During his campaign, President-elect Trump promised to require coverage of in vitro fertilization (IVF) treatments.
Trump’s base voters raised concerns about the ethical concerns raised by IVF and reformers have questioned the cost. In response to his opponents asserting Trump would ban IVF, Trump told NBC News in August 2024 he would not only defend it but mandate the government and private insurance companies cover it.
In February 2024, several IVF clinics paused treatments after the Alabama Supreme Court ruled frozen embryos should be legally considered children. Three couples filed wrongful death lawsuits after a clinic destroyed their frozen embryos. Gov. Kay Ivey signed a law protecting doctors from lawsuits and criminal prosecution the following month.
In June 2024, President Joe Biden expanded IVF coverage under the Department of Veterans Affairs to unmarried service members and those in same-sex relationships who are unable to conceive because of service-related injuries or health conditions.
Trump’s planned move would be a more significant and widespread expansion of federal IVF promotion and subsidies.
What Is IVF?
In many cases, doctors and patients are confused about what IVF entails, says medical ethicist Mark Blocher, founder of Christian Healthcare Centers, the largest nonprofit direct primary care organization in the United States.
In an unpublished paper detailing guidelines for Christian health care professionals, Blocher writes, “IVF is one of several so-called medically assisted reproduction technologies widely used in the U.S. Over 8 million babies have been born using IVF since the first successful IVF live birth in 1978.”
IVF involves stimulation of the woman’s ovaries with medication, writes Blocher, “which is intended to produce multiple ova (eggs) for insemination.”
Doctors then retrieve four or more ova for insemination in a petri dish. Embryos undergo genetic testing, and any that are “found to have genetic anomalies are typically destroyed.”
Next, doctors transfer an “appropriate” number of healthy embryos to maximize the chances of a successful pregnancy. They can store unused embryos for future use.
“If several embryos successfully implant on the uterus, doctors may recommend aborting selected embryos to maximize the survival of the remaining embryo(s) and better manage the mother’s wellbeing,” writes Blocher.
Ethical Debate
Many Christians rejected IVF in its early years as an attempt to “play God,” Blocher notes.
Clinicians “create conditions that would never occur naturally,” writes Blocher. “For example, over-stimulating a woman’s ovaries with hormones to release as many as eight, ten, or twelve ova in a single menstrual cycle. Normally, women produce one ova per menstrual cycle.”
The Catholic Church and Southern Baptists, two of the largest religious denominations in the United States, explicitly condemn IVF on moral grounds.
“The initial goal of IVF was to assist married heterosexual couples experiencing medical difficulties with childbearing,” writes Blocher. “However, America’s permissive views on human sexuality and the cultural redefinition of marriage/family was seized upon by the fertility industry to offer its services to wealthy celebrities, same-sex couples, unmarried single women, and gay men paying surrogates to bear their children.”
Fertility clinics have become a $5.4 billion industry, with most women requiring three to four cycles to achieve one live birth, according to Blocher.
Cost Debate
A Forbes analysis reports a single IVF cycle costs up to $30,000 and sometimes more. If the incoming Trump administration requires insurers and government programs to cover IVF, taxpayers, insurance companies, or some combination will be on the hook for as much as $90,000 to $120,000 per IVF cycle per patient.
The price would be paid by inflation and debt, says Vincent Cook of the University of California, Berkeley.
“To the extent that health insurers are forced to cover the costs of IVF treatments in the policies they offer, the price of health insurance policies would have to go up,” wrote Cook at Mises Wire. “Employers who pay for most health insurance policies, in turn, would have to shift costs onto workers by reducing their wages (and onto owners of natural resources, etc.).”
Insurance was not designed for elective procedures, says John C. Goodman, co-publisher of Health Care News and president of the Goodman Institute for Public Policy Research.
“Insurance is appropriate for unpredictable, unlucky events that people have no direct control over,” said Goodman. “IVF is not a risky event. It is a procedure people choose, and since it typically requires multiple tries, it is very expensive. People should be free to buy insurance that does not force them to cover other people’s lifestyle choices.”
Creating New Demand
Total current expenditures on IVF in the United States are about $8 billion per year, and at the moment it is a niche market, says Cook.
“There are estimates that only a quarter of those who desire IVF treatments can actually afford them at current prices, so artificially reducing the price paid by patients to zero might mean at least a four-fold increase in the number of IVF cycles administered,” wrote Cook. “It might even mean more if clinics (which would also have no incentive to control costs) encourage a greater number of cycles per patient to increase the chances of achieving a successful pregnancy.”
Harry Painter ([email protected]) writes from Oklahoma.
Internet info:
Marissa Conrad, James Grifo, M.D., Ph.D., “How Much Does IVF Cost?” Forbes Health, updated Aug 14, 2023: https://www.forbes.com/health/womens-health/how-much-does-ivf-cost/
Vincent Cook, “The Trump Campaign Tries to Buy Votes by Subsidizing IVF,” Mises Wire, September 20, 2024: https://mises.org/mises-wire/trump-campaign-tries-buy-votes-subsidizing-ivf
Jonah McKeown, “The ethics of IVF: Where Catholics and Baptists Can Agree,” June 20, 2024, Catholic News Agency: https://www.catholicnewsagency.com/news/258052/the-ethics-of-ivf-where-catholics-and-baptists-can-agree
John M. Haas, Ph.D., S.T.L., “Begotten Not Made: A Catholic View of Reproductive Technology,” United States Conference of Catholic Bishops, 1998: https://www.usccb.org/issues-and-action/human-life-and-dignity/reproductive-technology/begotten-not-made-a-catholic-view-of-reproductive-technology
