One of President Donald Trump’s boldest campaign pledges was to make in vitro fertilization (IVF) completely free. Yesterday, the Trump administration released its long-awaited proposals — which are nowhere making IVF free, or even significantly more affordable.
That promise, a late gamble to win back women voters aggrieved by the GOP’s hostile stances on reproductive rights, had been immediately controversial within his own party. Even though seven in 10 Americans support access to IVF, some religious conservatives believe the procedure — which involves fertilizing eggs outside the body and then transferring embryos to a womb — violates the sacred connection between sex and conception. They also object to embryos being destroyed in the process. In June 2024, the Southern Baptist Convention, the largest Protestant denomination in the US, approved a resolution against IVF, and social conservatives have been lobbying the administration for more medically fringe “natural” solutions to tackling infertility instead.
Trump’s new proposals fall far short both of his campaign pledge and a February executive order soliciting recommendations to “aggressively reduc[e] out-of-pocket and health plan costs” for the treatment. (IVF can cost up to $25,000 per cycle and most patients undergo multiple cycles to achieve a live birth.) On offer is federal guidance (essentially a suggestion) for employers to provide fertility coverage as a stand-alone, optional benefit, similar to dental or vision insurance. The administration also secured an agreement with drugmaker EMD Serono to sell common IVF medications at steeply reduced prices through the forthcoming TrumpRx.gov portal, a new website where patients can buy prescriptions directly instead of using insurance.
Neither move includes new subsidies, mandates, or funding — meaning most patients will see little to no relief.
The voluntary employer guidance proposal is unlikely to work in practice. First, employers already can offer fertility benefits if they want to. The guidance asks employers to shoulder as much as $25,000 per IVF cycle for an employee’s medical care when many businesses already struggle to provide basic health insurance to staff.
And unlike vision or dental plans, where low costs are spread across most employees, a standalone IVF plan would only attract the small fraction of workers who need expensive treatment, meaning premiums would almost certainly go up for them.
The TrumpRx discounts, meanwhile, would not help most patients. Most people purchase fertility drugs through their health insurance, meaning they can’t use the TrumpRx site even if its prices are lower. And even for those paying in cash, the discounts target a narrow slice of the overall bill. Drug costs make up a relatively small share of IVF expenses; most costs come from lab work, procedures, and embryo storage. The White House estimates their discounts will save patients up to $2,200, or less than one-fifth of the cost of one IVF cycle. Despite the lack of real relief for patients, many on the right were not thrilled, either.
Despite lobbying pressure, the Trump administration did not back down from vocally embracing IVF, either as a means to help patients experiencing infertility or as a tool to boost the country’s birth rate. When asked at his Thursday press conference what message Trump had for religious conservatives opposed to IVF, the president shrugged it off. “This is very pro-life,” he replied. “You can’t get more pro-life than this.”
What the Trump administration could have done to lower costs
The president declined to take the more ambitious steps available to him to expand access to IVF.
One option the administration left on the table was expanding the list of “essential health benefits” — the set of services that all individual and small-group insurance plans must cover, which already includes maternity and newborn care — under the Affordable Care Act. The Department of Health and Human Services had the power to require marketplace insurers to cover at least part of the procedure and establish a basic national floor for fertility coverage. New York has already done something similar at the state level, mandating that large-group insurers cover up to three IVF cycles.
Adding IVF to the list of “essential health benefits” wouldn’t have made it free, but it could have reduced the out-of-pocket costs by tens of thousands of dollars, expanding coverage for nearly 50 million Americans. Yet, Republicans have long fought to weaken or roll back the list of essential health benefits, arguing that the ACA’s coverage requirements drive up premiums and limit consumer choice.
The administration also could have expanded IVF coverage within the federal government’s own health plan, which covers roughly 8 million federal workers, retirees, and their families. The Office of Personnel Management has the authority to require participating insurers to offer fertility benefits, and the Biden administration used that same power in 2023 to mandate coverage for egg and sperm freezing.
Beyond executive action, the administration could have pushed Congress for more ambitious measures: tax credits for employers offering fertility benefits, direct federal subsidies for treatment costs, or expanded Medicaid coverage. It declined to spend political capital on any of these solutions.
Applause, outrage, and a familiar pattern
The rollout of Trump’s proposal was predictably fractured. Fertility groups lauded the White House for publicly championing IVF after months of uncertainty. In a statement, Sean Tipton of the American Society for Reproductive Medicine praised the administration for “using [its] platform to draw attention” to the fertility treatment gap in employer-provided health plans and for working with drug companies to tackle costs. RESOLVE: The National Infertility Association struck a similar tone, telling The 19th that Trump’s announcement marked “an important step forward.” Back in May, both national organizations said they had not been consulted by White House officials exploring IVF ideas.
Democrats and abortion rights groups, meanwhile, dismissed the proposals as hollow.
Reproductive Freedom for All president Mini Timmaraju said the announcement was another attempt “to gaslight the American public into believing he’ll deliver on empty campaign promises.”
Other anti-abortion groups condemned the policy outright. “IVF kills more babies than abortion,” Live Action’s Lila Rose wrote on X, while Students for Life president Kristan Hawkins said she was “thankful there’s no new healthcare mandate” but called the president’s ideas a disappointment. “It’s time to find real solutions that help families grow and flourish without killing Life in the process,” Hawkins stressed. Other anti-IVF groups like Us Before Them blasted the White House for delivering “a full federal endorsement of an industry that treats children as products to be ordered, screened, stored, and discarded.”
Some social conservatives initially tried to spin Thursday as a victory, since the administration had avoided more aggressive mandates. “It should be counted as a win for the traditional social conservative movement, which tirelessly pointed out the huge financial, ethical, and moral risks associated with a federal guarantee or mandate of IVF coverage,” Patrick Brown, of the conservative Ethics and Public Policy Center, said on X. He later walked that back slightly, telling me it was perhaps “not a ‘win’ but it’s also definitely not a ‘loss.’”
Still, the expectation that Trump would mandate taxpayer-funded IVF was always far-fetched. Fiscal conservatives had loudly opposed the idea, with senators like Rand Paul calling it “ridiculous” and Lindsey Graham warning of unlimited costs. Even former Trump administration economist Vance Ginn — who used IVF for two of his own children — argued against a government mandate, pointing to soaring deficits and constitutional concerns.
In the end, the winner was Trump, who earned glowing national media coverage for his extremely modest proposals. For most Americans, “making IVF more affordable and accessible” sounds like meaningful progress, even if it falls far short of the campaign promise to make it free. It’s the same performative moderation that has worked for him since the overturn of Roe v. Wade — promising to veto a national abortion ban even as his administration quietly reinstates funding restrictions, backs lawsuits targeting abortion medication, and fills agencies and courts with officials eager to narrow access.
The outcome was predictable: Trump gets credit for tackling a popular issue without spending the political capital to actually solve it.
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