More than six months into President Donald Trump’s second term, the White House has no plans to require health insurers to cover in vitro fertilization (IVF) services—despite a high-profile campaign pledge to make the treatment more accessible.
Two individuals familiar with internal deliberations confirmed that the administration has not advanced proposals to mandate IVF coverage, nor has it introduced federal subsidies to reduce the cost of treatment, which can range from $12,000 to $25,000 per cycle. The move marks a significant retreat from Trump’s 2024 campaign rhetoric, in which he vowed to make fertility care widely available.
“The government is going to pay for it, or we’re going to get — we’ll mandate your insurance company to pay for it,” Trump said in an August 2024 campaign speech. “We want to produce babies in this country, right?”
Inside the White House, officials are now distancing themselves from early discussions about requiring coverage through the Affordable Care Act (ACA) exchanges, which serve around 50 million Americans. According to sources who spoke on condition of anonymity, IVF mandates are not currently on the table, largely due to legal constraints and political concerns.
A senior administration official acknowledged that expanding access to IVF remains a “huge priority” but stressed that the president cannot unilaterally make IVF an essential health benefit under the ACA without legislative action from Congress.
Outside adviser Kaylen Silverberg, who has been in regular communication with White House officials, said recent discussions have shifted toward alternative approaches that emphasize holistic health over assisted reproductive technology. While he acknowledged the value of overall health improvements, Silverberg cautioned that such methods fall short of the president’s original commitment.
“Every responsible fertility physician already includes lifestyle changes in treatment plans,” he said. “But we don’t want to ignore 40 years of scientific advancements in IVF that can help people conceive more quickly and safely.”
In a statement, White House spokeswoman Abigail Jackson said the administration remains dedicated to expanding fertility treatment access. “President Trump pledged to expand access to fertility treatments for Americans who are struggling to start families,” she said. “The Administration is committed like none before it to using its authorities to deliver on this pledge.”
Divisions Within the GOP
The retreat underscores ongoing tensions within the Republican Party over family policy and federal intervention. Social conservatives, concerned by declining birth rates, have advocated for aggressive measures to support childbirth—including government-funded fertility treatment. However, traditional conservatives remain wary of mandates and new public spending.
Mandating IVF coverage under the ACA could also increase insurance premiums, a move that some fear could be politically damaging ahead of the 2026 midterms.
“How do you do this without burdening health insurers? That’s the key question they’ve been wrestling with,” one person familiar with the matter said. “It appears for now that they’re not going to go there.”
Trump signed an executive order shortly after returning to office, directing the Domestic Policy Council to recommend ways to reduce IVF costs and protect access. While internal debates explored making IVF an essential health benefit, such a designation would require that the treatment already be widely offered by insurers—something experts say is not the case.
Conservative policy analysts such as Avik Roy, founder of the Foundation for Research on Equal Opportunity, warned that forcing coverage could raise premiums by several percentage points. “Anytime you layer on something as an essential health benefit, it increases premiums,” Roy said.
Others, like Patrick T. Brown from the Ethics and Public Policy Center, questioned the legal foundation for including IVF in the essential benefits list. “It’s more uncommon than not for IVF to be currently covered,” Brown said. “So it’d be a pretty elastic ruling.”
Limited Reach, Ongoing Debate
Currently, approximately 24 million Americans are enrolled in ACA individual plans, with another 22 million in small business plans. This combined group—less than 20% of the U.S. population—is far smaller than the sweeping coverage Trump promised on the campaign trail.
“There were no details provided by Trump during the campaign as to how this would work, who would be eligible and how it would relate to health insurance coverage,” said Larry Levitt, executive vice president for health policy at KFF.
Silverberg, who chairs the advisory board of Americans for IVF, said he’s had multiple meetings with administration officials, including Chief of Staff Susie Wiles and Domestic Policy Council Director Vince Haley. He believes the administration is sincere but still uncertain on execution.
“They’re very serious,” he said. “But it’s clear they’re still exploring their options.”
Among those options is “restorative reproductive medicine” (RRM), a treatment philosophy backed by groups like the Heritage Foundation. RRM encourages improving general health to address infertility but has been criticized for delaying or replacing more effective technologies like IVF.
The American College of Obstetricians and Gynecologists warns that RRM alone can postpone effective treatment and reduce the likelihood of success.
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