Poli Alert Politics & Civics
Related Articles
The White House is retreating from a major campaign promise by President Donald Trump to mandate insurance coverage for in vitro fertilization (IVF), despite previously vowing to expand access to the costly fertility treatment.
According to two individuals with direct knowledge of internal discussions, Trump’s administration has no current plans to require health insurers, including those on the Affordable Care Act (ACA) exchanges, to cover IVF. The shift comes more than six months into Trump’s second term, during which the administration has also failed to introduce federal subsidies to reduce IVF costs.
“The government is going to pay for it, or we’re going to get — we’ll mandate your insurance company to pay for it,” Trump said in August 2024 during a campaign stop. “We want to produce babies in this country, right?”
But behind the scenes, White House officials have concluded that such a mandate would likely require congressional approval, a hurdle the administration has not moved to clear.
Background: A Fertility Pledge Amid Political Fallout
Trump’s promise to support IVF access followed political backlash from the reversal of Roe v. Wade, a decision made possible by justices he appointed. The pledge was part of a broader effort to shore up support among voters concerned about reproductive health access and declining U.S. birth rates.
Shortly after retaking office, Trump signed an executive order giving the White House Domestic Policy Council 90 days to present options for expanding IVF access and reducing treatment costs, which can range from $12,000 to $25,000 per cycle.
Legal and Policy Constraints
A senior administration official, speaking anonymously, said expanding access remains a “huge priority,” but acknowledged that Trump cannot unilaterally add IVF to the ACA’s list of essential health benefits without Congress.
Health policy experts like Patrick T. Brown of the Ethics and Public Policy Center have questioned the legality of designating IVF as an essential benefit, which typically covers services already widely offered by insurers.
“It’s more uncommon than not for IVF to be currently covered,” Brown said. “So it’d be a pretty elastic ruling.”
Avik Roy, founder of the Foundation for Research on Equal Opportunity, warned that such a mandate could raise premiums for tens of millions of Americans. “Anytime you layer on something as an essential health benefit, it increases premiums,” Roy said.
Administration Response: A Shift Toward ‘Restorative’ Fertility Care
In public statements, the White House continues to say it is committed to increasing IVF access. “President Trump pledged to expand access to fertility treatments for Americans who are struggling to start families,” said spokeswoman Abigail Jackson. “The Administration is committed like none before it to using its authorities to deliver on this pledge.”
However, sources say the administration is now exploring alternative fertility approaches, including “restorative reproductive medicine,” which emphasizes lifestyle and holistic health interventions over IVF. The Heritage Foundation and other conservative groups support the approach, but reproductive health experts warn it may delay or limit access to proven treatments.
Kaylen Silverberg, chair of Americans for IVF’s advisory board, who has consulted with the White House on fertility issues, said that pivot could fall “very short” of Trump’s initial promises. “We don’t want to be forced to ignore 40 years of scientific research,” he said.
Partisan Divide and Political Risks
The IVF debate reflects deeper tensions in the GOP. Some conservatives advocate robust pro-natalist policies, including subsidies and mandates, while others oppose new federal spending or insurance regulations.
Mandating IVF coverage on ACA exchanges — which cover around 24 million individuals — could raise insurance premiums and create political liabilities ahead of the 2026 midterms, GOP strategists say.
“How do you do this without burdening health insurers? That’s the key question they’ve been wrestling with,” one person familiar with the discussions said. “It appears for now that they’re not going to go there.”
Criticism and Broader Context
Liberal critics argue the administration’s posture is inconsistent with its stated family-first priorities. “You can’t seriously claim you’re pursuing pro-natalist policy when you’re kicking moms off Medicaid and when you’re leaving kids with less food,” said Bobby Kogan of the Center for American Progress.
Republicans like Sen. Katie Britt (R-Ala.) counter that Trump’s tax legislation included provisions to help families, including an expanded child tax credit and incentives for employer-based child care.
“When Republicans did [tax reform], the very first thing we did was put families and hardworking Americans first,” Britt said.
Next Steps: No Mandate on Horizon, Fertility Policy Unclear
The White House has not said whether it will seek congressional action on IVF or offer any new subsidies. For now, Trump’s sweeping campaign promise to make IVF broadly accessible remains unfulfilled.
“Every responsible fertility physician already asks patients to make lifestyle changes,” Silverberg said. “But we can’t let that be an excuse to turn our backs on real, effective treatment.”
