Access to Fertility Treatment and Care Act
- Bill Number
- H.R. 4648
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-12-19: Referred to the Subcommittee on Health.
- Last Updated
- 2026-07-01T08:08:33Z
AI-Generated Summary
Purpose of the Legislation
The "Access to Fertility Treatment and Care Act" (H.R. 4648) aims to expand access to fertility treatments by requiring most health insurance plans and federal health programs to cover these services when the plans already cover pregnancy-related (obstetrical) care. It seeks to reduce financial barriers to fertility care, making it available regardless of a formal infertility diagnosis, as long as a healthcare provider deems it medically appropriate.
Key Provisions
- Mandatory Coverage in Private Health Plans: Amends the Public Health Service Act (PHSA), Employee Retirement Income Security Act (ERISA), and Internal Revenue Code (IRC) to require group and individual health insurance plans that cover obstetrical services to also cover fertility treatments. This applies to plan years starting 6 months after enactment, with exceptions for certain union-negotiated plans.
- Definition of Fertility Treatment: Broadly defined to include:
- Preservation of eggs (oocytes), sperm, or embryos.
- Artificial insemination methods (e.g., intrauterine insemination).
- Assisted reproductive technologies (ART), such as in vitro fertilization (IVF), when eggs, sperm, or embryos are handled.
- Genetic testing of embryos.
- Medications for fertility (prescription or over-the-counter).
- Gamete (egg or sperm) donation.
- Other related services, like referrals or lab tests, as determined by the Secretary of Health and Human Services (HHS).
- Coverage Requirements: Treatment must be provided if recommended by a healthcare provider and performed at a facility meeting federal standards. Coverage applies even without an infertility diagnosis (as defined by the American Society for Reproductive Medicine).
- Cost-Sharing Limits: Out-of-pocket costs (e.g., deductibles, copays) for fertility treatments cannot exceed those for similar medical services. Plans cannot impose stricter limits on fertility care unless more favorable to patients. HHS must issue quick regulations (interim final rules without usual public comment period) to enforce this.
- Prohibitions on Interference:
- No incentives (financial or otherwise) to discourage patients or providers from offering fertility treatments.
- Providers cannot be prevented from discussing options with patients.
- No penalties or reduced payments to providers for providing covered care.
- No discrimination in coverage based on race, sex, age, disability, or other protected categories under federal civil rights laws (e.g., Civil Rights Act, Affordable Care Act).
- Notice to Enrollees: Plans must inform members about fertility coverage in writing, prominently in materials, by the earlier of the first mailing after regulations, yearly packets, or January 1, 2027; annually thereafter; and upon new enrollment.
- Flexibility for Plans: Allows negotiation of payment rates with providers; does not force patients to undergo treatment.
- Application to Federal Programs:
- Federal Employees Health Benefits (FEHB): Contracts must cover fertility treatments like private plans, with cost-sharing no higher than for obstetrical care; effective 180 days after enactment.
- TRICARE (Military Health): Requires coverage consistent with private plans; Department of Defense (DoD) sets matching cost-sharing and issues regulations.
- Veterans Affairs (VA): Provides fertility treatments to veterans and their spouses/partners who jointly apply; VA must issue regulations within 18 months.
- Medicaid: States must cover fertility treatments as part of family planning services, following private plan rules; effective October 1, 2026, with delay if state laws need updating.
- Medicare: Adds fertility treatments to covered services for seniors and disabled individuals; full coverage (100% of approved amount, no deductible or coinsurance); effective January 1, 2026.
Significant Changes to Existing Law
- New Mandate on Coverage: Previously, fertility treatments like IVF were often not covered or treated as elective; this makes them essential benefits in plans offering obstetrical care, similar to how the Affordable Care Act added maternity coverage.
- Broadened Eligibility: Extends beyond diagnosed infertility to any clinically appropriate case, a shift from prior optional or diagnosis-based coverage.
- Integration Across Laws: Aligns requirements in PHSA, ERISA, IRC, and adds conforming changes (e.g., updating references in existing sections). Introduces new sections in U.S. Code for TRICARE, VA, Medicaid, and Medicare.
- Anti-Discrimination Enforcement: Ties coverage to existing civil rights protections, strengthening accountability.
- Regulatory Fast-Track: Allows HHS and DoD to bypass standard rulemaking delays for cost-sharing rules.
Potential Impacts
- On Citizens: Improves affordability and access to family-building options for millions, including those facing infertility, same-sex couples, single parents, veterans, low-income individuals (via Medicaid), and seniors/disabled (via Medicare). Could reduce out-of-pocket costs, which often exceed $15,000 for IVF cycles, but might slightly raise premiums for all insured.
- On Government Agencies: HHS, DoD, VA, and Centers for Medicare & Medicaid Services (CMS) must develop regulations, oversee compliance, and update systems—potentially increasing administrative costs but promoting health equity. States may need to amend Medicaid plans, with flexibility for legislative delays.
- On Health Insurers and Employers: Requires plan adjustments, possible premium hikes, and notifications; self-insured employers (under ERISA) face direct compliance. No direct impact on international relations, as this is domestic health policy.
Main Stakeholders Affected
- Individuals and Families: Primary beneficiaries, especially those pursuing fertility care (e.g., infertile couples, LGBTQ+ individuals, military families, veterans).
- Healthcare Providers: Fertility specialists, clinics, and hospitals gain reimbursement assurance but must meet federal facility standards.
- Health Insurers and Employers: Must expand benefits; large employers sponsoring plans and insurers like UnitedHealth or Aetna face implementation costs.
- Government Entities: Federal agencies (HHS, DoD, VA, CMS) for oversight; states for Medicaid administration.
- Advocacy Groups: Organizations like Resolve (fertility advocacy) or civil rights groups benefit from anti-discrimination provisions.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens enforcement through civil rights laws (e.g., no discrimination under Section 1557 of the Affordable Care Act, which prohibits bias in health programs). Creates private right of action for violations via existing frameworks; allows interim regulations to speed implementation without full public input.
- Constitutional: Supports reproductive privacy and equal protection under the 14th Amendment by mandating non-discriminatory access to family-planning services, aligning with precedents like Roe v. Wade (pre-Dobbs) and Obergefell v. Hodges on marriage equality. No direct challenge to state abortion laws, as focus is on fertility (pre-conception).
- Political: Advances progressive goals on reproductive health equity but may spark debate over federal mandates, costs (estimated billions in new coverage), and religious exemptions (not addressed, potentially leading to lawsuits under RFRA—Religious Freedom Restoration Act). Could influence elections in districts with high infertility rates or veteran populations.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. DeLauro, Rosa L. [D-CT-3]
Cosponsors (4)
Rep. Doggett, Lloyd [D-TX-37], Rep. Schakowsky, Janice D. [D-IL-9], Rep. Foushee, Valerie P. [D-NC-4], Rep. Ross, Deborah K. [D-NC-2]
Recent Actions
- 2025-12-19: Referred to the Subcommittee on Health.
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, Oversight and Government Reform, Armed Services, and Veterans' Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, Oversight and Government Reform, Armed Services, and Veterans' Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, Oversight and Government Reform, Armed Services, and Veterans' Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, Oversight and Government Reform, Armed Services, and Veterans' Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, Oversight and Government Reform, Armed Services, and Veterans' Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, Oversight and Government Reform, Armed Services, and Veterans' Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-23: Introduced in House
- 2025-07-23: Introduced in House
Bill Versions
- Access to Fertility Treatment and Care Act — issued 2025-07-23 — PDF (24 pages)