer to be well, we can't help everyone so we can't help any of them."
The other side: Republicans have raised concerns during committee hearings about costs and data reporting requirements. Some have also advocated for exemptions for employers who object to certain procedures based on faith.
The bottom line: Ultimately, it'll be up to committee chairs and DFL leaders to decide whether the price tag is something they can — and want to — swallow this year.
- Senate Majority Leader Erin Murphy recently told reporters she's looking at whether they can scale the bill to meet this year's fiscal constraints.
A Walz spokesperson said the governor has not taken a position on the insurance mandate.
Mandates abound at the state Capitol
The IVF legislation is one of at least a dozen insurance benefit mandate bills under consideration at the Capitol this biennium.
State of play: Proposals cover everything from wigs for cancer patients to gender-affirming care.
- Mandates for insurance coverage for abortion, prosthetics, and obesity management have also been introduced.
What we're hearing: Hortman says abortion, gender-affirming care, and wigs are among those with "low to negligible costs" that are more likely to pass.
The other side: The Minnesota Council of Health Plans says that while it doesn't take positions on individual proposals, it worries about the cumulative impact of the additions, given that Minnesota already mandates more benefits than some comparable states.
- "We want consumers to be able to afford their monthly coverage, and the more mandates that are put on here, that puts more strain," president and CEO Lucas Nesse told Axios.
Reality check: None of these mandates would apply to large companies that are self-insured.
- So even if they pass, about 40% of Minnesota workers would lack the benefit guarantees.
Editor's note: This story has been corrected to show Maye Quade's amendment authorizes the human services commissioner to set a lifetime coverage cap, not the state health commissioner.