Will Trump’s Announcement Expand Access to IVF? – KFF

Report on Fertility Care Accessibility and the U.S. Administration’s IVF Plan in the Context of Sustainable Development Goals

Executive Summary

This report analyzes the state of fertility care access in the United States and evaluates a recent White House announcement aimed at expanding In-Vitro Fertilization (IVF) services. The analysis is framed within the context of the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities). While the administration’s plan proposes measures to lower costs for some IVF medications and clarify options for employer-sponsored benefits, its overall impact on achieving universal and equitable access to reproductive healthcare is projected to be limited. The plan does not address the fundamental financial and systemic barriers that prevent a significant portion of the population, especially low-income individuals and those without comprehensive employer benefits, from accessing necessary fertility treatments.

Analysis of the Proposed Plan to Expand IVF Access

The administration’s initiative focuses on two primary areas: reducing the cost of specific IVF drugs and clarifying pathways for employers to offer fertility benefits. These measures are intended to address the significant cost barrier, which is the leading reason individuals forgo needed fertility services.

H3: Drug Cost Reduction Initiative

The plan aims to lower the cost of certain IVF medications through a new government website, TrumpRx.gov. This initiative is based on an agreement with a pharmaceutical manufacturer to offer drugs at Most Favored Nation (MFN) pricing.

• Mechanism: The TrumpRx.gov website, projected to be operational in 2026, will connect patients directly with manufacturers to purchase select drugs (Gonal-F, Ovidrel, Cetrotide) at a discount.
• Projected Savings: The Centers for Medicare & Medicaid Services (CMS) estimates potential savings of up to $2,200 per cycle.
• Limitations and Impact on SDGs:
  • Incomplete Coverage: The discount applies to only a few of the many drugs used in highly individualized IVF treatment protocols. This partial solution fails to comprehensively address the financial burden, undermining progress towards Target 3.8 of SDG 3 (achieve universal health coverage).
  • Persistent Inequality: While offering some relief, the initiative does not cover the majority of IVF costs, such as egg retrieval and embryo transfer, which range from $15,000 to $20,000 per cycle. This leaves substantial financial barriers in place, particularly for low-income populations, thereby failing to advance SDG 10 (Reduced Inequalities).

H3: Clarification of Employer-Sponsored Fertility Benefits

The announcement clarifies existing pathways under the Health Insurance Portability and Accountability Act (HIPAA) for employers to voluntarily offer standalone fertility benefits. This does not create a new mandate or incentive but rather specifies regulatory options.

1. Independent, Non-coordinated Excepted Benefit: This allows employers to offer standalone insured fertility benefits, irrespective of whether they provide comprehensive health insurance. This option provides flexibility but risks creating fragmented coverage.
2. Limited Excepted Benefits: This includes Health Reimbursement Accounts (HRAs) for fertility expenses, but employer contributions are capped at $2,150 annually. This amount covers only a fraction of a single IVF cycle, offering minimal support and failing to bridge the significant access gap highlighted by SDG 10.

The voluntary nature of these options means that access to fertility care remains contingent on an employer’s discretion. This approach does not systemically advance SDG 5 (Gender Equality) or SDG 8 (Decent Work) by ensuring reproductive healthcare is a standard component of employee well-being packages.

Assessment of Impact on Sustainable Development Goals

The proposed plan’s reliance on voluntary measures and limited discounts means it is unlikely to make a significant contribution to achieving key SDG targets related to health, equality, and well-being.

H3: SDG 3: Good Health and Well-being

Access to fertility care is an integral part of sexual and reproductive health services under SDG 3. The KFF Women’s Health Survey finds that 13% of women aged 18-49 report needing fertility assistance. The current plan fails to establish a framework for universal access. It particularly neglects the nearly 16 million reproductive-age women enrolled in Medicaid, for whom IVF remains prohibitively expensive, as state Medicaid programs rarely cover such services.

H3: SDG 10: Reduced Inequalities

The initiative may widen existing health disparities. It primarily benefits individuals with employers who choose to offer these benefits or those who can afford the remaining high costs of IVF after a drug discount. It does not address the needs of the uninsured, underinsured, or those in low-wage jobs without comprehensive benefits. State laws requiring IVF coverage do not apply to self-funded plans, which cover two-thirds of workers, creating a significant regulatory gap that perpetuates inequality.

H3: SDG 5: Gender Equality

Equitable access to fertility care is a matter of gender equality and reproductive autonomy. Barriers to IVF disproportionately impact women. Furthermore, eligibility requirements in some state mandates, which are not addressed by this plan, often exclude single individuals and same-sex couples, undermining the goal of achieving equality for all.

Policy Context and Future Prospects for Expansion

The advancement of comprehensive fertility coverage faces significant political and structural challenges.

• Legal and Political Climate: The 2024 Alabama Supreme Court ruling that categorized embryos as “unborn children” has introduced legal uncertainty and highlighted the influence of fetal personhood concepts, which are opposed to IVF by influential conservative and religious groups.
• Weakened Institutional Capacity: Recent layoffs at the Centers for Disease Control’s Division of Reproductive Health and the Office of Population Affairs raise concerns about the federal government’s capacity to monitor, regulate, and support assisted reproductive technology services, which is essential for evidence-based policymaking aligned with SDG 3.
• Legislative Stalemate: Broader reform requires Congressional action. However, federal bills to protect or mandate IVF coverage have failed to pass. The Health Coverage for IVF Act of 2025, which would require comprehensive fertility coverage in certain plans, has seen no legislative movement, indicating a lack of political will for a systemic solution.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article discusses issues related to health care access, affordability, gender equality, and socioeconomic disparities, which directly connect to the following Sustainable Development Goals (SDGs):

• SDG 3: Good Health and Well-being: The core subject of the article is access to fertility care, a specific component of health and well-being. It focuses on the barriers, costs, and policy proposals related to In Vitro Fertilization (IVF) services.
• SDG 5: Gender Equality: The article centers on women’s health, citing the “KFF Women’s Health Survey” and discussing the needs of women aged 18-49. Access to reproductive technologies like IVF is a key aspect of reproductive health and rights, which is integral to achieving gender equality.
• SDG 10: Reduced Inequalities: The article repeatedly highlights how access to fertility care is unequal. It points out disparities based on income (cost as the primary barrier), insurance coverage (private vs. Medicaid), and employment (employer-provided benefits). It also notes how some state laws exclude single individuals and same-sex couples, creating further inequality.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s discussion of access, affordability, and equity in fertility care, the following specific SDG targets can be identified:

1. Target 3.7: Ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.
   • The article directly addresses this by examining a national-level proposal (Trump’s IVF plan) aimed at expanding access to fertility services, which are a component of reproductive health care. It discusses the limitations of this plan in achieving universal access.
2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • The article’s main focus is the lack of universal coverage for IVF. It details the high costs (“$15,000 to $20,000” per cycle) that create significant financial risk for individuals and discusses a proposal to make essential IVF drugs more affordable through the TrumpRx.gov website.
3. Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.
   • This target is relevant as the article discusses the barriers women face in accessing fertility treatments. The KFF Women’s Health Survey finding that “one in eight (13%) women ages 18 to 49 say they or their partner needed fertility assistance services” underscores the demand for these reproductive health services.
4. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices.
   • The article points to policies and practices that create unequal outcomes. It mentions that some state laws are “limited to those who have a diagnosis of infertility, which effectively excludes single individuals and same sex couples,” highlighting a discriminatory practice that this target aims to eliminate. It also discusses how the lack of coverage under Medicaid creates a significant inequality of outcome for low-income individuals.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article contains several quantitative and qualitative data points that can serve as indicators to measure progress:

• Indicator for Target 3.7/5.6 (Unmet need for fertility services): The article states, “Among those who reported needing fertility services at some point, 12% say they did not receive these services with cost cited as the leading reason.” This percentage of unmet need is a direct indicator of the gap in universal access to reproductive health care.
• Indicator for Target 3.8 (Financial barriers and coverage):
  • Cost of Treatment: The article specifies that an IVF cycle “ranges from $15,000 to $20,000,” which serves as an indicator of the high financial burden and lack of financial risk protection for individuals without coverage.
  • Employer Coverage Rates: The “KFF Employer Health Benefits Survey” finding that “one in four (27%) larger employers (200 or more workers) offers IVF coverage” is a clear indicator of the extent of private insurance coverage for these services.
• Indicator for Target 10.3 (Inequality in access):
  • Disparities in Public Insurance: The statement that “IVF is typically never covered by Medicaid” and that “no state provided comprehensive IVF services to Medicaid enrollees” is a powerful indicator of the inequality faced by low-income populations.
  • Discriminatory Legal Frameworks: The mention that some state laws exclude “single individuals and same sex couples” serves as a qualitative indicator of discriminatory policies that prevent equal opportunity in accessing fertility care.

4. Table of SDGs, Targets, and Indicators

Source: kff.org