HR-9941-119
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Veterans' Affairs, Armed Services, Education and Workforce, Ways and Means, and Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Lori Trahan (D-MA)
What it does
This bill would establish a federal statutory right to access assisted reproductive technology (ART, including IVF) and intrauterine insemination (IUI), preempting state laws that restrict such access unless they meet narrow exceptions. It would also expand ART/IUI benefits for military service members and veterans through the Department of Defense and Veterans Affairs, and require private group health plans, Medicaid, Medicare, and the federal employee health benefits program to cover ART and IUI without added cost-sharing.
Who benefits
Individuals and couples seeking fertility treatment, particularly those facing infertility, LGBTQ+ individuals and same-sex couples using ART to build families, active-duty service members and veterans (especially those with service-connected fertility impairment), health care providers offering ART/IUI services, fertility clinics, ART drug and device manufacturers, and health insurance issuers who gain explicit federal authorization to cover these services.
Who is hurt
States seeking to regulate ART/IUI practices (e.g., embryo disposition, licensing, or safety rules) would lose significant regulatory authority; private insurers, Medicaid programs, and employers who would bear increased costs from mandated coverage without cost-sharing limits; taxpayers funding expanded VA/DoD benefits; and religious or moral objectors (including some health care providers and employers) who may face conflicts between mandated provision/coverage and their beliefs, without a clear religious exemption comparable to Hobby Lobby protections.
Supporters argue
Supporters argue that IVF and fertility care are increasingly threatened by state-level restrictions following changes in reproductive law post-Dobbs, particularly proposals defining embryos as persons, and that a uniform federal right protects the roughly 1 in 6 couples experiencing infertility from a patchwork of inconsistent state rules. They contend that expanding VA and TRICARE coverage addresses documented gaps for veterans and service members with service-connected infertility, and that eliminating cost-sharing removes a major financial barrier, since IVF cycles often cost $15,000-$20,000 out of pocket.
Opponents argue
Opponents argue that the bill's broad preemption language would override legitimate state health and safety regulations of fertility clinics and could conflict with state laws on embryo disposition, surrogacy, and parental rights that states have traditionally regulated. They contend the private right of action and automatic injunctive relief provisions could invite excessive litigation against states, and that mandating coverage without religious or moral exemptions may burden providers and insurers with sincere objections, unlike the accommodation the Supreme Court required in Burwell v. Hobby Lobby (2014).
Constitutional context
The bill relies on the Commerce Clause and Spending Clause to justify federal preemption of state ART regulation and coverage mandates on private and public insurers; its broad preemption of state law raises Tenth Amendment and federalism questions similar to those addressed in NFIB v. Sebelius regarding coercive conditions on states. The bill's silence on religious exemptions for providers and insurers may raise Free Exercise and RFRA questions analogous to Burwell v. Hobby Lobby (2014).
Checks and balances
Congress would expand federal regulatory authority over state health and insurance law via broad preemption and grant HHS rulemaking power, with federal courts serving as the primary check through litigation over preemption scope and constitutional challenges brought by states or objecting parties.
Historical precedent
No directly analogous federal statute currently establishes a nationwide preemptive right to a specific medical procedure combined with mandatory private insurance coverage; the closest analogues are the ACA's coverage mandates and state-level fertility insurance mandates, but none combine broad preemption with a private right of action in this manner.