Former President Donald J. Trump said on the campaign trail Thursday that he wants to make in vitro fertilization treatment free for all Americans.
“Under the Trump administration your government will pay or your insurance company will be mandated to pay for all costs associated with I.V.F. treatment,” Mr. Trump said on Thursday at a rally in Potterville, Mich.
I.V.F. often costs tens of thousands of dollars. Policies to cover those costs would be difficult to implement, experts said.
Requiring insurers to pay would most likely mean passing laws in Congress or persuading a panel of experts to add I.V.F. to a list of free preventive women’s health services established by the Affordable Care Act, the health coverage law Mr. Trump tried to repeal.
Having the government pay directly for I.V.F. would mean creating essentially a single-payer health care system for a single condition. The approach would require Congress to fund a new division of a federal government to oversee the program.
“The president cannot do this on his own,” said Alina Salganicoff, director of the women’s health policy program at KFF, a health research nonprofit. “You need to have federal funds to do this. Congress needs to appropriate money.”
Mr. Trump voiced his support for I.V.F. after the Alabama Supreme Court ruled in February that embryos were “unborn children.” When the decision caused several fertility clinics to suddenly halt operations, he called on the Alabama Legislature to quickly pass legislation to protect the treatments.
That law ultimately passed and allowed the clinics to reopen, but I.V.F. has remained a major campaign issue. Democrats rallied around proposals to protect I.V.F. access, with candidates sharing their own experiences of infertility.
Republicans have struggled to overcome divides between the many voters who support keeping I.V.F. legal and religious conservatives who oppose the treatment because it often leads to the destruction of unused embryos.
Southern Baptists, the country’s largest Protestant denomination, voted in June to oppose I.V.F., calling for the protection of “frozen embryonic human beings.” The overturning of Roe v. Wade has emboldened Christian conservatives to begin laying groundwork for legislation that would restrict access to I.V.F.
Political obstacles aside, there is no easy path to make I.V.F. treatment free to all Americans. “This is a complicated endeavor,” Ms. Salganicoff said.
When asked how Mr. Trump would implement this policy, a campaign spokeswoman, Karoline Leavitt, did not provide any details, saying simply that the former president “supports universal access to contraceptives and I.V.F.”
In rare cases, the government has extended benefits for specific health conditions.
For decades, a federal program has provided dialysis to patients with end-stage kidney disease. And in the early stages of the pandemic, the government briefly made Covid vaccines free. Because these types of programs require federal funding, they cannot be created through executive order and require Congress to pass new laws.
Congress can also increase coverage for care it deems important by requiring insurance companies to pay for the service. Senate Democrats have proposed legislation that would require many health plans to cover I.V.F. In June, Senate Republicans blocked that law from moving forward. JD Vance, the Republican nominee for vice president and a senator from Ohio, was among those who voted against it.
Some states have required insurance companies to cover I.V.F. treatment, but even those laws have not made the care completely free. Because the treatments are expensive, the laws usually limit who can receive services and how much they can cost. New York State, which has one of the most generous I.V.F. laws, limits coverage to three cycles of treatment.
Mr. Trump could try to enact this benefit through the Affordable Care Act, otherwise known as Obamacare. That law, passed in 2010, has a section that requires insurance companies to cover a suite of benefits related to women’s health, including mammograms and birth control.
If a Trump administration wanted to add I.V.F. to the list, it would need to submit its idea to a panel of doctors that oversees that benefit and convince its members that I.V.F. is a preventive health service.
While that panel has approved coverage for some less traditional preventive services like breast pumps, I.V.F. would probably face long odds.
“The federal government has to be careful in making sure these services are preventive,” said Ms. Salganicoff, who helped set the original rules for that provision. “I.V.F. is a treatment, and pretty clearly outside the lines of a preventive service.”
Even if I.V.F. were added to that list, it would not be a surefire way to ensure coverage. The Obama administration had to scale back its birth control mandate in 2014 after the Supreme Court ruled that it could not be applied to certain employers, like Hobby Lobby, that voiced religious objections.