Trump has called for IVF to be free. How would that work?

Former President Donald J. Trump said during the campaign on Thursday that he wants to make in vitro fertilization free for all Americans.

“Under the Trump administration, your government will pay or your insurance company will be required to pay for all costs associated with in vitro fertilization treatment,” Mr. Trump said. he said on Thursday at a rally in Potterville, Michigan.

In vitro fertilization often costs tens of thousands of dollars. Experts say it would be hard to implement a policy that would cover those costs.

Requiring insurers to pay would likely require legislation to be passed in Congress or forcing expert panel to add in vitro fertilization to the list of free preventive services for women established by the Affordable Care Act, the health insurance law that Mr. Trump has tried to repeal.

Directly paying for in vitro fertilization would create a single health care system for a single condition. This approach would require Congress to fund a up-to-date federal government department to oversee the program.

“The president can’t do this alone,” said Alina Salganicoff, director of the women’s health policy program at KFF, a nonprofit health research organization. “It takes federal funding to do this. Congress has to appropriate the money.”

Mr. Trump voiced his support for in vitro fertilization after the Alabama Supreme Court ruled in February that the embryos were “unborn children.” When that decision caused several fertility clinics to abruptly shut down, he urged the Alabama Legislature to quickly pass legislation to protect the treatments.

That law eventually passed and allowed clinics to reopen, but IVF remained a major campaign issue. Democrats rallied around a proposal to protect access to IVF, and candidates shared their own experiences with infertility.

Republicans have struggled to bridge the divide between many voters who support the legality of in vitro fertilization and religious conservatives who oppose the treatment because it often leads to the destruction of unused embryos.

Southern Baptists, the nation’s largest Protestant denomination, voted against in vitro fertilization in June, calling for protection of “frozen human embryos.” The overturning of Roe v. Wade has emboldened Christian conservatives to begin work on legislation that would restrict access to in vitro fertilization

Political obstacles aside, there is no effortless way to make IVF treatment free for all Americans. “It’s a complicated undertaking,” Ms. Salganicoff said.

Asked how Mr. Trump would implement the policy, campaign spokeswoman Karoline Leavitt would not provide any details, saying only that the former president “supports universal access to contraception and in vitro fertilization.”

In infrequent cases, the government extends benefits to cover specific health conditions.

For decades, a federal program has provided dialysis to patients with end-stage kidney disease. And early in the pandemic, the government briefly made COVID vaccines available for free. Because such programs require federal funding, they can’t be created by executive order and require up-to-date legislation from Congress.

Congress could also expand coverage for care it deems critical by requiring insurance companies to pay for the service. Senate Democrats have proposed legislation it would require many health plans to cover in vitro fertilization. In June, Senate Republicans blocked the legislation from becoming law. J.D. Vance, the Republican vice presidential candidate and senator from Ohio, was among those who voted against it.

Some states required insurance companies to cover IVF treatment, but even these laws did not make care completely free. Because treatment is pricey, laws typically limit who can get the services and how much they can cost. Up-to-date York State, which has one of the most generous IVF laws, limits coverage to three treatment cycles.

Mr. Trump could try to implement this benefit through the Affordable Care Act, otherwise known as Obamacare. That law, passed in 2010, includes a section that requires insurance companies to cover a suite of women’s health benefits, including mammograms and birth control.

If the Trump administration wanted to add in vitro fertilization to the list, it would have to present its idea to the panel of doctors overseeing the service and convince its members that in vitro fertilization is a preventive service.

While the committee has approved coverage for some less established preventive services, such as pumping, the chances of success with in vitro fertilization are likely slim.

“The federal government needs to be careful that these services are preventative,” said Ms. Salganicoff, who helped write the original rule. “In vitro fertilization is a treatment and clearly falls outside the scope of a preventive service.”

Even if in vitro fertilization were added to the list, it would not be a surefire way to provide coverage. The Obama administration had to scale back its birth control mandate in 2014 after the Supreme Court ruled it could not be applied to certain employers, such as Hobby Lobby, that expressed religious objections.