On the campaign trail, President Donald Trump said his administration would pay for in-vitro fertilization (IVF) treatments, or mandate insurance companies cover it.
But a recent executive order (EO) doesn’t provide further details about how exactly the White House would deliver on this promise, leaving advocates and policy experts with more questions than answers.
The EO, which was released on Feb. 18, calls on the assistant to the president for domestic policy to submit “a list of policy recommendations on protecting IVF access and aggressively reducing out-of-pocket and health plan costs for IVF treatment” within 90 days.
While more employers have started covering fertility services such as IVF in recent years, they tend to be larger firms. Even when insurance covers IVF, the procedure can be expensive; a single cycle is estimated to range from $15,000 to $20,000. Women surveyed by KFF last year cited cost as the leading reason they couldn’t access fertility care.
Congress would likely need to act to meaningfully lower IVF costs, one policy expert told HR Brew. What’s more, the EO leaves certain issues that may be on benefits leaders’ minds unaddressed, such as who would be eligible to receive the treatment under such a program.
What IVF coverage looks like in the US. Despite the fact more health plans are starting to cover IVF, “in general, it is really hard to find coverage,” said Usha Ranji, KFF’s associate director for women's health policy. When patients do receive it, they’re most likely to access it through the private insurance market.
Although more than 20 states have laws requiring certain health plans to cover at least some fertility treatments, these statutes exclude self-funded employer plans, under which most covered workers (61%) are enrolled. Given the exemption of self-funded plans, which are typically utilized by large employers, the mandates cover “a tiny percentage of employees,” said Barb Collura, president and CEO of RESOLVE, the National Infertility Association.
Despite the fact that most US workers still don’t have access to fertility treatments through their insurance, Collura said she’s observed a “sea change” in the prominence of companies offering IVF through third-party providers, which operate outside of traditional health plans.
An executive at one such provider, Progyny, said it remained to be seen how much this EO would effect change.
“While this executive order holds promise in advancing access for the millions of people who rely on IVF to build their families; it only calls for policy recommendations, meaning impactful change seems down the road,” Janet Choi, Progyny’s chief medical officer, told HR Brew via email.
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Where the Trump administration could effect change. The EO falls short of Trump’s campaign promise to fully cover IVF, Ranji said, and any action to significantly lower treatment costs would likely involve a requirement that insurance plans cover it.
“It seems like something really broad-sweeping that would apply to all plans, or even just a large bulk of plans, would require action by Congress,” she said.
Though lawmakers introduced several bills to this end last year, they didn’t pass. One piece of legislation, the Right to IVF Act, was put forth by Democratic senators after the Alabama Supreme Court ruled that embryos should be considered children, temporarily compromising access to the treatment. But it was blocked by Republican lawmakers. The bill’s sponsors, Tammy Duckworth and Cory Booker, asked Republicans to vote on it again in response to Trump’s EO.
Collura said her organization supports the HOPE with Fertility Services Act, a bipartisan House bill that would amend the Employee Retirement Income Security Act to require insurers to cover infertility treatments, including IVF.
Lingering questions for benefits leaders. The question of fetal personhood, and whether embryos are entitled to the same legal protections as people, looms large for Flory Wilson, founder and CEO of Reproductive and Maternal Health Compass, which provides employers benchmarking data on maternal health benefits.
Where Republicans fall on this question, which emerged after the Supreme Court struck down the constitutional right to an abortion, and spurred the Trump administration’s interest in IVF, remains unclear.
“That has a huge chilling effect” for clinics and employers that cover IVF, Wilson said of the confusion surrounding the procedure’s legality.
Wilson also said she’s eager to learn more about who would be eligible to pursue IVF under a Trump-endorsed policy (the campaign previously promised “universal access”). Some employers see family formation benefits like IVF as a tool for attracting a more diverse workforce, given many LGBTQ+ individuals rely on them. But the Trump administration has recently taken aim at this community through directives such as an EO urging agencies not to publish statements in support of trans or nonbinary employees.
Ranji echoed this question: “The administration seems to be promoting heterosexual marriage, and so will there be any sort of limitations on expansions to fertility services?”