Trump’s IVF Coverage Goals Confront Congress, Industry Limits

President Donald Trump’s attempt to expand in vitro fertility treatments could create legislative, legal, and financial challenges if the administration mandates coverage for private employers and health plans.

Trump’s Feb. 18 executive order requires the domestic policy adviser to draft “a list of policy recommendations on protecting IVF access and aggressively reducing out-of-pocket and health plan costs.” A single IVF cycle runs between $14,000 and $20,000 on average, according to ARC Fertility.

Unlike with the federal workforce, Trump has limited authority over health-care benefits in the private sector, and would need buy-in from Congress for any widespread company directives, which could be targets for litigation.

Businesses are increasingly covering IVF on their own and a broad insurance mandate would only increase premiums and worsen cost and quality problems with IVF clinics, employer groups say.

“In the end, the cost of a mandate like that would just be higher premiums for employers,” said National Alliance of Healthcare Purchaser Coalitions President and CEO Shawn Gremminger, adding that most employer groups would fight any broad requirements.

Trump previously promised IVF costs would be fully covered either by the federal government or private insurance companies, distancing himself from an Alabama Supreme Court decision that briefly shuttered IVF services across the state.

Delivering on those promises will be tough. Congress would need to enact mandates for self-funded plans, which are regulated by the Employee Retirement Income Security Act.

Legislative Path

A bill favored by advocacy groups, known as the HOPE with Fertility Services Act, was sponsored by Trump Labor Secretary nominee Lori Chavez-DeRemer in the previous Congress. But fights between Democrats and Republicans over a series of IVF bills scuttled any chance of a deal.

At a minimum, any mandate must be paired with transparency and quality guidelines to ensure employers can partner with worthy, cost-efficient providers, said The ERISA Industry Committee President and CEO James Gelfand.

“Some of these clinics are private-equity owned behemoths that employ hundreds of doctors,” he said.

Voluntary coverage is ticking up each year. Nearly half of self-funded employers with at least 500 employees offered IVF in 2024, with 70% of employers with more than 20,000 employees offering the benefit.

Twenty-two states cover some form of infertility benefits, according to patient advocacy group RESOLVE. But the laws only apply to fully insured plans regulated at the state level and generally exclude small employers, which are the bulk of the state-regulated market. That’s because the Affordable Care Act requires states to cover the cost of any state-mandated benefit on the exchanges that is not part of the law’s 10 essential health benefits.

Trump could make IVF an essential health benefit under the ACA, said Barbara Collura, president and CEO of RESOLVE. That would require Trump to leverage a law he sought to repeal during his first term. But reaching the small group and individual markets in any way would be welcome, she said.

“I would look for the administration to help fix some of these, what I would call problems with the ACA that’s quite honestly leaving people out,” she said.

Any mandate in the private sector could spark legal challenges from religious organizations. The Alliance Defending Freedom said on the social media site X that IVF “remains largely unregulated and subject to serious ethical abuses, including the commodification and casual destruction of human life.”

Trump has signaled a willingness to carve out exemptions for religious employers to IVF coverage.

He has historically honored religious exemptions and the Religious Freedom Restoration Act, said Robert Muise, an attorney with American Freedom Law Center.

“I’m not concerned because the Trump administration understands that they still have to protect religious freedom and provide religious accommodations for those who might object to this,” he said.

Federal Workforce

Trump’s broadsides against the federal workforce seemingly run counter to any expansion of federal employee benefits, but Trump has more authority over the federal workforce.

Current coverage is spotty across the Federal Employee Health Benefits Program, the military’s TRICARE program, and the Department of Veterans’ Affairs, but increased under the Biden administration. Medicaid coverage also varies across states, where coverage focuses on cancer patients.

Alliance for Fertility Preservation Executive Director Joyce Reinecke said she hopes the Trump order will include a recommendation “that medically indicated fertility preservation be explicitly included in these efforts.”

Overall, 25 FEHB carriers cover IVF, according to FEDweek. Blue Cross Blue Shield and the Government Employees Health Association offer plans that provide coverage of up to $25,000 for IVF, and all FEHB plans provide base coverage of artificial insemination and IVF medications for three cycles of treatment.

The inclusion of some LGBTQ+ government workers in IVF coverage would also raise questions for Trump. The president has already eliminated recognition of transgender individuals at the federal level and curtailed certain gender-affirming care, though his focus has been more on gender identity than sexual orientation.

The VA began covering IVF for eligible unmarried veterans and those in same-sex marriages in 2024, as well as veterans that use donated sperm or eggs. Before the coverage was expanded, VA generally only allowed IVF services for married, heterosexual couples.

Peter Romer-Friedman, who represents plaintiffs in discrimination cases at Peter Romer-Friedman Law PLLC, said that the case law is clear on same-sex couples’ benefits.

“A number of federal courts have already held that it is unlawful discrimination to deny IVF benefits to LGBTQ people based on sexual orientation, so there haven’t been contrary decisions,” he said.

Any expansion, whether in the private or federal sectors, will bring cost concerns.

“I’m skeptical this is going to have a significant impact, given that they have relatively few choices,” Gremminger said of the order. “And the choices they have are either expensive to the government or expensive to employers.”