Donald Trump last week promised universal, free access to in vitro fertilization treatments. But as always, pay more attention to what politicians do than to what they say. And his past presidential record suggests that a second Trump term would be unequivocally bad for access to fertility care.
Then there are the cruel comments from GOP vice-presidential candidate JD Vance about “childless cat ladies.” Vance has since claimed that he was insulting only women who are childless by choice, not those hampered by biology. It’s not much of an excuse (take that, nuns!). It’s also not even true.
In a recently resurfaced interview from 2021, Vance explicitly mocked women “who can’t have kids” because they “passed the biological period when it was possible.” He described this group as “miserable” people who “have no real value system” and struggle to find “meaning.”
In response to all this bad PR, Trump did what he often does: He made a promise he has no intention of carrying out. If reelected, he pledged, he’d “mandate” fertility-care coverage for all Americans.
It can be futile to spend more time analyzing a Trump “proposal” than Trump himself has spent thinking about it. He offered no eligibility criteria, no budget score, none of the supportive analysis a political campaign would normally be expected to release. Trump couldn’t even identify who would provide this (very expensive) coverage. Would it be the government or private insurers under a mandate? Yeah, sure, one of those options, he said.
Even so, we can assess how Trump’s proclamation fits in with his prior record as president. The answer: It doesn’t.
An insurance mandate for fertility coverage would effectively be an expansion of essential health benefits. These are the categories of services, set nationwide by Obamacare, that insurance plans are legally mandated to cover, such as prescription drugs, ambulatory services, maternity care and substance-abuse treatment.
But as president, Trump repeatedly tried to weaken or eliminate the very existence of such mandates.
First, he pushed multiple bills that would have allowed states to opt out of essential health benefits, as well as other minimum insurance requirements. When that failed, he tried to do much the same thing through budget proposals and executive action. He also expanded alternative insurance plans that didn’t have to cover essential benefits (or preexisting conditions, for that matter), with the goal of undercutting all the other plans that are subject to these requirements.
If he’d been successful, the whole insurance system might have unraveled. Thankfully, Trump’s efforts were often limited by voter outrage and the courts; or, were subsequently reversed by his successor, President Joe Biden. But even today, Republican politicians continue to oppose minimum insurance coverage requirements. This past weekend, for instance, Sen. Lindsey Graham (R-S.C.) said he opposed Trump’s idea for mandating a requirement that insurers cover IVF “because there’s no end to that.”
Indeed, Republican lawmakers had the chance to expand fertility coverage this year. They refused.
Back in June, when Senate Democrats introduced legislation providing legal protections for IVF and requiring more insurers to cover fertility care, Republican senators blocked it. Both Graham and Vance were among those who voted against allowing the bill to advance.
Vance, for his part, claims there’s no need for federal lawmakers to protect the legality of IVF services. “I think it’s such a ridiculous hypothetical,” Vance said on CNN last week. “There’s no state in the union, whether a right-wing state or a left-wing state, that I think is trying to ban access to fertility treatments.”
The CNN anchor pointed out that when Alabama’s Supreme Court ruled that frozen embryos are “people,” the decision had de facto stopped IVF care in the state. That’s because IVF treatment routinely involves discarding nonviable or otherwise unused embryos. “Yes, a court made that decision in Alabama,” Vance replied. “And like the next second, the Alabama state legislature fixed that problem and ensured women had access to these fertility treatments.”
But this is false. The state legislature said it had fixed the problem, but it did not. Even the bill’s sponsor at one point acknowledged the law still leaves many unanswered questions. Among other issues, lawmakers decided not to define “personhood,” a critical concept given that judges determined the life of every “person” is protected under the state constitution. In the months since the state legislature acted, two Alabama IVF providers announced an end to these services, with one specifically citing ongoing legal risk.
The GOP vice-presidential nominee either didn’t know any of this or didn’t care. Which tells you how much contempt his party has toward women seeking to grow their families.
