WASHINGTON — Former President Donald Trump on Thursday proposed making in vitro fertilization (IVF) free for people who want to become parents, a bold proposal that could shift as much as $7 billion a year in costs to the government and insurance companies, experts told The Washington Post.
The Trump campaign has not said how the policy would be adopted, but the quickest way would likely be A bill is under consideration that would require insurance companies to consider infertility a covered medical condition. Alternatively, it could be done by amending the 2010 health care law signed by former President Barack Obama.
If Trump, 78, becomes the 47th president of the United States, he could issue an executive order expanding free IVF coverage to all federal employees, military personnel and veterans, which is currently available only in limited circumstances, but such an order would likely face legal challenges.
“Politicians promise and overpromise all the time,” Gerald Kominsky, a senior fellow at the UCLA Center for Health Policy Research, told The Post on Friday.
“In this particular case, [Trump’s] “We've never been promised anything when it comes to health care in this country.”
IVF is expensive, with treatments costing between $15,000 and $20,000 per cycle, according to the Department of Health and Human Services.
Vanessa Brown Calder, director of opportunity and family policy studies at the libertarian Cato Institute, estimates that making IVF available for free to everyone would cost about $7 billion a year, a calculation she said was based on Centers for Disease Control and Prevention data reflecting 413,776 assisted reproductive technology (ART) cycles in 2021, 99% of which were IVF treatments.
“Of course, this significantly underestimates the true long-term costs of the program,” Calder warned.
“Currently, most IVF patients pay out of pocket, which limits access to IVF. Furthermore, government-funded IVF creates new incentives for couples to delay childbearing or selectively preserve fertility, leading to increased use of and reliance on long-term infertility treatments.”
It is unclear how much the government will directly pay, but the increased costs to insurers are likely to be passed on to taxpayers through higher premiums.
“Dramatic moment”
Advocates have been fighting for years to make IVF free, and were excited by Trump's surprise announcement.
“It's great to see candidates from both major political parties in this country calling for universal access to IVF. That's a great thing and we applaud it,” said Shawn Tipton, chief advocacy and policy director for the American Society for Reproductive Medicine (ASRM).
“We're interested in working with the Trump campaign to see what that proposal would look like. Right now, the plan appears to consist of one sentence.”
Tipton added, “There's a Republican-sponsored bill going through Congress right now. He might say, 'Let's do it.'”
that The bill The bill is co-sponsored by Rep. Lori Chavez-Deremer (R-Oregon) and is co-sponsored by 14 House Republicans and six House Democrats, including New York Republicans Mike Lawler, Marcus Molinaro, Anthony D'Esposito, Brandon Williams, and Andrew Garbarino, and New York Democrats Dan Goldman and Patrick Ryan.
Tipton said ASRM would also like to know whether Democratic presidential candidate Kamala Harris, who has frequently expressed concern about shielding IVF from state-level anti-abortion laws, would support universal health coverage for IVF.
“Anyone can make the platitudes,” he said, “but it's time to move from poetic support for IVF to prose about what such a policy would look like.”
While there has been little progress toward mandating IVF coverage at the federal level, 13 states, ranging from Republican strongholds Arkansas and Utah to Democratic strongholds New York and Massachusetts, already require insurers to cover the procedure.
California, the most populous state in the United States, is poised to follow suit after the state legislature approved a mandate this week.
If enacted, the free IVF mandate would be a major bipartisan achievement for President Trump, who during his first term breathed new life into long-stalled criminal justice reform, ramming through a bipartisan bill known as the First Step Act after years of stalled policy.
“I've been in this policy area for 25 years, and IVF and fertility treatments have never received this much attention from the highest levels of policy,” Tipton said. “So this is really a dramatic moment. And the thing to do now is to take all of this interest and translate it into policy that actually gets covered.”
He noted that about 2.5 percent of babies in the United States are born through IVF each year, compared with 5 percent to 7 percent in European countries where IVF is free.
So far, state mandates have not led to a significant increase in the number of IVF births, but they could lead to a gradual increase.
Responding to criticism of the plan's cost, Tipton told The Washington Post that opponents should look at the bigger picture.
“Humanity needs to reproduce to survive,” he says. “Social Security needs young workers to pay taxes to make it financially viable.”
“We live in a society where those people are there, so we need to have children.”
Mixed reactions from Republicans
Trump's IVF plan has drawn mixed reactions from Republicans, with some supporting it as a bold, pro-family initiative and others, particularly abortion opponents, concerned about IVF's process of creating and destroying embryos.
Even Trump's closest allies have said they are privately horrified by the idea, with one former White House official calling it “terrible” and predicting that Trump would not lose support from anti-abortion conservatives on November 5.
The former aide said the “clumsy” plan “doesn't change what he's done and what he's trying to do on life,” calling Trump “the most pro-life president of our generation” for appointing three conservative Supreme Court justices who voted to overturn Roe v. Wade in June 2022 and return abortion policy to the states.
Trump's initiative is expected to appeal not only to suburban moderates but also to Democratic-leaning voters, including LGBT people who are having children through IVF.
“Affordable access to IVF is an important issue for the LGBT community across all political stripes, and President Trump's proposal would be a game changer for LGBT couples looking to start their own families,” Log Cabin Republican Representative Charles Moran said in a statement.
Susan B. Anthony Pro-Life America, a prominent anti-abortion group, called for enacting policies to prevent the destruction of fertilized eggs if Trump's plan is adopted.
“SBA Pro-Life America does not oppose fertility treatments that help couples struggling with infertility in an ethical manner and with strong medical safety standards,” said SBA Chair Marjorie Dannenfelser.
“We believe that human embryos should not be destroyed. Proposals on this issue often go too far by granting blanket immunity to IVF clinics, even to unscrupulous doctors who switch human embryos, fail to follow basic safety standards or inadvertently destroy human embryos desired by infertile couples,” she added.
Trump's IVF plan comes after Democratic candidates have spent months fighting legal battles in some states over whether IVF qualifies as an abortion following federalization of abortion policy.
In February, the Alabama Supreme Court issued a shocking ruling that embryos created through IVF must be considered “fetuses,” and the Republican-led state government in March rushed to ratify a new law granting criminal immunity to medical providers and patients.
