BILL ANALYSIS �
AB 912
Page 1
Date of Hearing: May 8, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 912 (Quirk-Silva) - As Introduced: February 22, 2013
Policy Committee: HealthVote:13-6
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires health insurance policies and health plan
contracts to cover medically necessary expenses for standard
fertility preservation services when a necessary medical
treatment may cause iatrogenic infertility to an insured or
enrollee.
FISCAL EFFECT
1)Approximately $69,000 to CalPERS for additional premiums.
2)Unknown costs, potentially greater than $100,000, to Covered
California, to the extent the fertility treatment preservation
services exceed the essential health benefits requirement
under the federal Affordable Care Act (ACA).
COMMENTS
1)Rationale . This bill addresses the lack of insurance in
situations where a cancer diagnosis may bring an additional
unexpected consequence: the potential loss of fertility.
Treatments that accompany a cancer diagnosis may have
long-term implications for the ability of a survivor to have
children. It is possible to preserve fertility in men and
women before chemotherapy and radiation begin, and then treat
the resulting infertility after the patient is given a clean
bill of health from the cancer.
The American Society for Reproductive Medicine, a cosponsor of
this bill, argues advances in medical treatment mean many
diseases once thought fatal or chronic, can now be treated and
cured. Unfortunately, the very treatment that saves lives may
AB 912
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also cost both men and women the potential of biological
children. Along with their affiliated organization, the
Society for Assisted Reproductive Technology, supporters
maintain that losing the chance to have children in the future
is a major fear for cancer patients. Supporters cite surveys
and anecdotal information from treating physicians which
suggests one-third of patients, if not able to obtain
fertility preservation services, choose less effective medical
care in an attempt to preserve their fertility. Supporters
argue this could result in worse outcomes, resulting in more
expensive treatment.
2)Iatrogenic infertility . Iatrogenic infertility is caused by a
medical intervention used to treat a primary disease or
condition. The medical intervention is often gonadotoxic
(radiation, chemotherapy, and prescription drugs) or surgical
treatment. Iatrogenic infertility is typically caused by
cancer treatments such as radiation, chemotherapy, or surgical
removal of reproductive organs. Less frequently, fertility is
compromised by treatments for autoimmune disorders such as
systemic lupus erythematosus, rheumatoid arthritis, or Crohn's
disease.
Patients at risk for iatrogenic infertility differ from
patients being treated for infertility in that they need to
undergo fertility preservation services before undergoing the
treatments that may put fertility at risk. For example, a male
patient undergoing treatment for cancer would need to freeze
his sperm prior to starting treatment for cancer. While at the
time of the procedure, his fertility may be intact, if he does
not take part in fertility preservation treatment, his future
ability to father a child may be at risk.
The Californias Health Benefits Review Program (CHBRP)
determined this bill would result in an increase of state
costs for health insurance premiums paid for state workers by
the California Public Employees Retirement System. Medi-Cal
would not be affected, but because the treatment required
under this bill exceeds what is required under federal health
reform, that state would be subject to a requirement to defray
costs if the state enacts this measure.
3)Opposition Opponents , including the California Chamber of
Commerce and America's Health Insurance Plans, note this bill
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is well intentioned but would exacerbate the problem of rising
health costs.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081