Congress mandates fertility coverage across all major health insurance systems
H.R. 4648 — Access to Fertility Treatment and Care Act · Filed by Rosa DeLauro (D-CT) · 4 cosponsors · Introduced Jul 23, 2025 · Referred to committee
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What it does
This bill requires health insurance plans and government health programs (Medicare, Medicaid, TRICARE, VA, federal employee plans) to cover fertility treatments—including egg/sperm preservation, artificial insemination, IVF, genetic testing, and related medications—if they already cover childbirth. Plans cannot charge higher copays or deductibles for fertility care than for other medical services, and cannot penalize doctors for providing it or discourage patients from seeking it.
Why we flagged it
The bill's core function is to mandate fertility treatment coverage across all major U.S. health insurance systems. It is a straightforward healthcare access expansion, not a tax measure, appropriation, or regulatory carve-out.
What the text implies
- Fertility coverage mandate may increase insurance premiums for all enrollees, including those who do not use fertility services, creating a cross-subsidy that some may view as unfair.
- The bill allows plans to negotiate reimbursement rates with providers, potentially creating two-tier fertility care: high-reimbursement facilities vs. low-reimbursement clinics, affecting access quality.
- Medicaid expansion to fertility treatment may strain state budgets, particularly in states with limited Medicaid funding, potentially delaying implementation or reducing other Medicaid services.
- The definition of 'fertility treatment' is delegated to HHS Secretary via interim final rulemaking (bypassing notice-and-comment), creating regulatory uncertainty about what is actually covered until rules are finalized.
- Veterans and military spouses gain fertility coverage, but the bill does not specify whether VA/TRICARE will cover treatments at private fertility clinics or only in-house services, potentially limiting actual access.
Who it affects
Ordinary people with insurance gain access to fertility treatments at the same cost-sharing level as other medical care, removing a major financial barrier to family-building. The bill expands coverage across all major insurance pathways (private, Medicare, Medicaid, military, VA), benefiting millions of people struggling with infertility or seeking to preserve reproductive capacity.
Who stands to gain
- fertility clinics and reproductive medicine practices
- pharmaceutical companies (fertility medications)
- genetic testing laboratories
- egg/sperm banks and embryo preservation services
Named in the bill
HHS Secretary, Department of Veterans Affairs, Department of Defense, Centers for Medicare & Medicaid Services, American Society for Reproductive Medicine, PHSA (Public Health Service Act), ERISA (Employee Retirement Income Security Act), Internal Revenue Code, Social Security Act, TRICARE, Medicare, Medicaid — and 1 more
Where it stands
4 cosponsors: 4 Democrats.
- Jul 23, 2025 — Introduced · Congress.gov: “Introduced in House”
- Jul 23, 2025 — Referred to House Committee on Veterans' Affairs and House Committee on Armed Services · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means…”
Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.
Money around this bill
4 lobbying clients named this bill on 7 disclosure filings across 3 quarters, Dec 2025 to Jun 2026. Those filings disclosed $1,209,908 in lobbying spend. A filing names 71 bills on average, so that figure is what each filing reported, not a share belonging to this bill.
More lobbying clients named this bill than 72% of bills with at least one filing.
Rosa DeLauro, the sponsor, reported $624,463 in PAC receipts in the 2026 cycle.
- National Treasury Employees Union — $690,000 on 2 filings
- Human Rights Campaign — $439,908 on 2 filings
- Hadassah, the Women's Zionist Organization of America, Inc. — $60,000 on 1 filing
- American Society for Reproductive Medicine (asrm) — $20,000 on 2 filings
Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.
How this was measured
Analysis — Quorum's AI read the full bill text on Jul 6, 2026; transparency and hidden-provision scores are compared against the median of 16,222 analysed bills.
Status and sponsors — Congress.gov's bill record — actions, committee referrals and cosponsors — loaded nightly. The timeline shows status changes, not every procedural action.
Money — Senate Lobbying Disclosure Act filings whose specific-issue field names this bill for quarters ending Dec 2025 to Jun 2026. A filing's amount is reported whole beside the median number of bills a filing names; it is never divided across them. PAC receipts are FEC-reported contributions to the sponsor's candidate committee in the 2026 cycle.
As of — lobbying records through Jul 20, 2026 · page rendered 2026-10-20.
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