Victory in the Aloha State

After more than a decade of advocacy by Hawaiian patient and provider advocacy organizations, Hawaii Governor Josh Green signed HB 1864 into law on July 9, 2026. This legislation requires state-regulated health insurers to cover standard fertility preservation services for individuals facing iatrogenic infertility, including cancer patients. The new law will cover procedures such as sperm banking and egg and embryo freezing and go into effect for health plans issued or renewed in Hawaii after December 31, 2026.

Due to Hawaii’s Prepaid Health Care Act of 1974 (PHCA) – the nation’s only state employer health coverage mandate that predates federal ERISA law – coverage will reach a broader percentage of Hawaii’s population compared to other state fertility preservation laws. We estimate that more than 700,000 Hawaiians, approximately half of the state’s population, will now have fertility preservation coverage should they ever need it.

The Alliance for Fertility Preservation would like to thank every patient advocate and organization that has been fighting tirelessly for this coverage since the first Hawaii bill was introduced in 2012. We are especially grateful for the Hawaii Society of Clinical Oncology, ASCO, Fertility Institute of Hawaii, Breast Cancer Hawaii, ACS CAN, Blood Cancer United, Susan G. Komen and all of the patient advocates who bravely shared their stories throughout this long journey.

Fertility Preservation Toolkit

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James Smith, M.D.

James Smith

Dr. Smith graduated from the University of California, Berkeley with a degree in molecular biology and subsequently matriculated from UCSF’s School of Medicine, earning a master’s degree in 2000 (UC Berkeley Joint Medical Program) and a medical degree in 2002. After completing a general surgery internship and urology residency at the University of Utah in Salt Lake City, Dr. Smith returned to UCSF as a Reproductive Urology / Andrology fellow from 2007-2009. Since 2009, Dr. Smith has been Director of Male Reproductive Health at UCSF caring for patients with a wide range of reproductive and sexual health concerns. Through basic investigations of sperm physiology, translational projects to develop new means to preserve and restore fertility for cancer patients, and health services research, he and his colleagues strive to help patients become parents after facing fertility threatening treatment and to improve access to male reproductive health care.

At the national leadership level, Dr. Smith seeks to build an environment of diversity, innovation, equity, and collaboration within the reproductive field. He is currently President of the Society for Study of Male Reproduction (SSMR) and Chair of its Diversity Committee; President-Elect (President 2022-2023) of the Society for Male Reproduction and Urology (SMRU) and Past Chair of the American Society of Reproductive Medicine (ASRM) Fertility Preservation Special Interest Group. Over the last 3 years, he served as Co-Chair of the American Society of Andrology’s annual program, “ASA 2021: Personalized Reproductive Medicine for the Male: From Bench to Bedside.” Fundamentally, Dr. Smith loves to collaborate with trainees, clinicians, scientists, patient advocates, and biotech partners to work toward solving complex reproductive clinical, research, and public policy challenges.