Having a baby via in vitro fertilization is about to become more accessible for many Californians after Gov. Gavin Newsom signed a law requiring certain health insurers to cover the fertility treatment.

IVF is a process in which eggs are retrieved from the ovaries and fertilized by sperm in a lab. The fertilized egg, or embryo, is then transferred to the uterus. The process can be stressful and emotional. It’s also expensive. Treatments can run in the tens of thousands of dollars, making it unattainable for some and leaving others in debt.

California’s move to insure IVF comes after four similar bills over the last five years stalled in the Legislature. At least 14 other states already require that IVF be covered.

Newsom’s signature also follows IVF’s emergence as a contested issue in the presidential election, and after a controversial court decision in Alabama jeopardized access to fertility treatment for people in that state.

“California is a reproductive freedom state,” Newsom said in a written statement. “As a national leader for increasing access to reproductive health care and protecting patients and providers, including those under assault in other states, I want to be clear that the right to fertility care and IVF is protected in California. In many other states this is not the case.”

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Senate Bill 729 will require that large group health plans — that is, employers that cover at least 100 people — provide coverage for the diagnosis and treatment of infertility. This includes a maximum of three egg retrievals and unlimited embryo transfers.

The law pertains to approximately 9 million Californians enrolled in large group, state-regulated health plans. The new law does not apply to people who get their health coverage from religious employers, or people enrolled in Medi-Cal.

The law will go into effect in July 2025 for most beneficiaries, and in July 2027 for government workers who get their health benefits from the California Public Employees’ Retirement System.

Approximately 1 in 8 couples experience fertility problems. In 2019, just over 2% of all births in the country were a result of fertility treatments.

The new law also broadens the definition of infertility so that same sex couples can be treated. Making intrauterine insemination and IVF more accessible and affordable is key to achieving reproductive equity for LGBTQ+ people, said Sen. Caroline Menjivar, a Van Nuys Democrat and author of the bill.

According to an analysis of the proposal, out-of-pocket costs for one round of IVF can cost close to $20,000. Some women may need multiple rounds.

IVF a difficult financial choice for California families

In advocating for her bill, Menjivar shared that she and her partner had to decide how to spend their savings — use the money to start a family or place a down payment on a house. They opted for the house.

“Today is a personal and emotional victory. And, it is a triumph for the many Californians who have been denied a path towards family-building because of the financial barriers that come with fertility treatment, their relationship status, or are blatantly discriminated against as a member of the LGBTQ+ community,” Menjivar said in a written statement.

California law currently requires insurance companies to offer coverage for usually less expensive fertility treatments, such as diagnostic testing, medication or surgery. It’s been up to employers whether to provide coverage for those treatments. Some don’t.

Earlier this year an Alabama court decision launched IVF into the political spotlight. The court ruled that frozen embryos created through IVF are considered children. Therefore accidentally destroying an embryo would equate to wrongful death of a minor. That prompted some clinics to pause services, limiting IVF access in that state.

It also heightened attention on IVF in the presidential election because of the U.S. Supreme Court’s shift to the right on abortion and reproductive health during former President Donald Trump’s administration. Running for office again, Trump has said he would support requiring the government or insurers to pay for IVF.

Access to reproductive care in California

California Democrats have championed policies that expand access to abortion since the Supreme Court in 2022 overturned Roe vs. Wade. Supporters of the IVF law said it’s another example of expanding reproductive health care to California families.

“It’s about, ultimately, the ability to decide when and if you want to start a family, that includes to make the decision that you are not ready or that you are ready,” Assemblymember Buffy Wicks, an Oakland Democrat and co-author of the bill, said in a press conference last month. Wicks, who has shared that her second child was a result of IVF, carried similar proposals in years past without success.

A big hurdle for the legislation over the years has been the price tag. A legislative analysis of the measure estimates the new mandate would increase premiums for state employees, costing the state up to $80 million in the first two years.

Health insurers opposed the measure. The California Chamber of Commerce also opposed the bill noting that health insurance costs are already a top expense for businesses.

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This story was originally published by CalMatters and distributed through a partnership with The Associated Press.