In the midst of chemotherapy, a double mastectomy, and the countless medical appointments that accompany a cancer diagnosis, Katie McKnight hurried to initiate the in vitro fertilization process with the hope of one day giving birth after her recovery.
Diagnosed in 2020 with an aggressive form of breast cancer, McKnight, 34, of Richmond, Calif., turned to IVF to increase her chances of getting pregnant while considering the impact of the disease and its treatment on her fertility. The IVF process involves retrieving eggs from the ovaries, fertilizing them with sperm in a laboratory, and then implanting them in the uterus.
Despite starting the process, undergoing sedation to retrieve her eggs, and paying annual fees to store the embryos created with her husband, McKnight currently cannot afford to remove the embryos from the freezer.
Katie McKnight, 34, of Richmond, Calif., takes a photo before her first egg retrieval for IVF after a breast cancer diagnosis in 2020.
(Katie McKnight)
“You either have to be able to access a lot of money, or you just keep them frozen and suspended there. It’s such a weird place to be,” McKnight expressed earlier this month as she prepared for her fifth reconstructive breast surgery. “I got this far, now how am I going to finish this? How am I going to actually realize this dream?”
While California is hailed as a reproductive health sanctuary, it does not mandate insurance coverage for IVF.
McKnight, a member of the board of Bay Area Young Survivors, a support group for young breast cancer patients, is advocating for legislative changes to require insurance companies to cover IVF. With her husband, she hopes to implant an embryo as soon as possible, concerned about the potential spread of her cancer to her ovaries. Despite having health insurance through her job, it does not cover IVF.
On average, IVF costs Californians a minimum of $24,000 out of pocket, according to the U.S. Department of Health and Human Services.
Costs vary depending on treatment, with most patients needing multiple rounds of IVF for success, and employer insurance coverage for the procedure. A 2021 survey found that 27% of companies with over 500 employees offered IVF insurance nationwide.
Thanks to a law signed by Democratic Gov. Gavin Newsom in 2019, McKnight was able to have her egg retrievals covered by insurance before undergoing chemotherapy, which can lead to infertility. However, the coverage does not extend to fertilization and embryo transfer.
A proposed bill in the state Legislature this year aims to compel large insurance companies to provide comprehensive coverage for infertility treatment, including IVF.
However, the bill faces challenges due to potential costs and California’s multibillion-dollar budget deficit. Similar proposals have previously failed, with opposition from insurance companies citing increased premiums for all as a result of new mandates.
IVF holds significant importance for McKnight as it enables genetic testing to identify embryos carrying the BRCA gene mutation, which significantly raises the risk of breast cancer. She has opted to discard these embryos to avoid passing on cancer to her future children.
An embryologist works at the Virginia Center for Reproductive Medicine in Reston, Va., in 2019.
(Mark Boster / Los Angeles Times)
McKnight became emotional discussing the recent political debates surrounding IVF nationwide, particularly after an Alabama court ruling in February that classified frozen embryos as “children” and held those who destroy them accountable for wrongful death.
The decision disrupted IVF services in Alabama, prompting state lawmakers to draft legislation to protect the procedure. However, uncertainties remain regarding access in light of unresolved legal issues.
Over a dozen states have introduced laws protecting “fetal personhood” this year, which could potentially entangle IVF in religious debates opposing abortion rights, following the Supreme Court’s Dobbs decision in 2022 that rolled back federal abortion protections.
“It terrifies me. It’s unfathomable to me,” McKnight expressed. “I do not want to put a child into this world that has to go through all of the hard stuff that I’ve lived, and I feel like that is my choice.”
Infertility is prevalent, with about 1 in 5 married women of childbearing age unable to conceive after a year of trying, according to the CDC.
In 2021, over 11,000 babies were born in California using assisted reproductive technology like IVF, accounting for nearly 3% of all infants born in the state that year, as per the U.S. Department of Health & Human Services.
More than a dozen states, including New York, Arkansas, and Connecticut, mandate health plans to offer some IVF coverage.
The American Society for Reproductive Medicine criticized California, known for progressive abortion laws, for not fully supporting reproductive freedom. The group endorsed SB 729, which aims to extend insurance coverage to IVF.
SB 729, introduced by state Sen. Caroline Menjivar (D-Panorama City), would redefine “infertility” in health plans to include LGBTQ+ couples who do not meet current standards for fertility services.
Many health plans that cover IVF base infertility on the inability of a man and woman to conceive after a year of unprotected sex, excluding LGBTQ+ couples seeking fertility services. The new bill would broaden the definition of infertility to encompass “a person’s inability to reproduce either individually or with their partner without medical intervention.”
Menjivar personally relates to the issue, having postponed plans to start a family through IVF and opting to buy a home instead due to cost considerations. She highlighted friends traveling to Mexico for more affordable fertility care.
California Sen. Caroline Menjivar (D-Panorama City), left, and former Senate leader Toni Atkins (D-San Diego) at the state Capitol.
(Fred Greaves / For CalMatters)
The California Assn. of Health Plans and several insurance companies oppose the bill, warning that such mandates lead to increased premiums for businesses and policyholders.
According to a legislative analysis, the bill could result in an additional $183 million in costs for employers and enrollees in the first year of implementation, nearly doubling the following year. The state could incur tens of millions more in separate expenses due to premium hikes for state employees, as per the analysis.
“While this bill is well-intentioned, it will unintentionally exacerbate health care affordability issues,” the California Chamber of Commerce, also against the bill, stated.
To reduce costs, the latest estimate of the bill exempts small health plans, religious employers, and Medi-Cal from the mandate to cover IVF.
Recent IVF policy discussions have placed some Republicans in a political dilemma, as they oppose abortion on “personhood” grounds but support IVF access. California Assembly Republicans, advocating for women facing fertility issues, introduced a resolution urging the protection of IVF access and calling on Alabama to reverse its ruling.
Assemblymember Josh Hoover (R-Folsom), a co-author of Assembly Concurrent Resolution 154, emphasized the importance of safeguarding IVF access for families. However, some state Republicans who back the resolution opposed last year’s IVF insurance bill.
The fate of the insurance bill remains uncertain this year, with Hoover expressing reservations about its impact on small businesses and taxpayers.
For Democrats like Menjivar, the Republican resolution, which focuses solely on women struggling with fertility issues and excludes LGBTQ+ families, lacks substance.
“It’s all talk,” Menjivar criticized. “This does absolutely nothing, there’s no meat to it whatsoever.”
Menjivar refuses to support the resolution without modifications, frustrated by what she perceives as Republican hypocrisy in supporting anti-abortion policies that now intersect with IVF challenges.
“They made their bed and they’re trying to squirm out of it and they’re getting stuck,” she concluded.
