Could Trump administration usher in mandates to cover IVF treatment? Maryland is there already.

Nov. 11—Candidate Donald Trump vowed, if elected, that the government would cover IVF treatment for all Americans or mandate that insurers pay for the costly medical service.

After last Tuesday's election, advocates of making fertility treatments more affordable and accessible are uncertain about what lies ahead under the new administration, as Trump offered no details of his plan during the August statement to NBC News.

Maryland is one of a handful of states that already has such health insurance mandates in place, where certain policies must cover the cost of IVF. It's also home to the Rockville headquarters of one of the nation's largest fertility clinics, Shady Grove Fertility, which touts more than 100,000 babies born.

Expanding such health benefits nationwide, "would be fantastic for our patients and something we hope comes to pass," said Joyce Reinecke, executive director for the Alliance for Fertility Preservation, which focuses on serving women with cancer. "The need to build families is something that cuts across every political group. Infertility care is part of the continuum of reproductive care and medical services people need access to."

But some advocates remain skeptical about the next president's ability to bring about such sweeping change. It has faced opposition in Congress and has become tangled up in the political debate over abortion.

"The former president has been all over the map in terms of what he says about abortion access, about reproductive rights and about access to different forms of reproductive health care," said Jocelyn Frye, president of the National Partnership for Women & Families. "There is an active effort to really deny folks access to IVF and other sorts of reproductive health care. People are right to be worried."

Cost is the number one barrier to medical treatment, according to the National Infertility Association. The group, which advocates for expanding infertility treatment access and coverage, says that 46% of people lack any insurance coverage for infertility.

A bill before Congress would put in place a federal IVF insurance mandate. A representative of the American Society for Reproductive Medicine said it makes more sense to require insurance coverage rather than publicly funded treatment because most people get coverage through employer-based plans.

"Everybody who has some kind of health insurance would have coverage that included infertility," said Sean Tipton, chief advocacy and policy officer. "People think that insurance covers you when you get sick, and for fertility patients, it too often does not. This bill would fix that."

Senate Republicans, however, have not backed the idea, with some opponents arguing it would lead to higher premiums.

After a failed vote to advance the bill in September, Sen. John Thune said Republicans support IVF.

"This is simply an attempt by Democrats to try and create a political issue where there isn't one," the Republican from South Dakota said, according to reports.

Patient advocates and health professionals argue that premiums have not been shown to increase in states that require coverage. Analyses have shown an increase of only pennies on the dollar in per-member costs, for patients seeking fertility preservation, Reinecke said. That can include banking of eggs, ovarian tissue or embryos in advance of needing to undergo medical treatment such as chemotherapy that could threaten fertility,

"Health insurance exists to spread the costs of health care among a big general pool, and to make that work, you have to cover everything," Tipton said.

About 20 states, including Maryland, have passed laws requiring health insurance to cover infertility diagnosis and/or treatment. Seven states have "fertility preservation laws" to cover medically-induced infertility. Self-insured plans used by multi-state employers follow federal law and are exempt from state law. Exemptions also exist for employers with fewer than a set number of workers.

In Maryland, health and hospital insurance policies that are issued within the state and offer pregnancy benefits also must cover the cost of IVF. The state in 2021 stopped requiring patients to be married to receive benefits. Insurance covers three IVF attempts per live birth, not to exceed a lifetime benefit of $100,000. Patients may be required to have tried less expensive treatments first.

Businesses with 50 or fewer employees are exempt, while religious organizations may be exempt if beliefs and practices prohibit IVF. Under new regulations, Maryland became one of the first states in which Medicaid coverage extends to preservation treatment.

The state is home to Shady Grove Fertility which calls itself a national leader in fertility research, and has locations throughout the Baltimore region. The center's website says nearly three-fourths of patients have some coverage for infertility treatment and 90% have coverage for their initial consultation.

"[Shady Grove Fertility] is of course supportive of any measures that might enable or increase patient access to care," said Megan Augustine, a spokeswoman.

Coverage for infertility treatment has expanded over the past seven or so years as states have passed and expanded mandates for coverage of both preservation and treatments such as IVF.

"I'm hopeful that that trend will continue and that these vulnerable patients continue to be protected," aid Reinecke, whose group focuses on cancer patients who often must undergo treatment that causes infertility. "I do think it would be unfortunate if that promise was not fulfilled."

Reinecke said Trump's comments caught her off guard, particularly after the U.S. Supreme Court's reversal of federal abortion rights two years ago and the February ruling by the Alabama Supreme Court that embryos created through IVF should be considered children. That case has raised concerns about clinics' legal ability to offer treatment in some states, even if federal coverage passes.

While IVF enjoys "enormous" support that cuts across the political spectrum, "if people wanted to protect it, they would protect it," said Frye, of the Women & Families group. "At the end of the day, there is a cohort of people who really want to deny access to a wide range of reproductive health care."

Amid such a backdrop, however, an increasing number of large employers have begun offering infertility treatment coverage, viewing it as a way to attract young workers. Companies such as Google, Apple, Microsoft and Amazon offer such benefits, often through third-party vendors.

Amazon boasts that more than 30,000 of its employees in the U.S. have used benefits such as IVF, egg freezing and genetic testing, offered to all covered employees regardless of gender, sexual orientation and relationship status.

"Now more than ever, employees are looking to their employers for support in all areas of their lives," Lian Neeman, Amazon's global director of benefits, said in describing the benefit on the company's website. Neeman said the benefit helps to "reduce anxiety around what can be a confusing and stressful process."

It's difficult to say what share of treatment is generally covered by insurance because insurers and employers consider it proprietary, Tipton said. In his view, employer opposition remains a key obstacle.

"All we're pushing for is that disorders of the reproductive system be treated like any other medical condition," he said.

Have a news tip? Contact deputy managing editor Jay Judge at [email protected].

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