Utah News

Public policy can reward or penalize marriage, raising a natural question in the Beehive State, which considers itself to be family friendly: Do Utah policies create a marriage “penalty” or “bonus”?

The Kem C. Gardner Policy Institute recently dived into tax policies, as well as benefit and other programs, to see if Utah’s government policies create “marriage penalties” or “marriage bonuses.” It found a mixed bag.

“A marriage penalty arises when tax structures, welfare program eligibility rules or other government programs place a disproportionate burden on a married couple compared to two unmarried individuals, effectively providing a financial disincentive to marry,” said Maddy Oritt, senior public finance economist at the institute, in background material on the findings. “While some marriage penalties, both direct and implicit, exist in Utah’s tax structure and benefit programs, they are relatively few and limited in scope.”

A marriage bonus is created when a married couple receives a financial benefit greater than would be given to two unmarried individuals.

That has been a consistent topic among conservatives at the federal level that grew hotter during the election campaign, amid concerns that fewer people are marrying and some policies provide disincentives to do so.

The report finds there are not typically marriage penalties in the tax structure, though some of the targeted tax credits disadvantage couples who are married because of income levels at which the credits phase out.

However, there are marriage penalties in some of the state and federal benefit programs — many of which are designed by the federal government but run at state level. The penalties are most likely to occur when a program targets aid to single parents or doesn’t for married couples “exactly double the benefit or income threshold for a single person.” Those are most often provisions set up in federal programs administered in the states.

The report calls household composition a place where “implicit” penalty occurs, noting that means that “benefits scaled based on household size do not increase proportionally for each additional household member, nor does household income determine eligibility. This occurs with both married and cohabiting couples.”

Breaking down the penalties or bonuses

When the institute judged the presence of penalties based on if the benefit or income threshold for a married couple “exactly doubles” that of a single person, the report notes that in looking at single compared to married households, there is a direct, explicit marriage penalty in the:

• Social Security Tax Credit
• Earned Income Tax Credit
• Retirement Tax Credit
• Child Tax Credit

The institute did not find a similar marriage penalty in the:

• Taxpayer Tax Credit
• My529 Educational Savings Tax Credit
• Health Benefit Plan Credit
• Taxpayer Exemption
• Circuit Breaker

When it comes to household composition, the implicit marriage penalty is found only in the Earned Income Tax Credit and the Health Benefit Plan Credit, per the report.

Comparing head of household, which refers to a single person with a dependent, to married households, the report says that the head of household status confers a benefit greater than half of the married benefit in all of the above-mentioned tax provisions except the education savings credit, the health credit and Circuit Breaker.

The report points out, too, that many programs use income tax returns as the basis for determining eligibility. That means that if cohabiters file separate tax returns, the income of a domestic partner might not be part of the calculation, “so cohabitation may not result in a penalty while marriage could result in a penalty based on how household size and income factor into assessment.”

The report, however, doesn’t separate out the difference between marriage and cohabitation as it weighs the penalties related to policies that rely on household size itself.

Will people choose not to marry?

Per the institute, most studies find marriage penalties and bonuses, especially in tax structure, don’t greatly impact whether couples marry.

Marriage penalties are more apt to impact how much a spouse works or even if a spouse works. “A marriage bonus exists for couples with one spouse in the labor force and one outside, as the earning spouse pays taxes at a lower rate after marriage and may claim a larger standard deduction. The non-working spouse, however, now faces a higher tax rate on the next dollar of income earned (or marginal tax rate). Some studies find that this discourages the spouse outside the labor force from seeking employment,” the report said.

Utah policy specifics

The analysis finds marital status has no role in determining sales tax, gas tax or property tax. Within the income tax structure in Utah, though, marital status may make a difference. Many of the credits do not exactly double deductions or other numbers for married couples, compared to claiming one adult.

The report notes that both eligibility determination and benefits for many state and federal programs do have marriage or household composition penalties, “with Medicaid and college tuition benefit programs at certain Utah universities creating direct marriage penalties. Other programs, such as TANF (Temporary Aid for Needy Families) and SNAP (Supplemental Nutrition Assistance Program), introduce household composition penalties that may disincentivize marriage, including income eligibility limits that do not double in a two-person household with two earners or benefits that do not double if two individuals create a single household.”

According to the report’s authors, direct marriage penalties could be eliminated for married couples compared to single couples by changing the income caps and benefit levels so they are precisely that of single filers. Household composition’s implicit penalties could be eliminated by making the income thresholds exactly proportional for each additional member of the household.

States don’t have a lot of wiggle room to impact penalties or bonuses from marriage within programs designed by the federal government, but they could tackle those within state-level provisions, per the institute.

A national discussion

Marriage penalties are a national topic and have been for quite some time.

Back in 2015, Deseret News’ own American Family Survey, done in conjunction with Brigham Young University’s Center for the Study of Elections and Democracy, found that 31% of Americans said they knew people who didn’t marry because they would lose a safety net benefit. Sutherland Institute recently reported that 10% of beneficiaries from such programs said they didn’t marry because they didn’t want to lose the help they were receiving.

As Vox reported in November, “A 2022 analysis from the National Bureau of Economic Research estimated that, without marriage penalties, 13.7% more low-income single mothers would marry each year, and 7.5% more would be married by age 35. The study suggests these women typically do marry, but penalties might delay tying the knot.”

Congress has considered a number of bills related to marriage penalties in the last couple of years, including a measure aimed at allowing disabled adults who receive Supplemental Security Income to marry without a penalty.

In October, Jamie Bryan Hall, director of data analysis at the Ethics and Public Policy Center, in a letter to a House committee called marriage penalties “the greatest injustice in the federal income tax code.”

In November, the American Enterprise Institute brought together experts from Virginia’s Office of Diversity, Equity and Inclusion; the Georgia Center for Opportunity; the Niskanen Center and the Sutherland Institute to look at marriage penalties in the tax code.

Just a week ago, Indiana’s Gov. Mike Braun signed an order that is designed to find marriage penalties in that state’s tax and benefit policies, so they can be eliminated, as reported by FOX59.com.

“Marriage is the fundamental cornerstone of strong families and strong communities, and we need to make sure Indiana’s tax and benefits systems aren’t penalizing Hoosiers for getting married,” Braun said in a news release. “This executive order will make sure Indiana’s policies are providing an incentive for Hoosiers to build strong families, rather than getting in the way.”

In an interview for Public Discourse, Brad Wilcox, director of the National Marriage Project at the University of Virginia, among many other titles, including Deseret News contributor, decried what he called “statism — the modern states tendency to supplant many of the functions and much of the authority once held by the family to the detriment of marriage (including ‘marriage penalties’ that make marrying a bad financial deal for lower-income families).“

He added that he would “love for Congress and the states to minimize marriage penalties in means-tested programs like Medicaid,” among other actions.

Niskanen Center reported that some Republicans would like to eliminate the “head of household” filing status because they believe it creates a marriage penalty. That’s prompted the center to create a counterproposal to avoid disadvantaging single people with children by raising their taxes. Instead, the center argues, phasing out the head of household status while making adjustments to other tax credits like the child tax credit, to “offset any negative impacts on single parents.”

With Utah’s offseason just beginning, there will be time to heal, watch and learn from the current playoff teams, and game plan for the upcoming season.

Having already re-signed a significant number of players, Utah finds itself in a comfortable position: knowing who will be on its roster next season while still having the flexibility to target free agents thanks to a manageable cap situation.

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But just because the team can spend the money doesn’t mean it will.

“A lot of teams that you saw that ‘won the summer’ didn’t win the winter,” Bill Armstrong said. “Once the money’s gone, it’s usually locked in for a long term and next year, we’re talking about, ‘How do we get rid of some of that money?’ So, it’s really a tricky one, where you have to very, very cautiously spend your money.”

But still, one of the major questions facing Utah this offseason is how it will construct its second line.

Utah Hockey Club Enters First Off-Season With Big Decisions Ahead It’s been a week since the Utah Hockey Club’s inaugural season came to an end. Now that we’ve heard from everyone within the organization, the focus shifts to the offseason and how they plan to make the team better.

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One spot was consistently filled by a talented Utah player, whether it was Dylan Guenther, Nick Schmaltz, or even Logan Cooley when he returned from injury, to skate alongside the line’s anchor, Barrett Hayton, barring any injury.

Even when injuries hit, players like Alexander Kerfoot were more than ready to step in and fill the role.

But the thing about lines is that they’re made up of three players. And for Utah, that third spot on the second line never felt secured, as a revolving door of Matias Maccelli, Michael Carcone, and, most recently, Kailer Yamamoto cycled through the role.

Given that Utah already has five players to fill the first and second lines, it would make a lot of sense for Utah to target some talent in free agency to fill that sixth spot.

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Both Maccelli and Carcone played over 50 games for Utah, but by the end of the season, both had taken turns as healthy scratches. Neither saw regular starting time down the stretch, with Kailer Yamamoto being elevated to the active roster for the final 11 games of the season.

With Carcone making it clear in his exit interview that he’s looking for a change of pace with a new team, Utah’s depth at the position has already begun to thin.

Utah could opt to run it back with either Maccelli or Yamamoto, especially with Yamamoto looking decent in his final stretch of games, but given the team’s cap space and financial flexibility, it makes sense to look beyond simply re-signing Yamamoto or starting Maccelli.

“A couple years ago, we needed players no matter what,” Tourigny said. “If you’re a good player, we (were) happy to have you. Now, we’re looking for specific areas of our game to be better.”

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There’s also Utah’s recent push to bring over Russian prospect Danil But, a left winger, a position the team currently lacks depth in, showing Utah is looking to improve the roster this offseason. BROGAN LINK

So while Utah will probably want a new face for its second line, Utah likely won’t do anything if it doesn’t see it as a good fit.

After all, Utah already benefits from having a young core that continues to grow together, and Utah will keep leaning on that.

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But adding another free agent who can strengthen one of the top two lines wouldn’t just give Utah a more stable unit, it could also give Barrett Hayton another top-tier talent to join him and Nick Schmaltz, assuming Utah’s first-line trio of Cooley, Guenther, and Clayton Keller is what coach André Tourigny sticks with next season.

This also assumes Utah decides to re-sign Jack McBain, who played well on the third line with Lawson Crouse and Josh Doan toward the end of the season.

Along with McBain, this assumes that Nick Bjugstad, who found strong chemistry with Alexander Kerfoot and Kevin Stenlund, is also signed.

With both guys resigned, that would leave the second line as the primary area to address.

Utah Reportedly Facing Issues With Trademark Office The Utah Hockey Club is having some serious trouble when it comes to picking a permanent team name.

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And while Doan played really well alongside Crouse and McBain, he also showed some chemistry with Hayton when he temporarily moved up to the second line before being bumped back down.

While it might seem like a strange idea to move Doan, given how well he played alongside Crouse and McBain, Utah could consider shuffling its lines if Doan continues to develop his offensive game.

But for now, Utah would likely prefer to keep Doan’s puck-stealing ability and physical presence right where he is: alongside two heavy hitters in Crouse and McBain.

And who knows, Yamamoto did bring some consistency during his 11-game stretch to close the season. Depending on how he performs with the Tucson Roadrunners, Utah could choose to keep him in the lineup if no free agent options feel like the right fit.

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But with free agency not opening until July 1, Utah will have plenty of time to strategize how it wants to address the spot.

Utah’s Logan Cooley To Play For Team USA At World Championships Utah Hockey Club’s Logan Cooley has confirmed that he will play for Team USA at the World Championships in May.

Utahn Jordan Maddocks was on a mission Monday — dressed as a banana.

Maddocks competed in the Boston Marathon and reclaimed his Guinness World Record for the fastest marathon run by someone dressed as fruit.

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“The world record for the fastest fruit is officially back in Utah. 2:33:19 (5:51 pace) at Boston. What a wild ride. I’ve never given out more high fives or felt more love from a crowd,” Maddocks wrote on Instagram.

Note to readers • This story discusses sexual assault. If you need to report or discuss a sexual assault, you can call the Utah Rape and Sexual Assault Crisis Line at 801-736-4356.

The University of Utah had no obligation to help a sex assault victim — even though she was allegedly raped by one of the school’s football players — because the attack happened off campus, according to a federal judge.

That significant ruling issued last month from U.S. District Court Judge David Barlow now dismisses the U. from the lawsuit filed by Marissa Root, bringing her high-profile case to a quiet end after more than three years of fighting.

“Because this record does not supply the required nexus between the university and the off-campus party at a private residence, the university cannot be liable under Title IX,” wrote Barlow in his decision. That’s the federal law that charges universities with ensuring students receive education without sex-based discrimination; it also mandates that schools operate offices that provide support to students who have been sexually assaulted.

Root’s December 2021 filing had initially drawn widespread attention when she alleged that both the U. and Utah Valley University, where she remains a student, both declined to provide her any resources after she reported being assaulted. UVU was previously released from the case in 2023, when Barlow similarly determined that the Orem school had no responsibility because the alleged attacker wasn’t a student there.

Ultimately, Root has said that neither school helped her when she first reached out with allegations against the player. With both now dismissed from the case, it’s left her questioning: Where should victims go for support? Where can they get assistance?

“I had barriers at every single turn, from the hospitals to the universities to the police department to the district attorney,” she told The Salt Lake Tribune. “For me, now that this has been dismissed, there wasn’t an avenue that I got to feel heard in.”

The Tribune generally does not identify victims of sexual assault, but Root has agreed to the use of her name.

From the beginning, Root says the process for her to report the assault was marred by missteps. That included, she said, a hospital nurse telling her she’d have to pay for her own rape kit, which is not correct; staff later realized the error, but not before Root said she had a panic attack in the emergency room and it nearly stopped her from moving forward.

The Unified Police Department, where she ultimately reported the alleged September 2019 assault, also lost critical evidence in her case — a recording of the U. football player, Sione Lund — and delayed sending in Root’s DNA test for months, according to court documents.

Without the recording, and with Lund refusing to come in again when the department noticed it was gone, prosecutors told Root that moving forward with a criminal case would be severely hampered.

Lund, a former linebacker who was dismissed from the team when charges were later filed, was ultimately sentenced in April 2023 under a plea deal to 30 days in jail. He was originally facing two felony counts of rape and forcible sodomy; he pleaded guilty to one felony count of attempted forcible sodomy.

A U. spokesperson responded to the judge’s latest ruling with a statement calling it “a tragic case with far-reaching implications for everyone involved.” The school, the statement said, is committed to preventing violence and making sure “students feel safe, supported and heard.”

It continued: “We hope Marissa and the people who love and support her find opportunities for healing from this traumatic experience.”

Root, now 29, feels the school could have done more to help her heal but chose not to.

“I have to heal on my own from what happened,” she said. “… But even though I have been silenced over and over and over again for over five years, that forced me to find my own voice. And that’s never going away.”

What the ruling means

Root had argued in the lawsuit that both schools showed deliberate indifference and left her to deal with the alleged assault alone.

As a UVU student, she argued, the school should have been obligated to help her. And she asserted the U., where the football player attended, also could have provided her resources.

But under the judge’s ruling, a college does not have to help victims or survivors of sex assault — even if they are students there — if the alleged assault did not happen on campus or at a school-sponsored event.

The brief seven-page decision from Barlow said the U., specifically, didn’t have substantial control based on the location of the alleged attack to make the school liable for responding to it. It didn’t own the property — a private residence in Holladay owned by Lund’s parents — and it didn’t organize or sponsor the party that Lund held there that night.

That varies widely, Barlow said, from a location like a fraternity house where a university would have some jurisdiction, even if technically off-campus, because it sanctions the activities.

That goes against, though, what most advocates had thought Title IX ensured and what guidance at the time from the Department of Education suggested.

S. Daniel Carter, president of SAFE Campuses, LLC, previously said Title IX does not instruct schools to send their own students to the school of an alleged perpetrator for help. But even if it did, the second school should also have felt some responsibility to offer assistance.

“Legal requirements aside, a ‘pass the buck’ system can be deadly,” Carter has said.

The U. had previously filed a motion in the court in August, calling for the case to be dismissed. The school’s attorneys argued, in line with Barlow’s ruling, that the university cannot be responsible for what its students do off campus in situations it doesn’t control.

That would leave schools broadly open to lawsuits and “expand liability” beyond what the law says, they asserted. Barlow only ruled on that part of the U.’s arguments, suggesting it was enough to dismiss the case.

But the U. went further in its filing to say it also didn’t owe Root anything because she was not a student at the university entitled to resources there. They called her “a nonstudent without sufficient connections to the university,” saying her arguments that she attended several sporting events and often studied at the U.’s library were not enough. It would leave them responsible, the school said, for every person who ever walked on campus.

And the university argued it also didn’t know of any prior instances of alleged sex assault with Lund that would make it responsible for taking action against him.

Root contends, though, that the U. knew Lund was “an unsafe person.”

“He was defended. He was protected,” she said. “That was my biggest worry and why I wanted to go in there and make a complaint in the first place, so they understood there was a person on their campus who was a huge risk and a huge danger.”

Discovery in the lawsuit notes that Lund had previously been placed on probation by the U.’s football staff for being under the influence of drugs or alcohol at least twice, in violation of team policy.

He was disciplined both times, the U. said. But that didn’t make him a red flag to potentially assault someone, they contended. And though school policy instructs players to treat women with respect and not drink, that doesn’t mean the school has control over whether players follow it, as Lund’s attorneys argued.

The judge agreed with the university.

Barlow wrote: “Reliance on the 2019 Players Policy Manual’s general instruction that football players should treat women with respect both on and off campus does not mean that the university has control over the context of virtually every off-campus location in which one or more of its athletes attends a private party.”

The University of Utah had originally used similar arguments when it denied responsibility for the death of student athlete Lauren McCluskey in October 2018, saying her attacker was not a student so the school didn’t have any authority over him.

That prompted concern among students about the implications, including when their university would be obligated to protect them. The U. ultimately settled the case with McCluskey’s parents, acknowledging it was aware that McCluskey reported her concerns several times to the campus police department and housing officials and the school failed to take them seriously before she was killed outside her dorm.

What happened in the criminal case

Root had just started her sophomore year in fall 2019 at Utah Valley University when she went with a group of friends to the party at Lund’s parents’ house, she detailed in her lawsuit. Most of the men at the party were University of Utah football players, she said.

She later told police that at some point, Lund isolated her in his room. Root told him, “No,” several times, according to the charging documents, and repeated that she did not want to have sex with him. The police documents state that he then allegedly forced himself on her, as well as allegedly forced her to perform a sex act on him.

Root went to a hospital after with two friends. Following that, she sought help at UVU, where staff said she should talk to the U. instead, since the reported attacker was a student there.

Root argued in her lawsuit that the U. declined to help her and said their obligation was instead to the player, who was their student. She said the advocate there never asked for his name and dissuaded her from saying it.

The university said in its filing that the Title IX employee felt Root did not want to name her attacker and didn’t press her on it. That’s the first time that detail, gathered during a deposition, had been disclosed.

The U. said in a statement for this story: “After Root made an initial report to the University of Utah’s Office of Equal Opportunity, staff repeatedly reached out to her to try to ascertain the name of the perpetrator.”

Root denies that. When the school later learned it was Lund, after police in February 2020 started interviewing members of the football team about the case, the U. says he was suspended indefinitely and removed from the team.

The school also says it provided training for all football players about preventing sexual assault three weeks after Root told the U. staffer what happened.

Meanwhile, police bungled Root’s case, according to both her lawsuit and statements from the Unified Police Department in the court docket. The original detective failed to make any significant notes in the files for roughly two years. And the recording of Lund was not saved.

That detective later resigned. And when Root and her mom called the department for an update, the sergeant who answered couldn’t initially find her report. “We’re going to figure this out. But there’s nothing in your case file,” Root remembers him saying.

She was devastated. “I lost it. I became so emotional,” she said. “I’d been doing this for two years and there was nothing.”

She had to repeat telling a new detective everything she had already recounted about the assault. Given the hurdles, prosecutors later worried about taking the case to trial, Root said.

Root went forward with a plea deal; her biggest ask was that Lund be added to the sex offender registry, and he was. His name was ordered on the list for years.

“Although I did agree to this plea deal because I want closure,” Root said on the day Lund was sentenced, “it does not change the fact that he is guilty of rape.”

Lund apologized to her. But members of Lund’s family sat in the courtroom and audibly scoffed when Root spoke. The judge in the case, 3rd District Court Judge Kristine Johnson, addressed that behavior and said she found it “incredibly troubling.”

“This was not consensual sex,” Johnson said. “Let me be crystal clear.”

Root’s life now

Nothing in the process went how she hoped, Root said. Still, she said she would go through it again.

“It took five years of my life,” she said. “But I did my best to protect other women.”

For the first time, with the lawsuit now closed, Root spoke openly about the trauma that feels like a constant shadow.

“I think that this will forever affect me,” she added. “He got 30 days. I got a life sentence.”

Because of the assault, she said, she was “emotionally comprised.” She feels she made self-deprecating choices that she wouldn’t otherwise have. She says she didn’t consider herself worthy of anything, which destroyed her relationships.

That feeling hasn’t gone away entirely. She’s married now, though, with a 2-year-old daughter.

Root is also pushing to finish her degree at UVU. Her timing for that fell off track, she said, after the attack; and she moved all her classes online, uncomfortable to be on campus at a school she said didn’t support her. She’s expecting to graduate this fall with a degree in public relations.

She said she wants to be an advocate for victims and survivors of sexual assault.

“It is a hard journey to go through the justice system,” she said.

Choking back tears, Root said she knows she deserves to be heard, and she will teach her daughter that.

“I get to have that confidence that I didn’t give up,” she said. “I fought for myself when no one else did. … A lot of times we don’t get justice. As hard as that is, that’s not what’s the most important thing. The most important thing is that I used my voice when there are thousands of women who don’t get to use theirs.”

For nearly three agonizing years, Mariah Freschi and her husband have been trying to have a second baby. The California mother recently underwent surgery to remove her blocked fallopian tubes, leaving in vitro fertilization as her only option to get pregnant. But the cost quoted by her Sacramento-area clinic was $25,000 — out of reach for Freschi, a preschool teacher, and her husband, a warehouse worker.

“When we first found out IVF was our only option, it just felt so overwhelming,” said Freschi, who has insurance through the California marketplace. “No one sets aside 20, 30 grand to grow your family.”

The Freschis are far from alone in requiring medical assistance to have children: About 13% of women and 11% of men in the U.S. experience infertility, while others are in a same-sex relationship, single, or want to preserve their eggs or sperm before undergoing various medical treatments.

And, like the Freschis, many Americans do not have health insurance that pays for IVF.

During his campaign, President Trump vowed that the government would cover IVF or require insurers to cover it. In February, he signed an executive order seeking policy recommendations on expanding IVF access, dubbing himself the “fertilization president” a few weeks later.

Whether the administration’s efforts will change policy remains unknown, but state-level attempts to mandate fertility coverage reveal the gauntlet of budgetary and political hurdles that such initiatives face — obstacles that have led to millions of people being left out.

“There are economic opponents, and there are ideological opponents,” said Sean Tipton, a lobbyist for the American Society for Reproductive Medicine. “It is a tough lineup of opponents. And that’s very consistent from state to state.”

Twenty-two states have passed legislation requiring insurers to cover at least some fertility care, and 15 of those require coverage for IVF. The laws vary widely, though, when it comes to who and what gets covered, largely because of debates over cost. Fertility services can range from diagnostic testing and ovulation-enhancing drugs to IVF, widely considered the most effective but also the most expensive treatment, during which one or more lab-fertilized eggs are transferred to a uterus.

It’s mostly those footing the bill amid rising health care costs and state deficits that have voiced opposition. State insurance mandates “factor in significantly” when it comes to whether employers continue to provide coverage at all because of financial concerns, according to Chris Bond, a spokesperson for AHIP, which represents health insurers, who also said employers “want to have flexibility with how these benefits are structured.”

States cite concerns about higher premiums and the budget impact of having to cover government workers. In the past few years, infertility coverage bills in Minnesota, North Dakota, and Louisiana, for example, failed largely over cost.

IVF advocates, however, cite data from a decade ago showing that fertility care in states with mandates has accounted for less than 1% of total premium costs, a figure similar to estimates for newer mandates. And advocates often argue that building a family is a human right, though fertility care is disproportionately used by wealthy, white women. Covering IVF for the Medicaid population, which includes more than 70 million Americans, rarely works its way into legislative proposals.

The California example

California is a case study in how many of these conversations play out. Cost concerns sank IVF legislation in the state for several years before lawmakers approved a mandate last year. SB 729 goes into effect July 1 and requires large employers with state-regulated health insurance to cover infertility diagnosis and treatment, including IVF. State employees will get coverage in 2027.

California’s mandate is considered one of the most comprehensive and inclusive in the country, said Barbara Collura, president of Resolve: The National Infertility Association, making same-sex couples and single parents eligible for coverage. But it still leaves out most of the state’s insured population, including those covered by Medicaid, the Affordable Care Act marketplace, and self-insured companies, which account for the majority of workers and are federally regulated.

Mimi Demissew, executive director of Our Family Coalition, an LGBTQ+ rights nonprofit that co-sponsored SB 729, said her group envisioned the broadest possible mandate, which would have included people covered by small employers, the marketplace, and other privately purchased plans. “We dreamed big,” she said. “But the pushback and the whittling down was because of the budget.”

Gov. Gavin Newsom’s finance department opposed SB 729 over concerns about the state’s budget and higher premiums. And groups representing the state’s health plans and employers cited costs in their opposition, with the California Chamber of Commerce calling health care “one of the most formidable expenses a business experiences,” per a legislative analysis.

The law going into effect this year is estimated to cover around 9 million people, 5 million fewer than originally proposed. Annual premiums, whose cost is typically shared by employers and employees, are projected to increase for people with state-regulated health insurance by approximately $40 per person covered in the first year.

Mandates vary widely by state

More than 10 states — including California — have what fertility experts call “comprehensive” coverage, which requires some insurers to cover IVF with minimal restrictions. But even in those states, large swaths of the population miss out.

In Massachusetts, which has one of the country’s oldest, broadest mandates for infertility coverage, including IVF, only about 30% of women were eligible as of 2019.

Those covered by these mandates, however, are grateful. Luisa Lopez, a nonprofit executive, credited the three IVF cycles that New York’s mandate covered with allowing her and her husband to have a baby after 10 years of trying.

“I feel very lucky to live in a state that prioritized this,” Lopez said. Still, she said, she was on the hook for thousands of dollars in copays and other costs.

In states with narrow mandates, coverage is elusive. With limited exceptions, only state employees have qualified for IVF coverage through Utah’s mandate, for example. Joseph Letourneau, a University of Utah fertility specialist who successfully lobbied for fertility preservation coverage for Medicaid patients and state employees with cancer, said he couldn’t recall ideological opposition to fertility coverage but that some legislators were concerned about raising costs.

Oklahoma and Kentucky limit coverage requirements to patients who wish to preserve their fertility because of specific medical conditions.

Pushback beyond costs

Some opponents of IVF coverage say life begins at the moment of conception and have expressed concerns about the disposal of embryos during the IVF process.

Chieko Noguchi, a spokesperson for the U.S. Conference of Catholic Bishops, said the Catholic Church teaches that IVF is morally wrong because it “involves the death or freezing of embryonic children and treats human beings like products that can be bought and ordered.”

In Republican-controlled-Georgia, some advocates say the proposal of abortion restrictions has distracted from efforts to mandate fertility coverage. SisterSong, a reproductive justice nonprofit, supports two bills that would require private insurers and Medicaid to cover IVF in Georgia. But, the organization’s director of maternal health and birth equity initiatives, Leah Jones, acknowledged a steep uphill battle given the costs and anti-abortion legislation that some advocates fear could criminalize IVF. Having to fight just for the legality of IVF, she said, detracts from expanding access.

“We’re always on the defense,” Jones said.

Several states, including Georgia, are weighing or have passed bills that would protect access to IVF after Alabama’s state Supreme Court ruled that embryos created through IVF should be considered children, leading to temporary suspension of those services. Zemmie Fleck, executive director of Georgia Right to Life, said the Georgia anti-abortion bill would not make IVF illegal.

This fissure in Mr. Trump’s base over protecting versus restricting or even prohibiting IVF has raised questions about how his executive order will play out. Letourneau of Utah said some of his patients have asked if the order will cover their treatment costs.

The White House did not respond to requests for comment.

An uncertain road ahead

While a growing number of companies provide IVF coverage as a health benefit, most patients are left to find ways to pay on their own. Some have turned to loans — IVF financing startups such as Gaia and Future Family have raised millions in venture funding.

The Freschis have applied for grants, are crowdfunding, and have put their upcoming cycle on a credit card.

“It’s so scary,” said Freschi, describing worries about potential unexpected IVF costs. “It just feels like you’re constantly walking around with a weight on you.”

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