The government’s leadership on IVF starts with its own employees

Tammy Wildgoose and her husband wanted to build a family. After a year and a half without success, Wildgoose was diagnosed with infertility and they turned to in vitro fertilization. But there was a problem — her health insurance wouldn’t cover it.

Without that coverage, the process was financially out of reach. So Wildgoose decided to take a second job with Amazon on top of her regular, full-time employment because it offered better coverage options than her employer. When that coverage ran out, she took yet another job with Tractor Supply so she could continue her IVF journey on their insurance plan. She did whatever it took to start and build her family.

Fortunately, after three grueling rounds of IVF, Wildgoose became pregnant. Months later, she gave birth to a healthy baby boy. Her family-building journey was off to a successful, joyous start. 

But that good news masks a glaring problem. 

Wildgoose is a federal employee who has served her country as a public servant for six years. She receives her insurance through the Federal Employee Health Benefits Program. That means that the federal government, the very entity we expect to be leading the charge to protect access to IVF, does not provide its own employees with adequate insurance options that cover infertility care.

That is an outrage.   

Use of IVF and other forms of assisted reproductive technology has increased dramatically in recent years. Between 2012 and 2021, the use of ART more than doubled. The percentage of babies born through assisted reproductive technology rose by a full 50 percent in the same timeframe, with IVF accounting for more than 99 percent of ART procedures performed. All in all, 86,146 babies born in 2021 were conceived with the help of IVF or other forms of assisted reproductive technology.

According to the National Survey of Family Growth, 9 percent of married women and 9 percent of men have experienced or will experience some form of infertility. As a result, one in eight women have received infertility treatment at some point in their lives. And that doesn’t even cover the many LGBTQ couples or individuals who rely on fertility treatments to build their families. 

This is not a niche issue. It affects millions of women and families across America. But without some form of insurance coverage, IVF is often out of reach for families. Out of pocket costs for one cycle of IVF can cost a patient between $15,000 and $30,000, with prescription drugs accounting for 35 percent of that cost.

So far, insurance coverage has not kept up with that reality. Twenty-nine states do not require insurance carriers to cover any fertility services at all. Twenty-one states and Washington, D.C. require coverage of some amount of select assisted reproductive technology services. Only 14 states and Washington, D.C. have a mandate in place for IVF coverage. 

Despite the increasing prevalence of fertility care, coverage for assisted reproductive technology has stagnated and, in some cases, regressed. Tragically, some states have seized on the overturning of Roe v. Wade to advance draconian restrictions on IVF. We need look no further than Alabama for evidence of that. But this is not solely a state-level problem. As Wildgoose’s story shows us, the federal government has not played an active enough role in leading the charge for increased infertility coverage. In fact, coverage for its own employees has been severely lacking.

There are nearly 3 million federal employees like Wildgoose in the U.S., serving the American people with honor and distinction in every state and territory. They are dedicated, patriotic public servants. But their employer, the federal government, has failed to ensure they have adequate access to insurance plans that cover IVF and other forms of assisted reproductive technology.

The Federal Employee Health Benefits Program is the largest employer-sponsored health insurance program in the world. When the federal government conspicuously fails to provide adequate coverage for infertility treatment, insurance companies across the country take notice and adjust their own coverage options accordingly. This harms both the federal employees and the tens of millions of Americans whose own coverage is influenced by the government's decisions.

It is high time for the federal government to recognize its leadership role on this issue. How can the American people trust the federal government to defend and expand their access to IVF if it can’t defend and expand access for its own employees?

Thankfully, after a significant push from myself and Sen. Tammy Duckworth (D-Ill.), the Biden administration has taken meaningful steps in the right direction. For plan year 2024, the Biden administration succeeded in providing federal employees with 24 federal program plan options providing varying levels of coverage of infertility care.

Critically, for the first time in U.S. history, this administration secured the inclusion of a national plan with IVF coverage, ensuring that every federal employee, no matter where they live, will be guaranteed access to at least some coverage. Wildgoose hopes to select that option next year, allowing her to grow her family again without relying on outside employment.

But there is significant work left to be done.

Last year, Sen. Duckworth and I introduced bipartisan legislation that would require every carrier in Federal Employee Health Benefits Program to cover assisted reproductive technology, including IVF. Executive action on this issue is necessary and appreciated, but it is not a permanent solution. Our bill is the only lasting solution to a problem that cannot be solved by the executive branch alone.

In the wake of Alabama's Supreme Court decision, House Speaker Mike Johnson (R-La.) went to great lengths to profess his support for IVF and the women who use it. Now is the chance for him to make good on those words and bring the bill to the floor for a vote.

For the Wildgoose family, for all our federal employees, and for every woman in America, I implore him to make that choice.

Gerald E. Connolly represents Virginia’s 11th District in the U.S. House and is a senior member of the Committee on Oversight and Accountability.