This IVF bill is a perfectly reasonable compromise. So, of course, Congress won’t pass it.

It isn’t a perfect science, but when a piece of legislation gets white-hot ire from both sides of the political aisle, it is either totally objectionable or a fairly moderate compromise. The most recent example, a Republican-led effort to federally protect in vitro fertilization (IVF), has been lambasted by both Republicans and Democrats for various reasons. After reviewing the bill, we are putting it safely in the “moderate compromise” category, and Congress members should reconsider their objections. 

The IVF Protection Act from Sens. Ted Cruz (R-Texas) and Katie Britt (R-Ala.) would tie Medicaid funding to the condition that states not restrict IVF. In other words, if a state or even local municipality decides to restrict IVF practices, then the state would likely lose its federal Medicaid dollars in return. The bill does not include any requirement to furnish IVF—so it could not be used to compel someone unwilling to provide the service to do so—nor does it impede states’ ability to impose health and safety regulations on the practice of IVF.  

Response to the bill has been negative. Some groups on the left think the bill doesn’t go far enough to protect IVF, calling it “phony,” or a “scam.” Similarly, some groups on the right have expressed displeasure, saying it caters to the unwieldy “Big Fertility” industry and that tying Medicaid funding to IVF leaves states in a bind with setting ethical standards. 

These rejections vary in sincerity. First, the bill still technically allows states to outlaw IVF if they choose to reject Medicaid funding, meaning this is not an infallible way of preserving IVF access. However, tying Medicaid funding to IVF is a pretty good carrot-and-stick initiative, as the amount of funding states receive for Medicaid is staggering. In 2022, the United States spent over $804 billion on Medicaid expenditures, with every state except Wyoming receiving at least $1 billion federal dollars annually. What’s more, approximately 83 million individuals are enrolled in Medicaid, making it a major factor for voters. A 2023 survey found that 75 percent of voters believed the future of Medicare and Medicaid is “very important” for presidential candidates to discuss in 2024, beating out other issues like gun violence and abortion. States would be hard-pressed to keep Medicaid running without federal dollars. 

And while some states have rejected Medicaid expansion in recent years, it wasn’t out of spite. The 10 states that rejected expanded coverage receive over $154 billion annually, or about 19 percent of Medicaid’s annual funding. One chief reason for rejecting the expansion was that it would be too expensive for the states themselves to match the funding—so it would surely be too expensive to supplant it entirely. For example, Wyoming, the state with the lowest amount of aid from Medicaid, still receives $677 million annually ($579 million less than the second lowest-receiving state, South Dakota). If Wyoming were to reject Medicaid funding in favor of IVF prohibition, over 88,000 people (15 percent of Wyoming residents) would lose access to health care—61 percent of whom would be under the age of 21.

Second, to avoid criticisms that the bill isn’t clear enough about what qualifies as a restriction, it would benefit from more specificity about what is considered IVF prohibition. An outright ban would, of course, fall into that category. But what about limiting IVF to married couples only? Or to heterosexual couples only? What if a state prohibited the disposal of embryos and required all created embryos to be used in a pregnancy? There are currently some restrictions on who qualifies for IVF due to medical reasons, but the bill does not clarify whether those count, either. These questions may seem abstract, but that they have all been raised indicates a need for clarity regarding the bill’s intent. If the bill is intended to allow reasonable medical restrictions on IVF, such as patient health or safety, then it can easily be amended to say so.

Finally, calls from the right for more regulation of the IVF industry are a departure from a limited-government, pro-market ethos. Beyond that, the IVF Protection Act explicitly allows for states to set health and safety standards—so calls for more regulation of clinics are irrelevant to the bill’s intent. Further, IVF practices are not exactly the wild west. The Centers for Disease Control and Prevention, as well as leading reproductive medical societies, mandate certain reporting requirements and issue ethical standards for various facets of IVF procedures.

This bill will not do everything that either the staunchest IVF supporters or opponents want. It does not increase access, it does not delve into ethical considerations of IVF, and it does not overhaul the regulatory environment. But all of these goals are beside the point of the bill. Offering security to families seeking IVF treatment so that they can continue to see an IVF doctor without legal retribution is a solid enough goal. And it’s one that 86 percent of Americans (and 84 percent of conservatives) support. 

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