During the 2024 campaign, Donald Trump suggested that he would work to make the expensive fertility treatment called in vitro fertilization much cheaper, and possibly completely covered by insurance. His administration bragged about an executive order in February directing aides to draft policy recommendations on “aggressively reducing out-of-pocket and health plan costs for IVF treatment.” But now, new reporting suggests that the Trump White House will do next to nothing to mandate insurance coverage of IVF. It’s a predictable outcome for a proposal that was both detail-free and far-fetched, not least because it would have enraged his most conservative supporters.
Beginning in August 2024, Trump claimed that, if he won, he would make IVF free. “Under the Trump administration, we are going to be paying for that treatment,” he told NBC News. “Your government will pay for — or your insurance company will be mandated to pay for — all costs associated with IVF treatment,” he said at a Michigan event. “Because we want more babies, to put it nicely.” (Access to both abortion and IVF were political liabilities for Trump, who repeatedly bragged about his role in getting the Supreme Court to overturn Roe v. Wade.)
Once in office, Trump signed that executive order seeking IVF recommendations in 90 days. The White House said toward the end of May that it was reviewing the report, but has disclosed little else. Around the same time, NOTUS reported that the administration had considered declaring IVF an “essential health benefit” under the Affordable Care Act, which would require coverage for about 45 million people with marketplace or small-business plans. (When private insurance companies cover such essential benefits, they typically do so voluntarily, so designation as an essential health benefit was one path for getting more insurers to cover IVF.)
Then, over the weekend, two White House officials told The Washington Post that Trump doesn’t actually plan to require insurance companies to cover IVF. One senior White House official acknowledged that, legally, the president can’t simply declare certain services to be essential health benefits; Congress would have to pass legislation saying as much. Furthermore, it could drive up people’s monthly premiums ahead of the 2026 midterms, when health care is expected to be a key issue.
Still, a spokesperson promises Trump will do something, eventually. “President Trump pledged to expand access to fertility treatments for Americans who are struggling to start families,” spokeswoman Abigail Jackson said in a statement. “The Administration is committed like none before it to using its authorities to deliver on this pledge.”
Some groups and outlets are describing this as a broken campaign promise — but is anything this man says about health care ever a promise? No, it was a cynical, empty slogan to win support from women voters. That will, of course, come as cold comfort to people who voted for him on this specific issue.
It was always going to end this way. Sen. Tammy Duckworth, D-Ill., who welcomed two children through IVF and co-sponsors a bill to require insurance companies to cover the treatment, had Trump’s number back in February, when she called his executive order “lip-service from a known liar.”
Not only is the Trump administration more concerned with extending tax cuts for billionaires than with helping everyday Americans access health care, but it has also allied itself with a far-right, anti-abortion movement that believes life begins at fertilization. That movement opposes IVF because it involves the routine destruction and storage of embryos.
Instead of IVF, groups like the Heritage Foundation, which published the Project 2025 playbook for a second Trump term, are instead pushing for investments in so-called restorative reproductive medicine. Proponents claim this approach can address the root causes of infertility at a lower cost through cycle-charting, lifestyle changes and screening for conditions like endometriosis.
The American College of Obstetricians and Gynecologists calls RRM an unproven concept with ties to the fetal personhood movement, and says it “has been used to discourage patients from accessing evidence-based IVF in order to avoid the creation of fertilized eggs.” That doesn’t appear to be stopping the Trump administration from offering a $1.5 million grant to start an “infertility training center” with a notice describing an approach similar to RRM. (The money is coming from a 50-year-old family planning program called Title X that has historically provided birth control to low-income women.)
It’s even less surprising that Trump is backing away from IVF, when one considers the people he’s installing in his administration. In early July, he appointed anti-abortion lawyer Josh Craddock to a role at the influential Office of Legal Counsel (OLC), which helps provide legal advice to the president. Craddock believes that “preborn human beings are legal ‘persons’ within the original meaning of the Fourteenth Amendment,” and that states and Congress are thereby required to ban abortion. He wrote in a law review article earlier this year that the president can create fetal personhood via an executive order.
Trump also nominated Elliot Gaiser to lead OLC, and while he is less outwardly a personhood fanatic, he has called abortion a “moral evil.” In response to written questions about abortion from Sen. Cory Booker, D-N.J., Gaiser said he believes that “nobody should be deprived of life, liberty or property without due process of law.” This is anti-abortion language for wanting to ban the procedure. The Senate confirmed Gaiser last week by a vote of 53-45, while Craddock’s role doesn’t require confirmation.
It’s not likely that these two men would ban abortion by executive order at the OLC, but they could still do a lot of damage. They could achieve a Project 2025 dream by declaring that the Justice Department can enforce a dormant anti-obscenity law called the Comstock Act against people who mail abortion pills. All they’d have to do is rescind a Biden-era memo which said that sending abortion medications through the mail doesn’t violate the 1873 law, as long as the sender doesn’t know that the drugs will be used illegally.
We get to wait and see if they’ll take such an action, or if Trump appointed them to these roles to try to keep a key constituency happy. He’s trying to appease both his voters, many of whom don’t want new federal abortion restrictions, and the conservative base, which helped him get elected and hates abortion and IVF.
If these two do allow federal prosecutions for abortion pills, that would undermine Trump’s mantra that he wanted to “leave abortion to the states.” It would be just another campaign trail lie— like “IVF will be covered.”
This article was originally published on MSNBC.com
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