How IVF exposed fissures in the Republican coalition

Donald Trump is struggling with female voters and occasionally acts like he knows it.

With the November election fast approaching, Republican political consultants have been bemoaning the fact that their presidential candidate continues to publicly boast about overturning Roe v. Wade — something a majority of Americans oppose. Trump’s openly anti-abortion pick for vice president, JD Vance, also continues to attract attention for his deeply unpopular insults of women who don’t have biological children.

These dynamics are exacerbated by the fact that the economy — typically Republicans’ strongest issue — continues to improve; the Fed recently cut interest rates and inflation has fallen to its lowest point in three and a half years, with gas and grocery prices plunging.

To help improve his chances, Trump has been trying to dispel fears. At the September presidential debate, when asked if he would veto a national abortion ban, Trump repeatedly dodged the question, insisting it wouldn’t be necessary since abortion rights are now under state control. This is only half-true: Trump is right that he’s unlikely to face a national abortion ban from Congress in the next four years.

But most anti-abortion leaders weren’t counting on that, anyway. The anti-abortion movement has been banking on more appointments of friendly federal judges and taking control of key federal agencies that could use executive power to heavily restrict reproductive freedom.

“We don’t need a federal abortion ban when we have Comstock on the books,” Jonathan Mitchell, the legal architect behind a 2021 law in Texas that effectively banned abortion, told the New York Times earlier this year. Mitchell was referring to the Comstock Act, an 1873 federal law that could prohibit anything associated with abortion from being sent in the mail. Such a ban could mean not only restricting abortion medication, the most common method used to end a pregnancy in the US, but also any medical equipment used during surgical abortion, like speculums, suction catheters, and dilators.

The Comstock Act was rendered moot by Roe v. Wade in the 1970s but never formally repealed, and now, with Roe gone, some conservatives, including Mitchell and JD Vance, are pushing for its revival. “I hope [Trump] doesn’t know about the existence of Comstock, because I just don’t want him to shoot off his mouth,” Mitchell added, urging anti-abortion groups to also “keep their mouths shut as much as possible until the election.”

Things seemed to be mostly going according to Mitchell’s plan, with Trump avoiding answering reporters’ Comstock Act questions and publicly insisting abortion was now a state duty. That is, until August, when Trump — seemingly more nervous about his election chances — announced on Truth Social that his administration would be “great for women and their reproductive rights.” He also finally told the media he would not use the Comstock Act to ban mailing abortion drugs, and on top of that, announced his administration would mandate health insurance companies cover the hefty cost of in vitro fertilization (IVF).

Trump’s new stances have not been clarifying or convincing enough for most voters — indeed, on the heels of him promising free IVF, he said he thought Florida’s six-week ban was too strict, and then announced he’d be voting against Florida’s proposed abortion rights ballot measure in November. That measure would legalize abortion up to viability to protect the patient’s health, as decided by their provider, and polls show most Floridians back it.

Still, Trump’s new rhetoric of (somewhat, sometimes) embracing reproductive rights has antagonized parts of his conservative base, who feel he’s taking the anti-abortion movement for granted and that he’s having his “Sister Souljah moment” with the segment of the electorate that helped deliver his victory in 2016. The immediate question is whether these conservatives will sit out in protest in November, and if they do, whether Trump can make up for it by drawing in more voters elsewhere. The larger, more enduring question is whether this portends an emerging split in the Republican coalition on the question of abortion, just a couple of years removed from the anti-abortion faction’s greatest victory.

While opposition to abortion has been a fragile part of the GOP coalition for years, IVF emerged this year as a new point of tension among conservatives.

After Trump announced in late August that he’d back free IVF, anti-abortion groups immediately urged him to retract his stance. At first glance, it may seem puzzling that a faction of voters who identify as “pro-life” would oppose technology that helps people with infertility become parents. About 2 percent of births in the US are done through IVF, which involves fertilizing eggs outside of the body and then transferring embryos to a womb.

But the opposition makes more sense when IVF is understood as conflicting with “fetal personhood” — a core goal of a faction within the anti-abortion movement that seeks to grant fetuses (and embryos) full human rights and legal protections.

“Human embryos are created and discarded or frozen by dozens in most IVF procedures,” Matthew Yonke, a spokesperson for the Pro-Life Action League, told me. “It’s no way to treat human beings, and the federal government should not subsidize it.”

(Louisiana remains the only state to outright prohibit the destruction of embryos, requiring patients to either pay forever to store their unused embryos, or donate them to a married couple. Most states allow patients to decide what to do with any excess genetic material.)

Some social conservatives also lament that contemporary IVF treats parenthood like an individual right instead of a responsibility or privilege for committed couples, and others object to the ethical implications of sex selection and optimizing for certain characteristics, such as eye color or intelligence.

Ever since February, when Alabama’s Supreme Court issued its unprecedented legal decision that invoked God to claim frozen embryos count as “children” under state law, policymakers and prospective parents have been realizing how vulnerable IVF is in the United States, even as politicians scramble to assure voters it’s not actually at risk.

For religious conservatives who oppose IVF, the last seven months have provided a fresh opportunity to make their case against the assisted reproductive technology. In some states they’ve made political gains: the North Carolina Republican Party adopted a platform in June that opposes the destruction of human embryos. Also in June, the Southern Baptist Convention, the largest Protestant denomination in the US, approved a resolution against IVF.

Anti-abortion leaders are prepared to fight for their long-term goal of fetal personhood, just as they did for decades to overturn Roe v. Wade. In many ways, these new IVF battles are just beginning: This past spring, a supermajority of justices on Florida’s Supreme Court signaled openness to a future fetal personhood challenge, suggesting that “pre-born children” are “persons” entitled to the right to life under the Florida Constitution. Regardless of whether Trump wins in November, these fights over reproductive technology will continue to embroil conservatives and the Republican Party.

It’s not just the ethics of IVF that are causing fissures — Trump’s promise that the government would foot the bill has also sparked concern among conservative budget hawks.

The average out-of-pocket cost per IVF cycle stands at $24,000, according to a federal fact sheet, or $61,000 in total per successful live birth, since people often need multiple IVF cycles. While Trump’s team has refused to provide any financing details for his plan, some experts believe it would require significant new Congressional spending.

Ira Stoll, a prominent conservative columnist, tried to make the fiscally conservative case for Trump’s IVF policy in the Wall Street Journal. He argued the proposal would be less expensive than it seems since the costs of low birth rates “far outweigh the costs” of adding IVF to insurance companies. “The roughly $15,000 price of an IVF procedure is nothing compared with the priceless potential of an individual human being,” Stoll added, though existing research suggests IVF would not significantly increase the birth rate.

However, for most conservatives concerned with federal spending and rising deficits, the government mandating taxpayer-funded IVF treatment feels like a bad joke. National Review editor Philip Klein argued that the expensive Trump proposal would amount to a significant expansion of Obamacare and drive up health insurance premiums for all.

Vance Ginn, the chief economist at the Office of Management and Budget during the Trump administration, came out to blast the IVF proposal. “I’m for IVF, as we’ve used it for two of our beautiful kids, but nothing is ‘free,’” he wrote on X. “Can we stop handing out things to win votes like it’s candy when we’re running $2T[rillion] deficits and not abiding by the limited roles outlined in the US Constitution?”

Fiscal conservatives in Congress have also been concerned. Sen. Lindsey Graham (R-SC) rejected the free IVF proposal on ABC News, saying there would be “no end” to its cost. Sen. Thom Tillis (R-NC) was more restrained with NBC News. “I’m a little bit hesitant on an insurance mandate. Is there some other way that we could incent[ivize] these sort of coverages through the private sector?” he asked. “We got a lot of things we’ve got to pay for next year by extending the tax provisions.”

Sen. Rand Paul (R-KY) opted to be less diplomatic, calling the idea “ridiculous.” The “government has no money,” he said. “We’re $2 trillion in the hole, so I’m not for asking the taxpayer to pay for it.”

Even before his promises for free IVF, fiscal conservatives were growing increasingly frustrated with Trump, as he’s been virtually silent on the mounting federal debt, and issuing new campaign pledges like ending taxes on overtime pay and Social Security benefits, and exempting tips from taxes. Trump’s disregard for deficit spending could turn off some of these budget hawks in November, too.

Evangelical voters were a critical part of Trump’s path to victory in 2016, and his campaign in 2020, and most political strategists say he’ll need to earn at least 80 percent of white evangelicals nationally to win in November.

A recent Fox News poll showed him at 75 percent with this group, a number that could sink lower given his recent flip-flops. Al Mohler, president of Southern Baptist Theological Seminary in Louisville, Kentucky, has been warning — in recent op-eds, speeches, and podcast interviews — that the Republican Party is making a huge mistake by potentially motivating religious voters to stay home. Mohler has been urging Trump to clarify how he’ll restrict abortion in the Oval Office, just as Trump promised evangelicals before that he would work to overturn Roe v. Wade if elected.

Tony Perkins, president of the right-wing Family Research Council, has been making a similar argument that Trump needs to give religious voters something to be genuinely excited about. “It’s just on the margins, but it’s the difference in many elections,” Perkins argued in Politico.

For now there’s no clear survey evidence on whether Evangelicals really are planning to stay home in November, though Lila Rose, a prominent anti-abortion activist, has been urging her followers to withhold their votes unless Trump changes his tune. But Mohler, for his part, said he’s likely to stick with Trump in November because he trusts that Trump will ultimately stack his administration with anti-abortion leaders, regardless of what he says on the campaign trail.

“I have a high degree of confidence that a lot of people in crucial roles in a Trump administration would reflect that pro-life sentiment,” he told the New York Times. “I believe the opposite about a Kamala Harris administration … I have to look at a longer-term strategy. And I think the most responsible pro-life figures in the United States think similarly.”

IVF in particular is popular in the US, with 70 percent of adults supporting access to the treatment. Even among Christian and Republican voters, clear majorities believe IVF access is a good thing.

That’s why, even as Republican lawmakers continue to vote against federal bills to protect access to IVF, they have been publicly stressing their support for the technology. Pennsylvania’s Republican Senate candidate Dave McCormick is running on a $15,000 tax credit for fertility treatment, and in September, a conservative super PAC started funding a major ad campaign in support of IVF.

Public backing for abortion rights also continues to loom over Trump and the Republican Party; polls show voters have grown even more supportive of abortion rights than they were before the Supreme Court overturned Roe. Among women in particular, many say abortion rights are their top issue this November. A recent New York Times poll found that for women under 45, abortion is even more important to them than the economy. Another poll by Galvanize Action showed that 82 percent of white moderate women specifically plan to factor in a candidate’s stance on abortion when voting.

Whether this late-stage gamble by Trump to send mixed messages on reproductive rights pays off is anyone’s guess, but even if it does, the internal fights within the GOP coalition will likely remain — unresolved, festering, and ready to resurface after November.