Vanessa Brown Calder
On the campaign trail last week, former President Trump promised that under a future Trump administration, “government will pay” or “your insurance company will be mandated to pay” for all IVF treatment costs. Trump described the policy in pro-natal terms (“we want more babies”) and said he has always been in favor of IVF.
It is certainly positive to see the top of the Republican ticket vocally in favor of in vitro fertilization (IVF), particularly in light of recent comments by conservative critics. There are many reasons to support the procedure, which resulted in around 97,000 infants born in the most recent reporting year and constitutes the most successful way to treat a range of fertility issues.
However, for a variety of reasons, Trump’s plan to subsidize or mandate IVF is a mistake. Paying for IVF at the federal level would be extremely costly, it could create perverse fertility incentives, and the government should not compel taxpayers or religious employers to subsidize a procedure some disagree with.
First, subsidizing IVF would be enormously expensive. Subsidizing IVF would cost around $7 billion annually or about the annual cost of public housing or the Head Start program. This estimate assumes that 413,776 assisted reproductive technology (ART) cycles are performed annually, IVF constitutes more than 99 percent of ART procedures/cycles, the average IVF cycle costs between $15,000 and $20,000, and potential beneficiaries do not change their behavior in response to the policy.
However, new incentives are likely to change behavior. So a static estimate likely understates the true long-term cost of the program. For instance, most IVF patients are currently self-pay, limiting IVF use. Moreover, government-funded IVF would induce couples to delay childbearing or engage in elective fertility preservation, leading to growing use and reliance on fertility treatment over time.
As Jeff Singer, MD, mentioned Friday, if the government mandates that insurance companies provide IVF coverage, this will likely raise premiums as providers pass costs onto consumers. If insurance companies are required to provide IVF coverage, incentives for providers to offer competitively priced IVF will evaporate as many patients become less price-sensitive overnight.
The behavioral changes associated with a government program or mandate mean that although IVF use would increase, the policy may not ultimately be pro-natal. Patients and the public are not fully aware of IVF’s limitations, and declining births could result when patients are overly optimistic about IVF success.
Studies find that positive anecdotes and media portrayals of IVF distort patient perceptions. In a 2022 study, the average IVF patient expected a 59 percent success rate, whereas doctors’ average prospective estimate of patient success was nearly half that, at 30 percent. A 2021 study similarly found that women’s estimates of IVF success were vastly unrealistic.
Although IVF is a miracle for many couples, IVF success declines dramatically with patient age. According to CDC data, IVF procedures result in a baby about 50 percent of the time for women younger than 35, but less than 8 percent of the time for women older than 40. The promise of a government-funded fertility insurance policy could lead would-be parents to put childbearing off, only to realize childbearing is impossible later, even with reproductive technology’s help.
Finally, although certain critics’ claims about IVF are exaggerated and do not hold up to scrutiny, it is nonetheless the case that some religious people disagree with the use of reproductive technology, including IVF. Taxpayers, employers, and insurance providers should not be required to subsidize activities for which they object.
In summary, although Trump’s vocal support for IVF is welcome, Trump’s proposal is a mistake. Preserving individual freedom and protecting IVF from regulations that limit its efficacy is a good idea; subsidizing or mandating coverage is not.