Social and religious conservatives spent more than a year lobbying first the Trump campaign and then the administration against mandating or subsidizing insurance coverage of in vitro fertilization, which they consider akin to abortion.
Last week, their work paid off.
President Donald Trump unveiled policies to lower the cost of fertility drugs and to create a new pathway for optional employer-based coverage of IVF, arguing the moves would make it easier for couples to have children. But Trump, who promised on the campaign trail to make fertility treatments free for all patients, will not have the government pay for it or require insurance companies to cover the cost.
“There were letters and meetings and calls — a lot of activity,” said Kristi Hamrick, the lead federal policy strategist with Students for Life of America, an anti-abortion group. “We told [the Trump administration] that it would be an absolute violation of people’s conscience rights to force taxpayers to subsidize IVF, which has the business model that destroys more life than is ever born.”
The White House’s decision to stop short of an IVF mandate or taxpayer-funded program highlights the power that social conservatives and anti-abortion advocates still wield within the administration — even as their agenda has at times clashed with the secular flank of the GOP’s natalist wing that wants more government intervention to help families have children.
In a sign of how seriously they took the groups’ arguments, administration officials held a briefing call for a select group of activists ahead of last week’s announcement to address their fears of a coverage mandate. According to two anti-abortion advocates on the call, granted anonymity to discuss the private event, the White House did not take questions.
A White House official, granted anonymity to speak candidly about behind-the-scenes conversations, confirmed both the call and the key role anti-abortion groups played in developing the policy. Their influence ensured that no employer is obligated to cover IVF, that no federal funding supports it, and that new coverage options can include alternative fertility treatments promoted by groups who oppose abortion.
“It’s providing flexibility, not just in an ideological sense, but just in a medical sense,” the official said. “It would be bad policy just to push everyone onto IVF.”
Threading the needle
Trump promised in debates and interviews in the closing stretch of his 2024 campaign to either have the government cover the cost of IVF or mandate that insurance companies pay for the procedures. That kicked off a lobbying blitz from abortion opponents, many of whom — but not all — believe the fertility treatments are morally wrong because they involve the creation and destruction of multiple embryos.
“A lot of people met with different people within the administration over the last eight months to say, ‘This is not pro-life. This is not going to raise birth rates. This pumps money into an industry that a lot of pro-lifers have great concerns over, because of the potential for eugenics. So let’s tap the brakes on this,’” said Patrick Brown, a fellow at the conservative Ethics and Public Policy Center, one of several groups involved in the effort.
Their pressure campaign ramped up in February after Trump signed an executive order on “expanding access to in vitro fertilization,” and the White House Domestic Policy Council began hosting meetings and calls with two camps often in conflict: IVF proponents, including fertility doctors, and anti-abortion groups.
The former group pitched the White House on a number of policies to expand access to IVF, from mandating employer coverage at no cost to patients to using federal family planning dollars to pay for fertility care.
The anti-abortion camp, meanwhile, pushed the Domestic Policy Council in the opposite direction. It urged the administration to move away from IVF and instead promote “restorative reproductive medicine,” an approach that aims to address the root causes of infertility that conservative groups argue aligns with Health Secretary Robert F. Kennedy’s “Make America Healthy Again” agenda.
Mainstream patient advocacy groups like RESOLVE: The National Infertility Association also submitted recommendations, but were not invited to meetings or briefing calls, the group’s leaders told POLITICO.
The Domestic Policy Council sent a list of policy recommendations based on those conversations to Trump in May, but it languished for months without action.
The policy the White House announced last week tries to thread the needle between the two approaches, by encouraging but not requiring employer coverage and by allowing coverage of restorative reproductive medicine as well as IVF under a yet-to-be-detailed program. Officials are also expediting approval of a new fertility drug used abroad for use in the U.S., arguing that more competition in the market will make the drugs cheaper.
Roger Severino, a former Trump health official now at the Heritage Foundation, a conservative think tank, said Trump’s ability to convince “Big Fertility to immediately drop their IVF drug prices by half” vindicates his view that drug companies have “for years been taking advantage of the vulnerability of infertile couples.” He also praised the White House’s policy for sidestepping what he considers “conscience violations,” including taxpayer support for IVF or federal coverage requirements.
In his Oval Office announcement, Trump said of the new policies: “You can’t get more pro-life than this.”
Still, the announcement intended to please everyone drew swift backlash.
Some anti-abortion conservatives, including the Catholic Church, blasted the White House for going too far in promoting a practice they view as immoral, while IVF patients, health care experts and Democratic lawmakers argued the actions did not go far enough — calling the announcement “political theater,” a “nothingburger,” and “yet another one of Trump’s broken promises.”
“It feels like a lot of hand waving in the direction of an IVF benefit that will not translate to an actual IVF benefit becoming available to people,” said Adrianna McIntyre, an assistant professor of health policy and politics at Harvard University.
Even some conservatives who saw the announcement as “kind of a win” were displeased that the administration used its bully pulpit to tout IVF.
“‘It could have been worse,’ is not a victory, per se” Hamrick said, adding that Trump’s health officials should be as skeptical of the IVF industry as they have been about vaccines and food dyes. “It was a swing and a miss. It was disappointing. But at least it’s not a mandate. That would have been an absolute loss.”
Other major groups involved in the pressure campaign, including Susan B. Anthony Pro-Life America and Americans United for Life, were noticeably silent about the new policies, issuing no press releases or social media posts about them.
Several others, meanwhile, celebrated that Trump did not designate IVF an “essential health benefit” under the Affordable Care Act, which would have meant insurers had to cover it. The policy also dispelled conservatives’ fear — and dashed fertility advocates’ hopes — that the administration would require broader IVF coverage for federal employees and military members or use various carrots and sticks to push more employers to cover the procedure.
“It wasn’t as brute force of an approach as he was talking about on the campaign trail,” said Brown. That the new policies “won’t have that much of an effect is actually a win,” he added, and “a sign that the pro-life movement still has some real juice.”
‘Massive thing’ or ‘nothingburger’?
Some fertility advocates who consulted with the White House as it developed the policies also saw the announcement as a resounding win, arguing that fertility drugs will become significantly cheaper for patients and more small- and medium-sized employers will opt into fertility coverage.
“The right-to-lifers can say whatever they want but this is going to be a massive, massive thing,” said Kaylen Silverberg, a reproductive endocrinologist in Texas who treats infertility and advised the White House. “All I care about is that my patients win.”
Silverberg, who attended a separate pre-announcement Zoom call between the White House and others who had advised the Domestic Policy Council, said administration officials have made “very clear this is not the end of the conversation” and that there is “more to come.”
Americans for IVF, an advocacy group whose advisory board Silverberg chairs, is drafting legislation to propose to Congress “to give the president some more options.”
The White House official conceded the administration is unlikely to take further steps without action from Capitol Hill.
“I think what we can do via executive action we’ve done in a very overarching way,” the official said.
Yet the policy’s practical impact appears limited, and it’s unclear who will benefit and when. Fertility specialists note that the newly discounted drug represents a small fraction of the average $20,000 cost of a single IVF cycle, and the administration has done nothing yet to curb the costs of the consultations, lab tests, embryo storage or implantation surgeries that put the procedure out of reach for many.
And because the new rules make employer coverage optional rather than mandatory, and separate from regular health plans, experts say they are unlikely to significantly expand access or lower prices. Though the Trump administration compared it to supplemental vision and dental insurance, patient advocates and fertility care providers argue it would have much more “selection bias,” with only those planning to undergo IVF signing up for a plan.
“Insurance works by spreading the risk amongst everybody participating, but this is not going to do that,” said Sean Tipton, the chief advocacy and policy officer at the American Society for Reproductive Medicine, which represents doctors that work in the field. “So there are a lot of questions as to what the utility will be.”
Tipton and other experts stressed that U.S. employers are already able to offer IVF coverage for their workers either as part of their regular health insurance or as a supplemental plan. With no mandates or subsidies from the Trump administration, it’s not clear why any that don’t already do so would begin now.
Flory Wilson, the founder and CEO of the Reproductive & Maternal Health Compass, a group that advocates for better coverage of reproductive services in employer health insurance, said she heard crickets from the business community after Trump’s announcement.
“No one’s really talking about it. It’s a nothingburger,” she said. “I just don’t see how this is moving the needle in any meaningful way.”
