Showing posts with label domestic policy. Show all posts
Showing posts with label domestic policy. Show all posts
Sep 16, 2025
Aug 4, 2025
Promise Made
... promise abandoned. Color me unsurprised.
White House has no plan to mandate IVF care, despite campaign pledge
President Donald Trump has said he wants a “baby boom,” but critics say his administration has yet to make significant family policy changes — and that Medicaid cuts will hurt.
The White House does not plan to require health insurers to provide coverage for in vitro fertilization services, two people with knowledge of internal discussions said, even though the idea was one of President Donald Trump’s key campaign pledges.
Last year, Trump said that if he returned to office, the government would either pay for IVF services or issue rules requiring insurance companies to cover treatment for it. The pledge came as Trump faced political blowback over abortion rights after his appointees to the Supreme Court helped overturn Roe v. Wade.
“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,” Trump said in August 2024. “We want to produce babies in this country, right?”
More than six months into his second term, however, the Trump administration has not publicly proposed new federal subsidies to make IVF free or more affordable. In addition, White House officials are backing away from proposals discussed internally to mandate IVF coverage for the roughly 50 million people on the Obamacare exchanges, said the people, who spoke on the condition of anonymity to describe private conversations.
A senior administration official, who also spoke on the condition of anonymity to discuss internal talks, said that 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.
Kaylen Silverberg, an outside adviser to the administration who has been pushing for more IVF access, also said in an interview that the White House has most recently asked him about a fertility approach that prioritizes holistic health over tools like IVF. Implementing that alone would fall “very short” of Trump’s initial promises, Silverberg said.
A White House spokeswoman also said Trump is still working to fulfill his commitment to expand IVF.
“President Trump pledged to expand access to fertility treatments for Americans who are struggling to start families,” spokeswoman Abigail Jackson said in a statement. “The Administration is committed like none before it to using its authorities to deliver on this pledge.”
The situation reflects the GOP’s internal divisions on both IVF coverage and federal policy for families.
Social conservatives alarmed by the nation’s falling birth rates have called for more aggressive government intervention to support mothers and childbirth, including new federal funding and other protections. But their efforts have faced objections from traditional free-market voices in the party, who are wary of federal mandates or new spending initiatives.
Requiring the Affordable Care Act exchanges to cover IVF, for instance, would lead insurance companies to raise premium costs, which could prove politically damaging for the GOP ahead of the 2026 midterm elections.
“How do you do this without burdening health insurers? That’s the key question they’ve been wrestling with,” one of the people familiar with the discussions said. “It appears for now that they’re not going to go there.”
Shortly after taking office, Trump signed an executive order giving the White House Domestic Policy Council 90 days to present a list of policy recommendations for protecting IVF access and “aggressively reducing out-of-pocket and health plan costs for IVF treatment.” The order stated that IVF treatments can cost $12,000 to $25,000 per cycle.
Officials at the White House have weighed requiring IVF to be considered an “essential health benefit” under the Affordable Care Act, which would require insurers in the marketplace to cover it. That policy has been supported by a group called Americans for IVF, the American Society for Reproductive Medicine and Democratic lawmakers such as Sen. Tammy Duckworth and Rep. Lauren Underwood of Illinois and Sen. Cory Booker of New Jersey.
But numerous other conservative policy experts have expressed objections. Avik Roy, founder of the Foundation for Research on Equal Opportunity, a think tank that promotes free markets, said the move could increase premiums by several percentage points for tens of millions of Americans on the exchanges, as insurers absorb higher costs.
“Anytime you layer on something as an essential health benefit, it increases premiums,” Roy said. “To whatever degree people are pushing back for that reason as a policy matter, that’s always been the debate.”
Patrick T. Brown, a conservative who supports pro-family policy at the Ethics and Public Policy Center, also pointed out that it’s not clear whether IVF could legally count as an essential health benefit, which typically only applies to services broadly offered by insurers.
“It’s more uncommon than not for IVF to be currently covered,” Brown said. “So it’d be a pretty elastic ruling.”
Roughly 24 million people are enrolled in the ACA’s individual plans, while another 22 million are in small business plans for fewer than 100 employees. That represents fewer than 20 percent of the total population — far short of Trump’s suggestion that the government or insurers would cover IVF for all Americans — though private insurers typically cover essential health benefits voluntarily.
“There were no details provided by Trump during the campaign as to how this would work, who would be eligible and how it would relate to health insurance coverage,” said Larry Levitt, executive vice president for health policy at KFF.
Silverberg, chair of Americans for IVF’s advisory board, has been advising the White House Domestic Policy Council on potential ways to increase access to IVF and lower costs. He said administration officials have called him repeatedly with questions, and he met with Chief of Staff Susie Wiles and Domestic Policy Council Director Vince Haley at the White House in April.
He said he’s been impressed by their questions and attention to the subject: “I get the impression they’re very serious.”
During his most recent conversation with the White House about two weeks ago, officials also asked him about “restorative reproductive medicine.”
Restorative reproductive medicine suggests women should treat infertility by attempting to improve their overall health and has been promoted by the Heritage Foundation. When used as the only or primary method to treat infertility, RRM can unnecessarily delay access to IVF because lifestyle changes are already a part of most fertility treatment plans, according to the American College of Obstetricians and Gynecologists.
“We’re fine and dandy with that being part of what the ultimate solution is,” Silverberg said, adding that “every responsible fertility physician” already asks patients to make lifestyle changes before advancing to IVF. “But we don’t want to be forced to ignore 40 years of scientific research that has resulted in the development of all these new technologies that not only can help people conceive, but conceive quicker and conceive healthier babies.”
Liberal critics point out that Trump’s tax legislation included approximately $1 trillion in cuts to Medicaid and hundreds of billions of additional cuts to food stamps relied on by millions of low-income families.
“You can’t seriously claim you’re pursuing pro-natalist policy when you’re kicking moms off Medicaid and when you’re leaving kids with less food,” said Bobby Kogan, senior director of federal budget policy at the Center for American Progress, a center-left think tank.
But Sen. Katie Boyd Britt (R-Alabama), who last year introduced legislation to withhold Medicaid funding to any state that bars IVF, argued that the GOP law included several provisions that can help families have children.
The law increased the child tax credit from $2,000 to $2,200 and ties it to inflation, expanded the child and dependent care tax credit, and increased incentives for employers to cover child care expenses.
“You think about how long Democrats have talked about affordability and accessibility of child care — they had two bites at the apple through reconciliation and did not touch the child care provision,” Britt said. “When Republicans did, the very first thing we did was put families and hardworking Americans first by updating these provisions.”
White House has no plan to mandate IVF care, despite campaign pledge
President Donald Trump has said he wants a “baby boom,” but critics say his administration has yet to make significant family policy changes — and that Medicaid cuts will hurt.
The White House does not plan to require health insurers to provide coverage for in vitro fertilization services, two people with knowledge of internal discussions said, even though the idea was one of President Donald Trump’s key campaign pledges.
Last year, Trump said that if he returned to office, the government would either pay for IVF services or issue rules requiring insurance companies to cover treatment for it. The pledge came as Trump faced political blowback over abortion rights after his appointees to the Supreme Court helped overturn Roe v. Wade.
“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,” Trump said in August 2024. “We want to produce babies in this country, right?”
More than six months into his second term, however, the Trump administration has not publicly proposed new federal subsidies to make IVF free or more affordable. In addition, White House officials are backing away from proposals discussed internally to mandate IVF coverage for the roughly 50 million people on the Obamacare exchanges, said the people, who spoke on the condition of anonymity to describe private conversations.
A senior administration official, who also spoke on the condition of anonymity to discuss internal talks, said that 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.
Kaylen Silverberg, an outside adviser to the administration who has been pushing for more IVF access, also said in an interview that the White House has most recently asked him about a fertility approach that prioritizes holistic health over tools like IVF. Implementing that alone would fall “very short” of Trump’s initial promises, Silverberg said.
A White House spokeswoman also said Trump is still working to fulfill his commitment to expand IVF.
“President Trump pledged to expand access to fertility treatments for Americans who are struggling to start families,” spokeswoman Abigail Jackson said in a statement. “The Administration is committed like none before it to using its authorities to deliver on this pledge.”
The situation reflects the GOP’s internal divisions on both IVF coverage and federal policy for families.
Social conservatives alarmed by the nation’s falling birth rates have called for more aggressive government intervention to support mothers and childbirth, including new federal funding and other protections. But their efforts have faced objections from traditional free-market voices in the party, who are wary of federal mandates or new spending initiatives.
Requiring the Affordable Care Act exchanges to cover IVF, for instance, would lead insurance companies to raise premium costs, which could prove politically damaging for the GOP ahead of the 2026 midterm elections.
“How do you do this without burdening health insurers? That’s the key question they’ve been wrestling with,” one of the people familiar with the discussions said. “It appears for now that they’re not going to go there.”
Shortly after taking office, Trump signed an executive order giving the White House Domestic Policy Council 90 days to present a list of policy recommendations for protecting IVF access and “aggressively reducing out-of-pocket and health plan costs for IVF treatment.” The order stated that IVF treatments can cost $12,000 to $25,000 per cycle.
Officials at the White House have weighed requiring IVF to be considered an “essential health benefit” under the Affordable Care Act, which would require insurers in the marketplace to cover it. That policy has been supported by a group called Americans for IVF, the American Society for Reproductive Medicine and Democratic lawmakers such as Sen. Tammy Duckworth and Rep. Lauren Underwood of Illinois and Sen. Cory Booker of New Jersey.
But numerous other conservative policy experts have expressed objections. Avik Roy, founder of the Foundation for Research on Equal Opportunity, a think tank that promotes free markets, said the move could increase premiums by several percentage points for tens of millions of Americans on the exchanges, as insurers absorb higher costs.
“Anytime you layer on something as an essential health benefit, it increases premiums,” Roy said. “To whatever degree people are pushing back for that reason as a policy matter, that’s always been the debate.”
Patrick T. Brown, a conservative who supports pro-family policy at the Ethics and Public Policy Center, also pointed out that it’s not clear whether IVF could legally count as an essential health benefit, which typically only applies to services broadly offered by insurers.
“It’s more uncommon than not for IVF to be currently covered,” Brown said. “So it’d be a pretty elastic ruling.”
Roughly 24 million people are enrolled in the ACA’s individual plans, while another 22 million are in small business plans for fewer than 100 employees. That represents fewer than 20 percent of the total population — far short of Trump’s suggestion that the government or insurers would cover IVF for all Americans — though private insurers typically cover essential health benefits voluntarily.
“There were no details provided by Trump during the campaign as to how this would work, who would be eligible and how it would relate to health insurance coverage,” said Larry Levitt, executive vice president for health policy at KFF.
Silverberg, chair of Americans for IVF’s advisory board, has been advising the White House Domestic Policy Council on potential ways to increase access to IVF and lower costs. He said administration officials have called him repeatedly with questions, and he met with Chief of Staff Susie Wiles and Domestic Policy Council Director Vince Haley at the White House in April.
He said he’s been impressed by their questions and attention to the subject: “I get the impression they’re very serious.”
During his most recent conversation with the White House about two weeks ago, officials also asked him about “restorative reproductive medicine.”
Restorative reproductive medicine suggests women should treat infertility by attempting to improve their overall health and has been promoted by the Heritage Foundation. When used as the only or primary method to treat infertility, RRM can unnecessarily delay access to IVF because lifestyle changes are already a part of most fertility treatment plans, according to the American College of Obstetricians and Gynecologists.
“We’re fine and dandy with that being part of what the ultimate solution is,” Silverberg said, adding that “every responsible fertility physician” already asks patients to make lifestyle changes before advancing to IVF. “But we don’t want to be forced to ignore 40 years of scientific research that has resulted in the development of all these new technologies that not only can help people conceive, but conceive quicker and conceive healthier babies.”
Liberal critics point out that Trump’s tax legislation included approximately $1 trillion in cuts to Medicaid and hundreds of billions of additional cuts to food stamps relied on by millions of low-income families.
“You can’t seriously claim you’re pursuing pro-natalist policy when you’re kicking moms off Medicaid and when you’re leaving kids with less food,” said Bobby Kogan, senior director of federal budget policy at the Center for American Progress, a center-left think tank.
But Sen. Katie Boyd Britt (R-Alabama), who last year introduced legislation to withhold Medicaid funding to any state that bars IVF, argued that the GOP law included several provisions that can help families have children.
The law increased the child tax credit from $2,000 to $2,200 and ties it to inflation, expanded the child and dependent care tax credit, and increased incentives for employers to cover child care expenses.
“You think about how long Democrats have talked about affordability and accessibility of child care — they had two bites at the apple through reconciliation and did not touch the child care provision,” Britt said. “When Republicans did, the very first thing we did was put families and hardworking Americans first by updating these provisions.”
Feb 1, 2025
Choices
Every policy position,
every court judgement,
every item in every budget
is a statement
of the decision-maker's morality.
To be clear, I think the Republicans (at least the Plutocrats, and of course their MAGA jerk supporters) are going to jump on this with both feet.
They don't want to save Social Security - they want to kill it, and spike it, and bury so deep that people 30 or 40 years from now won't remember when those monthly deposits kept their grandma from having to live in her car.
And I'm absolutely sure they're going to try to sell it as a great opportunity for people to "invest in your future - control your own destiny - make sound fiscal judgement the basis of securing the best possible life for yourself in your golden years."
They want to hand it over to the sharks on Wall Street. Imagine the gang of smarmy fucks who're practically knee-deep in their own saliva, willing to crawl over a mountain of dead rotting corpses covered in shards of glass just to get a shot at "managing" 5 trillion dollars of your money.
YOUR MONEY
Every dollar is a Power Coupon.
If I have a million coupons, I have some decent power.
A billion is a thousand times more than a million.
A trillion is a thousand times more than a billion.
Fuck 'em.
I'll share my toothbrush with a leper
before I give those assholes
that kinda power.
William G. Gale and Samuel I. Thorpe
We live in a world of trade-offs, and a looming debate in Washington will decide how trillions of dollars in government cash is spent.
Republican lawmakers and President Donald Trump are eager to make permanent the provisions of the Tax Cuts and Jobs Act (TCJA) of 2017 that expire at the end of this year. This would prove quite expensive—according to the non-partisan Congressional Budget Office, it would raise deficits by more than $5 trillion through 2035. As Republicans finalize their tax proposals, it is worth asking what else could be done with those trillions.
The answer is “a lot.” With $5 trillion, we could bolster national defense, expand the child tax credit and reduce child poverty, fix our infrastructure, pay down the deficit … the list goes on.
There is no better example of how much revenue is at stake, however, than the following fact: For the amount of money it would take to extend the temporary provisions of the TCJA (not just over the next 10 years but permanently) policymakers could instead use the funds to keep Social Security solvent for generations.
Why are there temporary provisions? In 2017, Senate Republicans lacked the 60 votes needed to overcome a filibuster, so they passed the TCJA through the “reconciliation” process, which prohibits policies that raise the deficit after 10 years. To meet this requirement, Republicans opted to let almost all the individual income tax and estate tax provisions expire at the end of 2025. Extending those provisions and repealing some business tax increases that TCJA mandated would reduce revenues by about 1.2% of GDP per year by the end of the decade—and in subsequent years if the tax cuts are made permanent. Remember that number: 1.2% of GDP.
With a clear look at the cost of TCJA extension, the trade-offs become more obvious. Social Security is one of the nation’s most popular and successful programs, but it is in financial trouble.
Revenues that would otherwise go to making the provisions of TCJA permanent could be used instead to make Social Security solvent for at least the next 75 years.
The program relies on payroll taxes, income taxes on social security benefits, and the principal and interest on previous surpluses in the Social Security trust fund. Since 2010, however, payroll and income tax revenues have been smaller than benefit payments to retirees.
The trust fund has dwindled and is projected to be totally depleted by 2035 under Social Security’s intermediate assumptions, at which point the other revenue sources will only cover about 83% of benefit payments. Over time, those sources would cover even less of scheduled payments. Addressing this shortfall will require either spending cuts, payroll tax increases, or increased federal borrowing that equals—that’s right—a little less than 1.2% of GDP.
Revenues that would otherwise go to making the provisions of TCJA permanent could be used instead to make Social Security solvent for at least the next 75 years. In fact, it might keep it in the black for even longer, as revenues that would have gone to TCJA through 2034 could replenish the Social Security trust fund and extend solvency further into the future.
Choosing to keep Social Security on solid ground versus making the TCJA provisions permanent would have several advantages. First, it would avoid cuts to Social Security benefits, which 42% of retirees depend on for at least half of their income. It would also be progressive relative to extending the TCJA, which would cut taxes by more than $70,000 per household for those in the top 1% of the income distribution, compared to just $130 on average for households in the bottom 20%.
We live in a world of trade-offs, and a looming debate in Washington will decide how trillions of dollars in government cash is spent.
Republican lawmakers and President Donald Trump are eager to make permanent the provisions of the Tax Cuts and Jobs Act (TCJA) of 2017 that expire at the end of this year. This would prove quite expensive—according to the non-partisan Congressional Budget Office, it would raise deficits by more than $5 trillion through 2035. As Republicans finalize their tax proposals, it is worth asking what else could be done with those trillions.
The answer is “a lot.” With $5 trillion, we could bolster national defense, expand the child tax credit and reduce child poverty, fix our infrastructure, pay down the deficit … the list goes on.
There is no better example of how much revenue is at stake, however, than the following fact: For the amount of money it would take to extend the temporary provisions of the TCJA (not just over the next 10 years but permanently) policymakers could instead use the funds to keep Social Security solvent for generations.
Why are there temporary provisions? In 2017, Senate Republicans lacked the 60 votes needed to overcome a filibuster, so they passed the TCJA through the “reconciliation” process, which prohibits policies that raise the deficit after 10 years. To meet this requirement, Republicans opted to let almost all the individual income tax and estate tax provisions expire at the end of 2025. Extending those provisions and repealing some business tax increases that TCJA mandated would reduce revenues by about 1.2% of GDP per year by the end of the decade—and in subsequent years if the tax cuts are made permanent. Remember that number: 1.2% of GDP.
With a clear look at the cost of TCJA extension, the trade-offs become more obvious. Social Security is one of the nation’s most popular and successful programs, but it is in financial trouble.
Revenues that would otherwise go to making the provisions of TCJA permanent could be used instead to make Social Security solvent for at least the next 75 years.
The program relies on payroll taxes, income taxes on social security benefits, and the principal and interest on previous surpluses in the Social Security trust fund. Since 2010, however, payroll and income tax revenues have been smaller than benefit payments to retirees.
The trust fund has dwindled and is projected to be totally depleted by 2035 under Social Security’s intermediate assumptions, at which point the other revenue sources will only cover about 83% of benefit payments. Over time, those sources would cover even less of scheduled payments. Addressing this shortfall will require either spending cuts, payroll tax increases, or increased federal borrowing that equals—that’s right—a little less than 1.2% of GDP.
Revenues that would otherwise go to making the provisions of TCJA permanent could be used instead to make Social Security solvent for at least the next 75 years. In fact, it might keep it in the black for even longer, as revenues that would have gone to TCJA through 2034 could replenish the Social Security trust fund and extend solvency further into the future.
Choosing to keep Social Security on solid ground versus making the TCJA provisions permanent would have several advantages. First, it would avoid cuts to Social Security benefits, which 42% of retirees depend on for at least half of their income. It would also be progressive relative to extending the TCJA, which would cut taxes by more than $70,000 per household for those in the top 1% of the income distribution, compared to just $130 on average for households in the bottom 20%.
And unlike extending the TCJA provisions, it would not hurt economic growth: A recent CBO analysis finds that extending TCJA would have a slightly negative effect on growth within four years.
Public policy is about making choices, and lawmakers stand at a crossroads. If they choose to extend tax cuts that favor the rich while calling for cuts in “entitlements” (aka Social Security) that favor low- and moderate-income families, they will help those who don’t need it while penalizing those who do.
At best, that option is short-sighted and inequitable. Bluntly, it is a bad choice. Instead, maintaining Social Security benefits is the more appropriate option. Avoiding a massive and regressive tax cut would make it possible.
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