What The Hell America!

President Donald Trump issued an executive order he said would lower the cost of in vitro fertilization and protect access to it. But the order doesn’t clarify how it would lower costs, let alone eliminate them, particularly as his administration is trying to slash budgets. 

Trump promised during his campaign to make IVF available at no cost to all Americans. Multiple health policy researchers told The 19th that cutting out-of-pocket costs for IVF would likely require involving Congress and addressing not only how insurance treats IVF but also the needs of Americans without health coverage — about 26 million, though not all would necessarily seek reproductive health care. 

IVF is largely popular, but the rise of anti-abortion policies have jeopardized access to the fertility regimen. A year ago in Alabama, a state Supreme Court ruling temporarily outlawed the treatment. Trump’s rhetorical embrace of IVF, which accompanied an effort to distance himself from unpopular anti-abortion policies, puts him at odds with the GOP lawmakers who are more closely allied with that movement.

But implementing policies to expand IVF could be very expensive. Billionaire Elon Musk has been tapped by the Trump administration to cut government spending dramatically and has attempted to halt the distribution of money that Congress has already allocated. Those efforts have sparked legal challenges across the country — but the emphasis on cost-cutting could create a complicated path forward for any effort to try to build out any new health care benefits. 

Already, Republicans in Congress are pushing to reduce health spending by $880 billion, mostly from Medicaid, the health insurance program for low-income people, which covers about half of all pregnancies. 

“Coverage for IVF costs money, and it’s hard to see where that money comes from when Congress is looking to cut federal health spending to help pay for tax cuts,” said Larry Levitt, a vice president at KFF, a nonpartisan health policy research, polling and journalism organization. 

Medicaid benefits vary from state to state, but the program usually does not cover IVF, which can cost tens of thousands of dollars. Private insurance also largely does not cover IVF, though some states have passed laws requiring private health plans to include those benefits.

Research shows that most people who seek fertility treatment do not receive it because of the high costs. Estimates for a single cycle of IVF range from $12,000 to closer to $25,000. It can often take multiple cycles to get pregnant.

Trump could potentially direct the Centers for Medicare and Medicaid Services to work with individual state Medicaid programs to develop new IVF benefits, said Kathleen Kraschel, an assistant professor of law and health sciences at Northeastern University. Such an approach may not require Congress, but that would increase Medicaid spending, not lower it. 

The administration could also potentially try to interpret existing regulations in the Affordable Care Act to push some private health insurance plans to add IVF benefits, Ranji said. But Republicans, including Trump, have demonstrated little appetite for building on the 2010 health law, which Trump sought and failed to have repealed during his first presidential term.

“I don’t know what they could do without Congress,” said Usha Ranji, associate director for Women’s Health Policy at KFF.

It’s also not clear how any new Trump-backed policy would define who would receive benefits for IVF, which is often used by queer families and single people. The executive order issued Tuesday calls for policies that would help “loving and longing mothers and fathers have children.”

“I don’t know if there would be any limiting to heterosexual couples or married couples,” Ranji said. “We don’t know and we would have to see.” 

The political dynamics are complex. Conservative lawmakers, who have long been allied with the anit-abortion movement, would likely oppose enacting any new laws that expand IVF benefits, she said. The fertility regimen has drawn criticism from staunch abortion opponents, because it requires the development of multiple embryos, not all of which can or will develop into healthy pregnancies, and some of which patients may ultimately discard. Some anti-abortion activists view that as murder. 

IVF entered the political spotlight almost exactly a year ago, following the Alabama Supreme Court’s ruling, a decision hailed by abortion opponents while sparking widespread outcry. Following national backlash, the state legislature passed emergency legislation to restore access to the procedure. 

Months later, Senate Republicans blocked a Democrat-led bill to protect the right to IVF.