Copyright Star Tribune
Miraya Gran’s path to motherhood included seven miscarriages, taking out a second mortgage and holding a fundraiser to pay for in vitro fertilization (IVF), a costly but effective fertility treatment. Her daughter Isla is now 4 years old. Gran and her husband, Andy, who live in Bloomington, would love to make her a big sister. But they still don’t have fertility care coverage through their employer-provided health insurance, so the cost of adding to their family is too daunting. That’s why Gran and families like hers reacted with hope a year ago when President Donald Trump vowed on the campaign trail to make IVF available at no cost to all Americans. “Under the Trump administration your government will pay or your insurance company will be mandated to pay for all costs associated with IVF treatment,” Trump said at an August 2024 Michigan rally. While Trump didn’t forget about his vow to help families like the Grans, his Oct. 16 announcement about IVF affordability falls well short of that expansive promise. If there’s progress to be made in the short term, it’s up to the Minnesota Legislature, where there’s been bipartisan support for expanding fertility coverage and an opportunity to begin closing this frustrating care gap in the 2026 session. Trump’s new initiative will make select medications used in fertility treatment available at a reduced price, potentially at significantly reduced price, through the new TrumpRx.gov site when it is operational. But the president’s announcement did not include requiring insurers to cover IVF and other fertility care, which can include exams, testing, medical imaging and other expenses. Nor does the initiative call for using government dollars to aid families seeking this care or subsidize employers who want to provide it. The White House initiative essentially encourages employers to do so. “So my reaction to this announcement, is that it felt like political theater,” Gran told me in a recent interview, adding that the presidential initiative “basically gives fertility families a coupon” for costs. “IVF and fertility treatment is not a luxury,” she added. “It should not be an elective for me to access the science-based medicine that is there to build my family.” “About 9% of men and about 11% of women of reproductive age in the United States have experienced fertility problems,” according to a National Institutes of Health brief. “Studies suggest that after 1 year of having unprotected sex, 12% to 15% of couples are unable to conceive,” with about 10% still unable to have a child after two years. Not all couples will need IVF, but for those who do, “the cost can range from $12,000 to $25,000 per cycle and multiple cycles may be needed to get pregnant,” the White House announcement states. The drug deal touted by Trump will save an estimated $2,200 per cycle on drugs that can cost more than $5,000, according to the administration’s analysis. Fertility drugs are about 20% of a fertility treatment cycle, officials added. Other costs can add up quickly. The Grans, for example, spent $14,000 out of pocket on testing and a related procedure. More expansive insurance coverage would have reduced their personal costs, which is why they and other advocates seek equitable insurance coverage. “Even when employers provide some fertility benefits, in many cases coverage is limited to an evaluation by an infertility specialist and does not extend to procedures to achieve a pregnancy,” the Mercer survey analysis states. Too often that means patients must pay for IVF and other fertility care on their own. Twenty-four states and the District of Columbia are listed by Resolve, a national fertility advocacy association, as having some fertility coverage requirements in place. Minnesota is not among them. But even in states with relatively expansive coverage requirements, families can still be left with extensive bills to pay for on their own. Arkansas, for example, requires IVF coverage for state-regulated plans. But there’s a $15,000 lifetime maximum. In addition, Arkansas exempts health maintenance organizations (HMOs) from the requirement. In the last legislative session, a bill was introduced in both legislative chambers that, had it been enacted, would have likely made Minnesota fertility coverage one of the most comprehensive in the nation. It also called for using tax dollars to defray at least some of the costs of adding this coverage. The Minnesota Senate bill had two DFL authors and three Republican authors. Gran directs the Minnesota Building Families Coalition and is a co-founder of State Strong, a group of advocates working on IVF access in the states. She said last week that advocates will try again in the 2026 session. If passed, the legislation will not be a panacea. The requirements will apply to state-regulated plans. But many large employers’ plans are federally regulated. But its passage would still be a step forward, Gran said, helping build momentum for changes at the federal level, too. The argument against the bill essentially boils down to this: that it’s another health insurance mandate in a state that has a lot of mandates. As I noted in a column last March, the Minnesota Chamber of Commerce reckons the state has the second-highest number in the nation. Adding a fertility coverage requirement could drive up monthly premiums when affordability is already an issue. But a 2023 Minnesota Department of Commerce analysis suggests a manageable cost. For those with coverage through commercial plans, it concluded that the “average additional monthly cost of this mandate would be $1.30 per member in year 1 and would increase to $2.20 per member in the 10th year of implementation.” Gran also has a fair point. “Everyone is talking about the cost to businesses, the cost to insurance companies. What about the economic cost and hardship for families like mine?”
