By Bonner R. Cohen, Heartland Institute
The White House announced two initiatives it claims will significantly reduce the costs of in vitro fertilization (IVF).
On October 16, President Donald Trump announced drugmaker EMD Serono would offer its fertility drug GONAL-F at a 796 percent discount or more, in line with the lowest price paid by other developed nations, known as the most-favored-nation pricing. The drug would be offered directly to women through TrumpRx.gov.
The drugs represent about 20 percent of the total cost of a fertility treatment cycle, states the White House fact sheet.
Trump also announced the creation of a “New Benefit Option” in which employers will have a “new legal pathway,” resembling supplemental plans for vision and dental coverage, to offer employees fertility treatments. Forty-two percent of employers provide coverage of fertility services, the announcement states. Employer-paid premiums for health insurance are exempt from federal income payroll taxes.
The drug decision and benefit option were announced after the White House Policy Council delayed for months a list of policy recommendations to protect access to IVF.
Political Pushback
After Trump issued a February 18 executive order (EO), Expanding Access to In Vitro Fertilization,” Trump’s political base, medical ethicists, and free market insurance advocates pushed back, saying the EO fails to address the root causes of infertility, favors one remedy over others for mandated coverage, and ignores the ethical and practical problems IVF can present.
In early August, The Washington Post reported the White House had no plans to require health insurers to cover the cost of IVF or to mandate coverage for people who acquire their health insurance on the Obamacare exchanges, citing anonymous sources.
The source told the Post, “while expanding IVF access remains a ‘huge priority’ for Trump, the president can’t legally make IVF an essential health benefit without Congress first approving legislation to do so. It is unclear whether the administration plans to ask lawmakers to take up a bill, but the two people said that forcing insurance companies to cover IVF is not currently on the table.”
Cost Factor
Requiring health insurers to include expensive IVF treatments in their coverage could help offset the cost of the procedure, says Trump.
“Americans need reliable access to IVF and more affordable treatment options, as the cost per cycle can range from $12,000 to $25,000,” the EO states.
IVF would have to be considered an “essential health benefit” to be covered under the Affordable Care Act. Currently, individuals and couples write off some of the costs as a deductible medical expense on their taxes.
Birth rates in the United States and many other countries have been declining for decades.
“Fertility rates are projected to average 1.6 births per woman over the next three decades, according to the Congressional Budget Office’s latest forecast released this year,” Newsweek reported in June. “This number is well below the replacement level of 2.1 births per woman to maintain a stable population.”
Ethical Cost
The procedure involves the fertilization of mature eggs in a lab, creating human embryos that may be destroyed in the process. Medical ethicists such as Mark Blocher, author of Missional Medicine—Restoring the Soul of Medicine, say the technology could open a floodgate of individuals who want to raise children outside the family.
The president’s promise to support IVF has put the administration in a tough spot, says Jeff Stier, a senior fellow at the Consumer Choice Center.
“While there are understandable concerns by some in the ‘pro-life’ camp, IVF is, at its essence, a pro-family move,” said Stier. “The administration should consider how broad-based guardrails could mitigate ethical concerns and have a net ethical benefit, while still promoting American families.”
Having insurance cover IVF forces people to subsidize the procedure for others, says Stier.
“It’s hard to conceive a way out of the economic reality that if you squeeze the proverbial balloon in one place by requiring insurers to cover the expensive treatment, the costs will emerge through higher premiums,” said Stier.
Should Others Pay?
The question of whether insurance companies, enrollees, or taxpayers should pay for IVF is a critical one, says Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons.
“There is that moral question,” said Orient. “Leaving that aside, there is also a dark side to IVF. Some embryos are chosen; others are deselected. They may be discarded, frozen indefinitely, or selectively aborted in the event of a multiple pregnancy. Of course, countless embryos perish naturally. Does it make a difference whether a human plays God and denies a chance at life to a being that is the ‘wrong’ sex or perceived to be defective? Is a designer baby industry a good thing?”
IVF may endanger a mother’s long-term health, says Orient.
“There are risks to egg harvesting,” said Orient. “Dr. Jennifer Schneider has publicly raised questions because she lost her daughter, a three-time egg donor, to colon cancer at age 31. There has been no systematic study of long-term risk from the intense hormone stimulation.”
To resolve the ethical concerns, aspiring parents can consider adoption or unused frozen eggs, for which the donor gives up their property rights. In addition, prospective parents should consider prevention and cures, says Orient.
“Restorative reproduction health should be explored,” said Orient. “Possibly scarred Fallopian tubes can be restored. Young women also need to think about prevention. Untreated asymptomatic chlamydia infection is the ‘thief of fertility’ and is very common in today’s promiscuous culture.
“Should medicine draw a red line prohibiting intentional destruction of life, whether by ‘assisted dying,’ abortion, or deselecting embryos?” said Orient. “Government should not be funding such activities, the gateway to a brave new world.”
Bonner Russell Cohen, Ph.D., is a senior policy analyst with the Committee for a Constructive Tomorrow.
