Politicians say health plans should cover IVF. Currently only 1 in 4 employers do

One round of in vitro fertilization or IVF can cost you around $20,000 (or more). It’s a multi-step process that involves retrieving eggs from ovaries, fertilizing them in a lab, watching the embryos develop, and then transferring them into the uterus.

For those who are lucky enough to get pregnant and have a baby, it can take several cycles to get there.

It’s so expensive that access to insurance coverage for IVF is basically access, period.

So for the 150 million people in the U.S. who get health insurance through work, how many have help with some of those costs? A report out this week from KFF, a nonprofit research organization, finds only about a quarter of U.S. companies with 200 or more employees cover the procedure.

Matthew Rae, who ran the survey for KFF, says the rates are better for larger companies; more than half of those with more than 5,000 workers cover IVF. He notes that roughly a third of employers responded that they didn’t know what they covered for IVF and other family building options.

This is the first year that KFF asked about IVF in its annual Employer Health Benefits Survey, so Rae says, it’s impossible to say how these rates have changed over time. And they also didn’t ask for specifics about what is covered, such as medications or multiple rounds of treatment.

“I mean we just don’t know that much about it, other than what we have here,” Rae says. “We don’t know how much coverage they actually have or if that’s sufficient to do the course of IVF or meet the needs of their family.”

What’s clear is that this present day snapshot is a far cry from the future that politicians are touting. Former President Donald Trump pledged that if he’s elected in November he’ll help pay for IVF.

“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, fertilization for women,” he said at a rally in Potterville, Mich., in August. He has repeated the pledge several times.

People who believe in fetal personhood do not like this idea. In fact, IVF was shut down temporarily in Alabama in February, after the state supreme court ruled that embryos created through IVF could be considered “extrauterine children” under state law.

Fiscal conservatives aren’t fans of the plan either. The Cato Institute — a libertarian think tank — estimated that if the federal government picked up the tab for everyone’s IVF, it would cost $7 billion each year.

Currently, some states require insurers to cover IVF, but a federal insurance mandate would likely face legal challenges — as the mandate to cover birth control did.

Meanwhile, Congressional Democrats have been pushing for the “Right to IVF Act,” which would require “private insurers that cover obstetrical services to also cover fertility treatments.” The bill has been blocked by Republicans twice.

Even though the U.S. is a long way off from IVF for all, KFF’s Rae says more employers do seem to be adding the benefit, which makes sense in a tight labor market.

“Sometimes these things go in waves and there’s interest in an issue for a period of time and other times it’s a prolonged issue,” he says. “It’s hard to know.”

So the future of IVF coverage could depend on the outcome of the election, the labor market, reproductive rights court cases and more.