Happy October, Rulers! The fall air is bracing here in New York. Today, I’m eager to dive into the details on a reproductive health care issue that’s been dominating headlines this year. Let’s get right into it! This week, California Gov. Gavin Newsom signed a law requiring insurance companies in the state to pay for fertility treatments — including in vitro fertilization. These days, IVF is a hot topic on the presidential campaign trail. Democratic vice presidential candidate Gov. Tim Walz shared his own family’s IVF story while Republican presidential candidate Donald Trump says he supports IVF access and even pledged free IVF treatments for all Americans. And in the vice presidential debate Tuesday, both Walz and Sen. JD Vance (R-Ohio), mentioned protecting access to IVF — even though Vance voted against an IVF bill earlier this year. IVF became a centerpiece of the political conversation this year after an Alabama Supreme Court in February ruled that embryos are children. As a result, the state’s largest hospital temporarily stopped performing IVF treatments for fear of criminal prosecution. It’s since resumed the treatments. Some Republicans oppose IVF because the procedure entails the destruction of unused embryos which some, like former U.N. Ambassador Nikki Haley, view as “babies.” This summer, Rep. Matt Rosendale (R-Mont.) called IVF “morally wrong,” proposed anti-IVF amendments and hung anti-IVF posters outside his office. Meanwhile, Democrats like Sen. Tammy Duckworth (D-Ill.), who sponsored the “Right to IVF Act,” argue the treatment is an integral component of reproductive health care — not to mention reproductive freedom. “Having IVF in the news and in the spotlight has helped our efforts,” says Betsy Campbell, Chief Engagement Officer at RESOLVE: The National Infertility Association, an organization that worked alongside California legislators to draft and pass the recent bill. “If 2024 was the year of IVF… 2025 could be the year of IVF insurance,” Campbell says. “Protecting IVF is important, but if people can't afford the treatment, it's sort of an empty protection.” Members of Congress tried and failed twice this year to pass bills protecting IVF access on a national level. In June and again in September, Senate Republicans blocked legislation that would make it a right nationwide for women to access IVF. (Vance missed the vote on the September bill.) The California law, which covers fertility treatments for people with private insurance the state can regulate, opens up fertility treatments to millions more people. Advocates hope the increased attention on IVF during the heat of the campaign season could galvanize other states to follow suit and instate or expand their existing fertility coverage. In Pennsylvania — where there is currently no mandated coverage for infertility treatments — state Sens. Amanda Cappelletti and Lisa Boscola, both Democrats, believe the intense focus on fertility care will push through their own IVF bills. Boscola, sponsor of PA Senate Bill 475, which would mandate insurance coverage for fertility treatment, says she feels particularly suited to push for this legislation because of her own experience with infertility. “I myself had a hard time conceiving,” she tells Women Rule. “I did the hormone treatments and everything … And then that wasn't working. I had five miscarriages and one ectopic pregnancy.” (Boscola did not end up conceiving.) She says the recent Republican pushback against IVF and the buzz that ensued is a good thing — as long as it keeps the issue top of mind. “I think women will see in vitro covered sooner rather than later because of this election,” Boscola says. Cappelletti, sponsor of PA Senate Bill 602, providing for infertility care coverage, says her own struggles with fertility spurred her to sponsor the legislation. “I had two miscarriages before the successful birth of my daughter … I didn't need a politician telling me how to manage my miscarriages … what I need is my health care provider,” Cappelletti says. Her bill would require insurance companies to cover fertility treatments and “waive cost-sharing requirements related to infertility care” and prohibits refusing coverage “on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex or sexual orientation.” Across the country, 22 states already have some infertility coverage requirements and 15 specifically cover IVF, which can cost tens of thousands of dollars per cycle. Often, families undergo multiple rounds of IVF, making it prohibitively expensive for many. But even in states where coverage is a comparatively progressive place — like New York, where up to three cycles of IVF treatments are covered by city and state insurance — state legislators are pushing for more. New York State Sen. Jessica Scarcella-Spanton introduced a bill this year to remove the three-cycle restriction on coverage for IVF and mandate all insurance companies — not just city and state — to cover the procedure. “It's important that we take the lead on this,” Scarcella-Spanton says, “to make sure that New York State is not only a leader in IVF coverage, but an example for the rest of the country.” She says the three-cycle limit is unclear and restrictive, and that the mandate should apply to all insurers, not just city and state, so that women don’t have to pick and choose jobs based on treatment access. “I look at it as an investment in New York state families,” she says. Both the Pennsylvania lawmakers and Scarcella-Spanton say opponents push back on their bills out of concern for the potential increased costs of covering these treatments. According to Campbell, however, ensuring IVF is covered by insurance is actually cost effective. “The biggest obstacle is the myth of cost,” Campbell says, explaining that the actuarial firms who conduct insurance cost reports “always overestimate the actual cost of the procedures and how many procedures a single patient will use.” She argues that states with IVF insurance coverage have lower rates of multiple births and therefore less costly pregnancies, and that in countries where IVF is totally free, “only 40 percent of people who need it do it.” As Scarcella-Spanton sees it, IVF access, and coverage, is a bipartisan issue that almost everyone can agree upon. “I just think you almost sound unhinged, if this is a policy that you don't support, right?” she says. “I don't see how there's any bad press for anybody.”
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