Close the infertility treatment coverage gap

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Former President Donald Trump has put forward a bold new health policy proposal that’s both compassionate and family-friendly: mandating insurance coverage of in vitro fertilization (IVF), a well-known and expensive infertility treatment that many in Minnesota and elsewhere now pay for out of their own pockets.

Trump, a Republican seeking a second term, announced the initiative in late August at a campaign stop in Michigan. There were few details, such as whether other infertility treatments would be covered. Another key question unanswered: whether his own political party would provide the support to enact the requirement into law.

In June, Republican opposition blocked a Senate bill introduced by Sen. Tammy Duckworth, an Illinois Democrat, that would have required infertility treatment insurance coverage across the nation, as well as protected patients’ right to access the treatment if there are state-level efforts to restrict it.

Taking all that into account, there’s still value in Trump’s support, particularly the powerful spotlight it puts on this frustrating coverage exclusion. While 22 states have put at least partial remedies in place, Minnesota regrettably isn’t one of them. During the 2024 session, a bill to require coverage for infertility diagnosis and treatment lacked sufficient support at the State Capitol to become law.

Perplexing coverage carve-outs have long been a reality even for those with good health insurance. Among them: dental and vision care. Needing a separate plan for your teeth is especially mystifying, with oral health critical to overall good health and quality of life.

Infertility treatments have long been in the no-go coverage zone as well, even though infertility is a physiological problem and one that’s widespread. A 2018 article in the JAMA family of publications reports that “12.1% of women have impaired fecundity (the ability to conceive biologic offspring), and 6.7% of married women are infertile. Among men in that age group, the rate of infertility is 9.4%, with 15.8% of married men aged 25 to 44 classified as infertile or subfertile.”

The American Medical Association recognizes infertility as a disease. So why do so many people who want to become parents so often have to pay for it?

Just “56% of employers with 500 or more employees cover some type of fertility service but most do not cover treatment services such as IVF, IUI, or egg freezing,” according to KFF, a nonpartisan health policy organization. “Coverage is higher for diagnostic evaluations and fertility drugs.”

That’s a problem when infertility treatment can cost thousands. In 2024, total bill for a single cycle of IVF, for example, can run between $15,000 and $20,000, according to a Forbes Health estimate.

Even non-IVF treatments don’t come cheap. State Sen. Erin Maye Quade, DFL-Apple Valley, relied on a treatment called intrauterine insemination (IUI), to conceive her daughter, Hattie, now 2. The total cost came to around $12,000, with her family spreading out the payments to help make it affordable.

Maye Quade recognizes that not everyone can afford this, even with spread-out payments. That’s why she was the chief Senate author on a bill to require infertility treatment coverage in Minnesota. It’s also why she commendably will try again in 2025 after the legislation didn’t pass in 2024.

“I hope that this can be a unifying issue. People do not experience infertility on a partisan basis,“ Maye Quade said in an interview. “This is as family issue. It demands the Legislature’s attention.”

There were no Republican co-authors on either the House or Senate versions of the 2024 legislation. The party has a long history of opposing coverage mandates or expansions. Concerns rooted in religion about the storage and disposition of embryos may also be a factor. Maye Quade’s push to include public health programs, such as MinnesotaCare and Medical Assistance, may have been a factor as well.

Cost is another reason why the bill lacked wider support. Lucas Nesse, head of the Minnesota Council of Health Plans, said in an interview that this insurance trade organization didn’t take a position on the legislation. But he also noted that expanding coverage can lead to higher consumer insurance costs. That’s a fair concern.

But a 2023 Minnesota Department of Commerce report suggests that the price for mandating infertility treatment in the state would be manageable. The agency analyzed the impact on enrollees in private health plans regulated by the state of Minnesota. It concluded the average cost of the proposed infertility coverage mandate would be $1.30 per member per month, rising to $2.20 per member per month in 10 years.

Even if passed, the Minnesota legislation would only be a partial remedy. Many large employer health plans are regulated by the federal government, not the state. So congressional action, like in Duckworth’s bill, is imperative.

Still, the Minnesota bill would be a good start while Congress considers its next steps. While questions about Trump carrying out his campaign promise are legitimate, having this issue spotlighted by him at this moment is valuable, especially if it encourages members of his own party to newly lend their support to close this unfortunate coverage gap.