Ramesh mentioned Donald Trump’s new proposal to either have the government pay for IVF treatments or mandate that insurers do so. It’s worth noting that, in addition to rankling pro-lifers, the proposal would represent an expansion of Obamacare, which created the architecture for the federal government to dictate what insurers must cover.
Opposition to government mandated benefits was not only central to the case against Obamacare, but it has been a key component of the case for free market health care even longer. The reason why is that when government forces all policies to include certain benefits, it drives up the cost of insurance for everybody — especially those who would not be interested in using those benefits. In the pre-Obamacare days, when Republicans used to talk about allowing insurers to sell insurance across state lines, this was an idea for driving down costs in highly regulated states by allowing residents there to purchase leaner and cheaper plans elsewhere. Obamacare made insurance more expensive even in the lower-regulated states, which was a key driver of the backlash that ushered Republicans into control of Congress and helped Trump’s first White House bid.
Government-financed IVF treatment, which costs tens of thousands of dollars, would impose an enormous cost on taxpayers, or, as a mandated benefit, would dramatically drive up insurance premiums. Outside of requirements to sell insurance to older and sicker patients and capping the cost to them, IVF is one of the most expensive benefits one can mandate. By taking this position, Trump is calling for hiking premiums on every American who does not use IVF. Had Democrats tried to mandate IVF federally when Obamacare was being debated, it’s quite possible that would have been the breaking point for the more moderate Democrats, and it would have tanked the whole bill. Put another way, Trump has taken a position that was deemed too left-wing for Barack Obama.
In his first term, Trump was a pro-life president who tried to repeal Obamacare. His statements today (including his declaration that he would vote to expand abortion in Florida beyond six weeks), suggest that he wants to be a pro-choice and pro-Obamacare president.