Donald Trump’s Proposal for Free IVF Is Good Politics and Good Policy -- But He Has To Overcome His Party’s Resistance
Americans want a government that works for them, and Trump seems to realize that even when his party doesn't.
A good friend of mine has two beautiful children thanks to In vitro Fertilization (IVF), a process that allows a human embryo to be fertilized outside of a woman’s body and then later placed inside of her to develop.
Thanks to this miraculous technology, many parents who couldn’t conceive children otherwise have been able to start and maintain healthy families.
I was thinking about my friend today when Republican presidential nominee Donald Trump made a bold proposal.
“I am announcing today that under the Trump administration, your government will pay for or your insurance company will be mandated to pay for all costs associated with IVF treatment,” he said to applause during a campaign stop in Michigan.
His explanation for his plan? It would help boost the American fertility rate.
“Because we want more babies, to put it very nicely!” he explained.
Trump’s proposal is substantively attractive and politically apt.
As my friend could tell you, IVF treatments are expensive. If you have the misfortune of being unable to conceive children without it, you may be set back $20,000 or more.
Having to pay for IVF is essentially a tax for doing what most couples can do naturally. Trump’s plan relieves that tax by using the government — either through an insurance mandate or direct subsidy. It’s not a completely novel proposal. Some states like Delaware already mandate that insurers cover IVF.
Of course, the way I just framed it is not the way many of Trump’s Republican colleagues think about it. Past bills to do this only had a sliver of GOP support. (Although that could probably be boosted by a genuinely bipartisan effort to write legislation together.)
Let’s remember that Trump spent most of his life as a Democrat; he doesn’t have the same hostility to using the government to solve social problems as, say, former House Speaker Paul Ryan did (who was inspired to enter politics by Ayn Rand).
Even some of Trump’s own staffers, like former OMB economist Vance Ginn, balked at the plan.
“Can we stop handing out things to win votes like it’s candy when we’re running $2T deficits and not abiding by the limited roles outlined in the US Constitution?” he asked.
I’m not going to touch the argument that paying for IVF is unconstitutional (that is to quote the Democratic vice presidential nominee, weird) but 86,000 infants born with IVF or something like it in 2021 (less than 3% of all infants born), that’s not a big expense for the U.S. federal government in a $30 trillion economy to handle.
It’s true that we should probably worry about cost inflation, but that’s true across the health care sector — we don’t do a lot to control prices even with the mountain of money flowing throughout the system. Supporting IVF, however, is fine as one-off. It’s not a ton of money we’re talking about injecting into the economy, even if it would be enormously beneficial for individual families.
That’s not what National Review Online editor Phillip Klein thinks, though.
“Government-financed IVF treatment, which costs tens of thousands of dollars, would impose an enormous cost on taxpayers,” he thundered in response to Trump’s proposal. It would even amount to “an expansion of Obamacare.”
(Notice he complains about its cost without citing any numbers, but why do math when you have ideology?)
All of this lays out the bigger problem Trump would face if he tried to pass this proposal. A lot of people in his party don’t think the government should do anything in particular about health care costs. Not only do they not endorse the single-payer Medicare-for-All solution that progressives support, they don’t really support anything — including fairly conservative, market-oriented universal health care systems that exist in Singapore, Germany, Switzerland, or Japan.
This serves the purpose of inoculating the party’s ideologues who don’t believe in governing and keeping a steady flow of health care industry dollars flowing to GOP coffins.
That means that Trump would probably need a lot of Democrats to support his proposal in order to make it happen. Progressives would probably need to pressure Democrats to come to some sort of agreement with Trump, working with a minority of Republicans to win either an insurance mandate, a government subsidy, or some combination of the two.
The Republican Party’s nihilist approach to health care isn’t winning them any elections. They typically fall far behind Democrats when pollsters ask voters which party they trust more with health care.
Trump’s IVF proposal, on the other hand, is the former president at his best. Untethered from years of libertarian-conservative dogma, he can propose something that relieves a financial burden from hundreds of thousands of families and that also addresses a core political problem for the Republicans.
It certainly beats spending so much time complaining about his own personal grievances or just hurling insults at the other side, which seems to be far too much of his campaign.
The reason why it’s such good politics is two-fold.
In recent months, the Democrats have pointed to some far-right factions among social conservatives who are skeptical of the morality of IVF. Despite the fact that most Americans support access to IVF — and that includes a majority of Republicans — there is a group of social conservatives who worry that the procedure can threaten human life by discarding embryos.
Trump’s proposal is a one-two punch: he’s telling Americans that he’s firmly behind IVF — dismissing the hardline social conservatives who fear it — and that he’s willing to actually govern and make it affordable for all Americans — marginalizing the libertarians in the party who want the government to do nothing about health care.
Whether the rest of his party can come to their senses and realize that it’s both good politics and good policy remains to be seen.
The problem with the Republican Party is the same as with the Democrat Party. They play to the extremes and so any attempt by a politician to moderate to the middle gets hijacked.
For example, another problem with IVF is that it produces embryos, which to the "pro-life" crowd means more abortions. So it's a nonstarter for two reasons for the religious right: the money issue and the abortion issue. Trump recent reconciled that by suggesting that six weeks is too early to set an abortion ban, and you should have seen the comments on Twitter. Losing their minds. Trump is now "pro-choice" and "pro-abortion." Never mind that 80% of the country thinks six weeks is too early for a ban. These people are their own worst enemy.
Zaid, nice piece, and I think you are right. Two small objections: it's hard to say that buying something that one does not have is a "tax." I'm typing wearing fancy eyeglasses. A tax? Other people have better eyes . . . inequality, even differential impact, are not enough to call something a tax. Second, and more importantly, while it is nice for government to work "for" people like your friends, I think Trump was making a different point: society, the nation, has trouble forming families. The reason to support IVF in these situations is that families, young children are a public good, perhaps the ultimate public good (without which the polis dies). I would venture that at least some of the resistance to supporting IVF is that it seems like another at best transfer to individuals, feeding at the trough, etc. The actual dollar cost, as you point out, isn't driving this. Framing the issue more publicly might garner more support. As always, keep up the good work.