Assistance with fertility care is an urgent need for many families across the United States. According to findings from the 2024 Kaiser Family Foundation(KFF) Women’s Health Survey, one in eight reproductive-age women said that they or their partner needed fertility services to help them become pregnant or prevent a miscarriage. Fifteen states require some private insurers to cover some fertility treatment, but significant gaps in coverage remain. Only one state Medicaid program covers any fertility treatment, and no Medicaid program covers artificial insemination or in vitro fertilization.
Following the Dobbs decision, the future of assisted reproductive technology (ART) has been in question. In February 2024, the Alabama Supreme Court issued a ruling declaring frozen embryos in that state to be “unborn children” for the purposes of civil liability under Alabama’s wrongful death statute. Following national outrage from the decision, in March 2024, Alabama passed a law that provides immunity from civil and criminal charges for in vitro fertilization (IVF) patients and providers, which helped restart IVF services. However, this law did not overturn the state Supreme Court’s decision, keeping the legal status of embryos as “children” under the wrongful death statute.
In response to the uproar over the Alabama case, Senate Republicans announced support for protecting nationwide access to IVF. During the 2024 presidential campaign, Donald Trump pledged to make IVF free. On February 18, 2025, President Trump signed an executive order aimed at expanding access to in vitro fertilization (IVF). Following that executive order, on October 16, 2025, the White House revealed plans to offer discounts on certain IVF medications through a new government website, TrumpRx.gov. The White House also stated that it would work to develop more options for employers to voluntarily assist with fertility and family formation costs for their employees and dependents.
Following the White House’s announcement, the American Society for Reproductive Medicine (ASRM) issued a statement noting that, although the initiative was presented as a breakthrough for affordability, “key details about its implementation, scope, and equity remain unresolved.” Regarding legal considerations, they noted that classifying fertility coverage as an “excepted benefit” could undermine consumer protections under the Affordable Care Act (ACA) and the Employee Retirement Income Security Act (ERISA). Additionally, the announcement did not address the issue that across the country states are still navigating an evolving legal landscape that is emerging from disputes about pre-embryos making their way to court.
Many patients lack access to fertility services mainly because of high costs and limited coverage from private insurance and Medicaid. This initiative has no impact on existing state coverage mandates. As stated in the American College of Obstetrics and Gynecologists’ response to increase access to comprehensive care, employer-sponsored insurance plans should be both affordable and universally available. Coverage of IVF benefits can vary significantly and may not fully cover the entire cost of an IVF cycle, which typically ranges from $15,000 to $20,000. Many individuals facing infertility may need more than one IVF cycle. The cost of medication is just one part of the IVF process; discounts on these medications do not significantly lower the total expenses, which usually include both procedural and lab fees. As noted by KFF, laws regarding IVF insurance coverage vary, often limiting benefits to those with an infertility diagnosis and excluding single people and same-sex couples, and they do not apply to self-funded employer plans. The White House announcement leaves important gaps unaddressed. It also omits the 16 million reproductive-age individuals enrolled in Medicaid, who, even with a discount through TrumpRX, would find these treatments prohibitively expensive.
Senate Republicans have had the opportunity to support legislation that would provide comprehensive coverage of IVF and other ART treatments. However, despite their declared support, they blocked the passage of the Right to IVF twice, first in June and then in September 2024, legislation that would establish a right to IVF and ART, and help lower the costs of IVF treatments through expanded coverage. Republicans have cited increased costs to medical plans as their main concern with the bill, even though in 2024, 97% of large employers voluntarily offered fertility benefits reported no significant increase in costs to their medical plans. Despite this, the Access toFertility Treatment and Care Act, which would require most private insurance plans, as well as plans offered by Federal Employees Health Benefits Program, Medicaid, TRICARE, ERISA, and VA to provide coverage for treatment of infertility without any insurance or copays, remains a partisan bill. While the discounts are a step in the right direction, they fall short of truly enabling families to access the care they need.