Companies have increasingly offered generous fertility benefits to attract and keep top-notch workers. Now, the federal government is getting in on the act. Starting this year, federal employees can choose plans that cover several fertility services, including up to $25,000 annually for in vitro fertilization procedures and up to three artificial insemination cycles each year.
With about 2.1 million civilian employees, the federal government is the nation鈥檚 largest employer. Now, just as businesses of every stripe prioritize fertility benefits, in vitro fertilization 鈥 a procedure in use for 鈥 has become a for some anti-abortion Republican members of Congress and even presidential candidates.
It was inevitable that disagreements over IVF among abortion opponents would eventually break into the open, said Mary Ziegler, a legal historian and expert on reproductive health.
鈥淭he anti-abortion movement from the 1960s onward has been a fetal personhood movement,鈥 said Ziegler, a law professor at the University of California-Davis. Since the U.S. Supreme Court鈥檚 Dobbs decision eliminated the constitutional right to abortion, anti-abortion groups and the Republican Party are grappling with what 鈥渇etal personhood鈥 means and how that fits into their position on IVF and other technologies that help people have babies.
The Alabama Supreme Court set the stage for the recent brouhaha with a that frozen embryos created through IVF are children under state law. A pair of Democratic senators advanced legislation that would override state laws by establishing a and other such technologies. The bill was by a Republican opponent.
These events highlight the tough spot in which Republicans find themselves. Many support IVF, and they are keenly aware that it鈥檚 extremely popular: 86% of adults in said IVF should be legal. The outcry over the Alabama ruling and Republicans鈥 inability to coalesce around a federal response, however, has exposed fault lines in the party.
Some anti-abortion groups have strenuously objected to measures like that Senate bill, arguing that lawmakers must balance IVF with the responsibility to respect life.
Republicans 鈥渁re trying to finesse it, which is very hard,鈥 Ziegler said.
About face fertility problems, according to the National Institute of Child Health and Human Development. IVF, a process in which an egg is fertilized in a laboratory and later implanted in the uterus, is among the most , costing about $20,000 for one round. Even with insurance coverage, the procedure is pricey, but for some people it鈥檚 the only way to conceive.
In recent years, the number of companies offering fertility benefits to employees has grown steadily. In the early 2000s, fewer than a quarter of employers with at least 500 workers covered IVF, according to benefits consultant Mercer鈥檚 . In 2023, that figure had roughly doubled, to 45%. Employers typically cap IVF benefits. In 2023, employers had a median lifetime maximum benefit of $20,000 for IVF, according to the Mercer survey.
The federal government鈥檚 IVF benefit 鈥 paying up to $25,000 a year 鈥 is more generous than that of a typical employer. Coverage is available through the popular Blue Cross and Blue Shield Federal Employee Program’s standard option. Altogether, two dozen 2024 health plans for federal workers offer enhanced IVF coverage, with varying benefits and cost sharing, according to the federal Office of Personnel Management, which manages the federal health plans.
鈥淥PM鈥檚 mission is to attract and retain the workforce of the future,鈥 said Viet Tran, OPM鈥檚 press secretary, in written answers to questions. He noted that surveys have found that federal health benefits have influenced employees鈥 decisions to stay with the federal government.
Starting this year, plans offered to federal employees are required to offer fertility benefits, according to OPM.
But it鈥檚 unclear how the emerging political debate surrounding IVF and other reproductive health issues could affect national benefit and coverage trends.
Last month, after the Alabama Supreme Court ruled that frozen embryos left over following IVF procedures are considered children under state law, the and Republican Gov. Kay Ivey signed a bill that grants immunity to patients and providers who participate in IVF services. During the ensuing dust-up, a coalition of more than a dozen anti-abortion groups drawing a clear line in the sand. 鈥淏oth science and logic have made it clear that embryos must be accorded the same human rights鈥 as other human beings, it read. The Alabama law didn鈥檛 address the underlying issue of the 鈥減ersonhood鈥 of the embryos, leaving open the door for further litigation and potential restrictions on IVF in Alabama and other states, some legal analysts say.
More than have laws on the books that classify fetuses as people at some stage of pregnancy, according to an analysis by Politico.
It’s unclear whether the turmoil surrounding the Alabama case will have long-term repercussions for employee benefits there or in other states.
鈥淚f this were something that were to happen in multiple states, employers would have to figure out how to navigate around that,鈥 said Jim Winkler, chief strategy officer of the Business Group on Health, a nonprofit that represents the interests of large employers. At this point, employers will want to keep a watchful eye on the issue but probably not plan any changes, Winkler said.
A Mercer advised businesses with Alabama employees to review health plan policies related to medical travel and leave benefits. Further, 鈥渆mployers should monitor other states that broadly define fetal personhood and restrict reproductive healthcare,鈥 the blog post advised.
The of what happened with abortion coverage following the Supreme Court鈥檚 Dobbs decision in 2022. As states imposed restrictions on access to abortions, many companies began providing travel expenses for their workers to seek them.
But what happened with abortion may not be a good predictor of what will happen with IVF, said Dorianne Mason, director of health equity at the National Women鈥檚 Law Center.
Following the Alabama judge鈥檚 ruling, 鈥渢he legislature in Alabama moved so quickly to respond to the outcry,鈥 Mason said. 鈥淲hen we look at the legislative response to IVF, it鈥檚 moving in a markedly different direction on access to care鈥 than has occurred with other types of reproductive care.
