After a half dozen failed attempts over the years, the state House and Senate approved a bill Monday that would require insurance companies selling policies in Maine to offer fertility care to their members.

Mainers who struggle with infertility, which affects about 10 percent of the population, have championed the bill, but opponents say the expensive price tag will drive up healthcare costs for everyone, including the state, which pays to insure state workers.

“As a midwife, I am able to witness the immense joy of new parenthood, but also the deep pain of fertility challenges,” said Sen. Stacy Brenner, D-Scarborough, on Monday. “This has not only emotional implications, but also economic ones.”

Many young Mainers struggling to become parents have gone deeply in debt trying to conceive, she said, and many consider moving to a state that has fertility insurance laws. In New England, only Maine and Vermont do not require companies to offer fertility care.

“We are the oldest state in the nation and we have to do something about that,” said Sen. Heather Sanborn, D-Portland. “This is not just the right thing to do for these families struggling to have a child. It’s the right thing to do for Maine. We need these young families.”

Opponents expressed sympathy, but said it isn’t fair to put the expensive needs of a few ahead of the many others in the insured pool who can’t afford to pay higher premiums. Some small employers might decide fertility care makes insurance too expensive to offer at all, they said.

“This is a tough case because I consider myself to be a pro-life legislator,” said Sen. Trey Stewart, R-Presque Isle. “I think it’s a wonderful thing, but I think we sort of need to measure twice and cut once on this about how we are going to increase costs to the insurance pool in Maine.”

The bill, L.D. 1539, passed the Senate 21-12 and the House 72-57 on Monday.

Nineteen states require some infertility coverage. Some require conception failure before insurers must cover care. Some set maximum benefit limits. Some cover medicines, but not in vitro fertilization, which can cost up to $25,000, including medicines.

The cost of offering this expanded coverage would vary by health insurance plan. According to Stewart, marketplace plan premiums would go up about $5 to $6 a month, per person, to cover fertility care. The cost for state employees would go up no more than $1.41 a month, per person.

Initial cost estimates were much higher – Anthem Blue Cross Blue Shield, the health insurance provider for state employees, had originally projected an $8.28 increase a month, per person – but that didn’t match the experience of other states that mandated fertility care.

Upon review, lawmakers learned Anthem had included the cost of the limited fertility care already offered to state employees, which inflated the projected cost of expanded coverage, Sanborn told the Senate. It had also included the cost of insuring the extra babies that would be born.

“That is very unorthodox,” Sanborn said. “I’ve certainly never seen a note that says, ‘oh, if we cover this treatment for Lyme disease, a person might live longer, and so we’ll have to cover them for these other things that might go wrong.’ That’s not how health insurance costs are calculated.”

In an effort to assuage those concerned about cost, the Senate amended the bill and the House agreed to give the state Bureau of Insurance the right to adopt technical rules that could give insurance companies some cost-saving flexibility in their fertility coverage.

The health coverage and insurance committee’s original bill would have prohibited insurance companies from treating infertility differently than any other medical condition, requiring the same deductibles and annual or lifetime coverage limits as a heart attack or broken leg.

The amended bill still prohibits an insurance company from implementing a waiting period before a member can seek fertility care. Some states require couples to have tried to conceive for a certain amount of time before insurance companies must cover fertility treatments.

More than 50 people testified in favor of the bill during a public hearing last year, sharing heart-wrenching stories about being unable to conceive, going into debt paying for fertility treatment out of pocket and abandoning their dream of children when they ran out of money.

One of those was Rep. Colleen Madigan, D-Waterville, who shared her personal infertility challenges.

“When it was possible for me to have treatment, and have a child, my insurance did not cover fertility treatment and I didn’t have the money to pay for it,” Madigan said. “I paid a lot of money for the health insurance I got through my employer and when I needed it it was not available.”

It is too late for her now, Madigan said, but she didn’t want anyone else to have to endure such grief.

Some supporters told of the genetic markers that put them at high risk of having a baby that would die a painful death after only a few days. Without coverage, they said, they would have to keep playing the genetic lottery in hopes that they and their unborn child could beat the odds.

It is unclear if the bill would end up before the Appropriations Committee, which has about $12 million to fund bills that are not already included in Gov. Janet Mills’ budget, because it would not go into effect until January 2024. That means it would have no immediate fiscal impact.

It would likely increase the cost of the state employee healthcare plan in the future, although exactly how much is hard to determine given the volatility of the healthcare market, Sanborn said. Currently, analysts project Maine would pay $236,360 more a year for the expanded coverage.