Trumps Free IVF Proposal
Pandering like he was a sixth grader running for class president.
Highlights:
· It would increase health insurance premiums and the number of people with short-term health plans.
· An IVF mandate is inconsistent with the Republican approach to health care, which generally opposes mandates.
Trumps Free IVF Proposal
In a recent town hall Donald Trump promised free IVF procedures.
"I've been looking at it, and what we're going to do is for people that are using IVF, which is fertilization … the government is going to pay for it, or we're going to get -- we'll mandate your insurance company to pay for it, which is going to be great. We’re going to do that,"
This proposal, like so many offered by the Trump campaign, remind me of a promise made by wife when she ran for class president of her sixth grade class – free soda pop will come out of the water fountains.
Traditionally, Republicans have opposed all health insurance mandates as was vividly demonstrated by their opposition to the ACA.
The ACA expanded the notion of essential health benefits, which must be offered by most employer-based and state exchange health insurance. It appears as though Trump’s proposal would make IVF an essential health benefit.
The ACA prohibited insurance companies from denying benefits to people with pre-existing conditions. Alternatively, some Republican alternatives to the ACA would require people with pre-existing conditions to pay more for health insurance than people without health insurance. Infertility is the classic pre-existing condition.
If Trump’s proposal for an IVF mandate leaves current ACA rules on pre-existing conditions and age-rated premiums in place, health insurance premiums will rise. This most likely scenario is sort of an admission that Republican opposition to ACA mandates were unworkable.
If Trump’s proposal for an IVF mandate replaces age-rated premiums with premiums based on health status or pre-existing conditions, premiums for people with infertility problems will be unaffordable.
Most conservative and fiscally conservative health insurance experts would likely oppose this particular health insurance mandate. There are in fact many ways this mandate would adversely impact health insurance markets and outcomes.
Many current health plans have narrow provider networks, which do not include facilities offering IVF procedures. The IVF mandate could have a large impact on premiums for insurance plans which would have to create new contracts with IVF providers.
The proposal increases health insurance premiums, the number of people who cannot afford health insurance, and the number of people who would turn to short-term health plans that do not offer comprehensive health insurance benefits. Short term health plans were expanded by the Trump Administration. Many short term health plans do not cover pregnancy.
A serious analysis of an insurance mandate that covers an expensive new mandate like IVF coverage would compare the benefit of the new mandate to the costs associated with the loss of health insurance coverage from higher premiums.
A policy that attempts to make IVF more affordable for infertile couples is a laudable goal. Any attempt to subsidize IVF should be accomplished in a way that does not disrupt insurance markets and worsen health insurance outcomes.
It is hard to understand why Trump is so concerned about IVF and so unconcerned about the cost of pre-natal care and other pregnancy costs.
My wife won her race for sixth-grade class president. But in her first meeting with school administers she sheepishly walked away from her promise of free soda pop in the water fountains.
Hopefully, Trump’s free-soda-pop logic won’t prevail in 2024.