White House has no plan to mandate IVF care, despite campaign pledge

The White House does not plan to require health insurers to provide coverage for in vitro fertilization services, two people with knowledge of internal discussions said, even though the idea was one of President Donald Trump’s key campaign pledges.

Last year, Trump said that if he returned to office, the government would either pay for IVF services or issue rules requiring insurance companies to cover treatment for it. The pledge came as Trump faced political blowback over abortion rights after his appointees to the Supreme Court helped overturn Roe v. Wade.

“The government is going to pay for it, or we’re going to get — we’ll mandate your insurance company to pay for it, which is going to be great. We’re going to do that,” Trump said in August 2024. “We want to produce babies in this country, right?”

More than six months into his second term, however, the Trump administration has not publicly proposed new federal subsidies to make IVF free or more affordable. In addition, White House officials are backing away from proposals discussed internally to mandate IVF coverage for the roughly 50 million people on the Obamacare exchanges, said the people, who spoke on the condition of anonymity to describe private conversations.

A senior administration official, who also spoke on the condition of anonymity to discuss internal talks, said that while expanding IVF access remains a “huge priority” for Trump, the president can’t legally make IVF an essential health benefit without Congress first approving legislation to do so. It is unclear whether the administration plans to ask lawmakers to take up a bill, but the two people said that forcing insurance companies to cover IVF is not currently on the table.

Kaylen Silverberg, an outside adviser to the administration who has been pushing for more IVF access, also said in an interview that the White House has most recently asked him about a fertility approach that prioritizes holistic health over tools like IVF. Implementing that alone would fall “very short” of Trump’s initial promises, Silverberg said.

A White House spokeswoman also said Trump is still working to fulfill his commitment to expand IVF.

The situation reflects the GOP’s internal divisions on both IVF coverage and federal policy for families.

Social conservatives alarmed by the nation’s falling birth rates have called for more aggressive government intervention to support mothers and childbirth, including new federal funding and other protections. But their efforts have faced objections from traditional free-market voices in the party, who are wary of federal mandates or new spending initiatives.

Requiring the Affordable Care Act exchanges to cover IVF, for instance, would lead insurance companies to raise premium costs, which could prove politically damaging for the GOP ahead of the 2026 midterm elections.

“How do you do this without burdening health insurers? That’s the key question they’ve been wrestling with,” one of the people familiar with the discussions said. “It appears for now that they’re not going to go there.”

Shortly after taking office, Trump signed an executive order giving the White House Domestic Policy Council 90 days to present a list of policy recommendations for protecting IVF access and “aggressively reducing out-of-pocket and health plan costs for IVF treatment.” The order stated that IVF treatments can cost $12,000 to $25,000 per cycle.

But numerous other conservative policy experts have expressed objections. Avid Roy, founder of the Foundation for Research on Equal Opportunity, a think tank that promotes free markets, said the move could increase premiums by several percentage points for tens of millions of Americans on the exchanges, as insurers absorb higher costs.

“Anytime you layer on something as an essential health benefit, it increases premiums,” Roy said. “To whatever degree people are pushing back for that reason as a policy matter, that’s always been the debate.”

Patrick T. Brown, a conservative who supports pro-family policy at the Ethics and Public Policy Center, also pointed out that it’s not clear whether IVF could legally count as an essential health benefit, which typically only applies to services broadly offered by insurers.

“It’s more uncommon than not for IVF to be currently covered,” Brown said. “So it’d be a pretty elastic ruling.”

Roughly 24 million people are enrolled in the ACA’s individual plans, while another 22 million are in small business plans for fewer than 100 employees. That represents fewer than 20 percent of the total population — far short of Trump’s suggestion that the government or insurers would cover IVF for all Americans — though private insurers typically cover essential health benefits voluntarily.

Silverberg, chair of Americans for IVF’s advisory board, has been advising the White House Domestic Policy Council on potential ways to increase access to IVF and lower costs. He said administration officials have called him repeatedly with questions, and he met with Chief of Staff Susie Wiles and Domestic Policy Council Director Vince Haley at the White House in April.

He said he’s been impressed by their questions and attention to the subject: “I get the impression they’re very serious.”

During his most recent conversation with the White House about two weeks ago, officials also asked him about “restorative reproductive medicine.”

Restorative reproductive medicine suggests women should treat infertility by attempting to improve their overall health and has been promoted by the Heritage Foundation. When used as the only or primary method to treat infertility, RRM can unnecessarily delay access to IVF because lifestyle changes are already a part of most fertility treatment plans, according to the American College of Obstetricians and Gynecologists.

“We’re fine and dandy with that being part of what the ultimate solution is,” Silverberg said, adding that “every responsible fertility physician” already asks patients to make lifestyle changes before advancing to IVF. “But we don’t want to be forced to ignore 40 years of scientific research that has resulted in the development of all these new technologies that not only can help people conceive, but conceive quicker and conceive healthier babies.”

“You can’t seriously claim you’re pursuing pro-natalist policy when you’re kicking moms off Medicaid and when you’re leaving kids with less food,” said Bobby Kogan, senior director of federal budget policy at the Center for American Progress, a center-left think tank.

But Sen. Katie Boyd Britt (R-Alabama), who last year introduced legislation to withhold Medicaid funding to any state that bars IVF, argued that the GOP law included several provisions that can help families have children.

The law increased the child tax credit from $2,000 to $2,200 and ties it to inflation, expanded the child and dependent care tax credit, and increased incentives for employers to cover child care expenses.