BILL ANALYSIS �
AB 460
Page 1
ASSEMBLY THIRD READING
AB 460 (Ammiano)
As Introduced February 19, 2013
Majority vote
HEALTH 13-6 APPROPRIATIONS 12-5
-----------------------------------------------------------------
|Ayes:|Pan, Ammiano, Atkins, |Ayes:|Gatto, Bocanegra, |
| |Bonilla, Bonta, Chesbro, | |Bradford, |
| |Gomez, | |Ian Calderon, Campos, |
| |Roger Hern�ndez, | |Eggman, Gomez, Hall, |
| |Lowenthal, Mitchell, | |Ammiano, Pan, Quirk, |
| |Nazarian, V. Manuel | |Weber |
| |P�rez, Wieckowski | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Maienschein, |Nays:|Harkey, Bigelow, |
| |Mansoor, Nestande, | |Donnelly, Linder, Wagner |
| |Wagner, Wilk | | |
| | | | |
-----------------------------------------------------------------
SUMMARY : Requires coverage for the treatment of infertility to
be offered and provided without discrimination on the basis of
age, ancestry, color, disability, domestic partner status,
gender, gender expression, gender identity, genetic information,
marital status, national origin, race, religion, sex, or sexual
orientation.
EXISTING LAW :
1)Requires health plan contracts and disability insurance
policies to offer group coverage for the treatment of
infertility, except in vitro fertilization, under those terms
and conditions as may be agreed upon between the group
subscriber or the group policyholder and the plan or insurer,
as specified.
2)Requires group health plan contracts and disability insurance
policies to provide equal coverage to employers or guaranteed
associations, for the registered domestic partner of an
employer or subscriber to the same extent and subject to the
same terms and conditions as provided to a spouse. Coverage
must be equal to the coverage provided to the spouse.
AB 460
Page 2
FISCAL EFFECT : According to the Assembly Appropriations
Committee, this bill has negligible costs because this bill
clarifies existing law and does not create a coverage benefit
that did not previously exist. The California Health Benefits
Review Program (CHBRP) was unable to estimate the marginal cost
impact, if any. CHBRP did note this bill does not change the
current infertility mandate to offer, meaning the state would
not be subject to defray costs of a new benefit not included as
an essential health benefit under the federal Patient Protection
and Affordable Care Act.
COMMENTS : According to the author, insurance companies are not
complying with current state law that prohibits patients from
being treated differently based on sex, marital status, and
sexual orientation and current law that requires registered
domestic partners to be treated as spouses in regard to
fertility treatments. The author adds that the goal of this
bill is to clarify the application of current law as it pertains
to same-sex married couples and domestic partners and the
non-compliant practices currently used by insurance providers in
infertility treatments. The author explains that infertility is
the state of being unable to produce offspring; state law
defines infertility as: 1) the presence of a demonstrated
condition recognized by a licensed physician or surgeon as a
cause of infertility; or, 2) the inability to conceive a
pregnancy or to carry a pregnancy to a live birth after a year
or more of regular sexual relations without contraception.
Under the current definition of infertility heterosexual married
couples are typically treated as a unit for infertility. If a
husband has a low or no sperm count, both the husband and wife
are diagnosed with primary male factor infertility because the
spouse does not produce the gamete needed for conception.
Assisted reproductive technology is used to attain a pregnancy
where the wife is ultimately a patient regardless of her female
fertility status. If the couple's health insurance has
infertility coverage, they are able to access it under the
current definition of infertility. The author argues that an
example of how the current nondiscrimination laws are not being
adhered to is when an individual or couple are unable to
conceive and attempt to access their infertility coverage and
are denied based on not having an opposite sex married partner
with whom to have one year of regular sexual relations without
conception. The author concludes that there are many insurers
AB 460
Page 3
who currently cover all their insureds with infertility coverage
in their plan and this bill does not affect insurers who are in
compliance with existing nondiscrimination laws.
Equality California (EQCA) writes in support of this bill that
although California law already prohibits discrimination on the
basis of sexual orientation, gender identity, and marital
status, among others, in offering or providing coverage for
fertility treatments, this bill adds clarifying provisions.
According to EQCA and their partner organization, the National
Center for Lesbian Rights (NCLR), NCLR operates a helpline which
provides resources and legal information and has received calls
from a significant number of LGBT (lesbian, gay, bisexual, and
transgender) couples and single prospective parents who are
unable to obtain coverage for needed fertility treatment because
of their plan's overly restrictive definition of "infertility,"
even in situations where there is independent proof they have an
infertility condition. The National Association of Social
Workers, California Chapter also writes in support that this
bill would ensure that infertility treatment is more accessible
to all people and would require such treatment to be covered
without discrimination; it is important that all people have
equal access to infertility treatment and that the aspects of a
person's identity are not used to withhold treatment.
The California Association of Health Plans (CAHP) raises
concerns over whether the language in this bill would result in
unintended consequences. CAHP is concerned that by placing very
standard anti-discrimination language into statute for a
particular treatment, with no other clarifying parameters this
bill would suggest that plans must pay for services that may not
be safe or advisable from a clinical perspective. As an
example, the inclusion of "age" in the language might suggest
that legally a plan would be obligated to pay for infertility
services for an individual that is not age appropriate for the
treatment. Such misinterpretations of the law could invite
litigation or unneeded regulatory proceedings to clarify the
intent of the statute.
The Capitol Resource Institute writes in opposition that this
bill would violate the right to freedom of religion, conscience,
and thought of many medical professionals and employers; that
medical professionals should not be forced to perform procedures
that go against their moral convictions and employers should not
AB 460
Page 4
be forced to finance the procedures.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
FN: 0000415