A similar bill passed both houses in 2013 but was vetoed by Gov. Jerry Brown, who wrote that he did not want to mandate additional benefits given the "comprehensive package of reforms that are required by the federal Affordable Care Act."
Legislators across the nation also have proposed bills in recent years to make it easier for patients facing fertility-threatening treatments to get such care. Legislation has been introduced in New York, Hawaii, Connecticut and elsewhere.
The California Association of Health Plans has not taken a formal position on Portantino’s bill, but spokeswoman Nicole Kasabian Evans said the insurers’ trade group believes it is a bad time to mandate such coverage. “There is a lot of uncertainty in our health care system right now and we shouldn’t be adding costs until we know more about the changes that are coming our way,” Evans said.
Medical technology is expanding quickly, giving patients a growing number of choices to preserve their fertility, said Laxmi Kondapalli, a Colorado-based reproductive endocrinologist and cancer and fertility expert. The most common procedures are freezing eggs, sperm or embryos, she said.
There also are experimental treatments such as freezing part of the ovarian tissue, but they haven’t produced many successful pregnancies.
Access to treatment varies based on where patients live and what kind of insurance coverage they have, Kondapalli said, and many patients have to pay at least some of the costs out of their own pockets. The expenses include collection and storage for both women and men. Women have the added expense of drugs that stimulate production of the eggs as well as ultrasounds, blood tests and medical visits. Kondapalli said she would like to see more states requiring insurers to cover this kind of care.
"The financial burden can sometimes be overwhelming for patients, especially when they are starting to think about undergoing chemotherapy, radiation and cancer surgery," she said.
Alison Loren, an associate professor at the University of Pennsylvania’s Perelman School of Medicine, noted that insurers have no problem paying for wigs when patients lose their hair, or for implants when patients need breast tissue removed.
"Those are well-recognized complications of cancer therapy," said Loren, who treats patients with leukemia and does bone marrow transplants. "So is fertility, and it should be covered."
Medical providers don’t always talk to patients about their options, she said. Oncologists and others feel bad telling their patients they have cancer. Adding that they also may not be able to conceive is a “tough message to send,” she said.
A survey showed that less than half of US doctors informed cancer patients of childbearing age about fertility preservation, according to a 2011 study. Among the reasons is that doctors worry patients might not be able to afford the procedures.
The American Society of Clinical Oncology issued guidelines in 2006 to urge providers to talk about fertility preservation with cancer patients and to refer them to specialists. Even having the conversation about fertility options can help reduce stress and worry, said Loren, who helped update the guidelines in 2013.
"When people are diagnosed it is such a whirlwind," she said. "There is a long to-do list. On that to-do list should be to discuss fertility."
Several nonprofit organizations, including the Livestrong Foundation, help pay for the medications and procedures. Advocacy groups such as the Alliance for Fertility Preservationalso work to raise awareness and help improve access to care.
Joyce Reinecke, the executive director of the alliance, was 29 years old when she was diagnosed with cancer. Before beginning treatment, she decided to freeze embryos composed of her eggs and her husband’s sperm. Reinecke said she and her husband were fortunate they could afford the treatment, which cost more than $10,000.
"If we were not able to pay for that, it would have been devastating," said Reinecke, who now has 16-year-old twin daughters who came from those embryos.
Reinecke said young patients simply can't refuse cancer treatment that could save their lives, even if it poses a serious threat to their fertility. "To have to give up the opportunity to have biological children when there are methods of intervention that can prevent that loss is not fair," she said.
Thomas, the actress, received help from two nonprofits to cover some of the costs, but she still has to come up with nearly $4,000 of her own money.
She said it's as if she needed the permission of her insurer to have kids someday — and they said no.
"It is disappointing and hurtful that I have to even ask," she said.
This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.
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