Funny things come out of presidential debates. Debates have given us Dan Quayle’s attempt to shame a fictional character for having a baby out-of-wedlock, Al Gore’s obsession with lockboxes, Mitt Romney’s binders of women, and the word “strategery,” which actually came out of an SNL debate skit spoofing George W. Bush and not from W himself. The hits keep coming in the Trump era, which now includes three election cycles (no wonder we’re all so exhausted). The Trump/Clinton debates brought us “nasty woman” and “I’m not a puppet, you’re the puppet.” The 2020 debate season was subdued by Covid but included “Will you just shut up man,” and “I’m speaking.” Trump, who’s mental deterioration was on full display, contributed some doozies on Tuesday night. I was sure “she wants to do transgender surgery on illegal aliens in jail”—which sounded like a Mad Lib gone wrong—was going to become a new debate take away, but it was quickly overshadowed by “they’re eating the cats, they’re eating the dogs.” As we all know by now, this is a false and racist claim about Haitian immigrants in Springfield, Ohio that started as a Right Wing meme storm and has now led to death threats against the community. The fact that Trump said it on national television and then tried to back it up with “well, I heard it on TV,” should be enough to disqualify him as a candidate. (Oddly enough, the transgender surgery in jail comment had its roots in the truth.) I think my favorite phrase of the night, however, was Donald’s insistence that everyone knows he’s “a leader on fertilization.” It must be those racehorse genes. Trump Angers Everyone with IVF StanceWith only five children by three wives, Donald Trump is no Nick Cannon (who shares 12 children with six different women) or Elon Musk (who also has a dozen kids and grossly offered to impregnate Taylor Swift last week). Still, Trump informed us during the debate that he’s a leader on fertilization. Turns out, he wasn’t referring to any of the fruit of his on loins: Ivanka (the one he thinks is hot), Don Jr. (the one even he’s embarrassed by), Eric (the one he tolerates), Tiffany (the one he pretends never happened), or Barron (the one he’ll pretend never happened as soon as Melania’s contract is up). He was referring to his new plan to pay for IVF. Republicans have been struggling with the issue of IVF since February when the Alabama Supreme Court declared frozen embryos to be children covered by the Wrongful Death of a Minor Act of 1872. This opened the door for couples to sue clinics for any number of scenarios in which an embryo was destroyed. (The bizarre events at the center of this case involved a patient who’d somehow gained access and improperly opened a freezer tank thereby ruining all of the embryos inside. One of the couples affected by the incident sued.) In response to the potential floodgate of lawsuits, clinics in the states paused all services. The state legislature was able to rectify the situation in Alabama quickly, but the absurdity of referring to frozen embryos as children was good for Democrats across the country who were able to say, “We told you it wasn’t going to stop at abortion.” This put Republicans in a tight spot. They want to pretend they’re pro-family, and their mainstream voters want access to IVF, but some evangelicals object to it on moral grounds. Republicans in Congress tried to have it both ways by saying how much they support IVF while blocking a measure that would protect it nationally. Trump has consistently said he supports IVF because he wants more babies (hopefully not of his own), but this plan to pay for them seems new and more than a little bit desperate. Trump first mentioned it at a campaign stop in Michigan where he said, "I'm announcing today that under the Trump administration, your government will pay for—or your insurance company will be mandated to pay for—all costs associated with IVF treatment.” That talking point was reiterated on NBC News when he said, “We’re going to be mandating that the insurance company pay.” Not surprisingly, this “no-really-when-I’m-class-president-we’ll-have-free-coke-in-the-cafeteria” promise is pissing off a lot of members of his own party. As anyone who has struggled with fertility knows, IVF does not come cheap. The average cost of an initial IVF cycle is about $20,000. That’s if a couple uses their own eggs and sperm. At a mere $300 to $1600 a pop, donor sperm is a bargain basement deal compared to donor eggs which can add an extra $7,000 to $27,000 to IVF’s already steep price tag. Is Donny paying for that? What if that first round of IVF doesn’t work? Is he going to force insurance to pay for embryo freezing ($1,000 to $2,000 on average) and storage ($300-$600 a year)? And do they have to pay for the second and third and fourth try? What about the second and third and fourth kid? The Society for Assisted Reproductive Technology estimates that there were 390,000 IVF cycles performed in 2022 up 6% from the year before. Conservatively, that’s $8 billion a year. Demand has been growing and it will undoubtedly increase more if out-of-pocket costs go down. It’s likely that many people give up on the idea before they start because IVF is so far out of their price range. This kind of generosity from the man who has spent the last decade railing against the expense of Obamacare feels like a half-baked idea at best. (This time he has a concept of a concept of a plan.) It's certainly something he didn’t run by Congressional Republicans, many of whom are still pretending theirs is the party of low spending and small government. Sen. Bill Cassidy (LA), who is the top Republican on the Health, Education, Labor and Pensions Committee, seemed confused. He asked, “Is it the government? Is it the private sector? We don’t know how much is going to cost. What will it do to the price of premiums?” Sen. Thom Tillis (NC) said he was hesitant to institute a mandate, Sen. Joni Ernst (IA) said mandates weren’t her style, and good old Sen. Lyndsey Graham (SC) scoffed there’d be “no end” to the cost of such a policy. Even Trump loyalists were skeptical. Sen. Josh Hawley (MO) distanced himself from the plan saying, “I got the sense maybe it was something that he thought of on his own and wanted to float out there.” And Rep. Marjorie Taylor Greene (GA) said decisively (and quite coherently), “I’m not for government-mandated funding of IVF.” It's not just about the money, though. Evangelicals—who the GOP needs to win elections—are upset. Pro-Life Action League President Ann Scheidler told Politico, “Though we share his desire for Americans to have more babies, Trump’s plan to fund in vitro fertilization for all American women is in direct contradiction with that hope. Hundreds of thousands of embryos—each of them as fully human as you or me—are created and then destroyed or frozen in IVF procedures.” This comes as Trump continues to distance himself from a hardline abortion stance by saying everyone has always wanted it to be left up the states and that he was the only one who could make that happen. Only that’s not what evangelicals want. They want a national abortion ban. Not only is Trump refusing to say he’d do that, now he’s offering to pay for a process that destroys embryos. According to Albert Mohler, a prominent evangelical and head of the Southern Baptist Theological Seminary, “There is a real danger to the Trump campaign that pro-life voters just don’t turn out for him with the intensity that he needs.” That evangelicals got behind the thrice-married, porn-star diddling, pussy grabber in the first place has always enraged me. This man’s life and behavior flies in the face of everything they claim to believe in, but he said he could deliver the Supreme Court, and gosh darn it, he did. Now, it seems like evangelicals are looking to Trump and saying, “Yes, but what have you done for me lately?” His concept of a concept of a plan to pay for IVF is clearly not the answer they wanted, even if it does come with free coke in the cafeteria. Democrats, meanwhile, clearly feel that this is a winning issue for them despite Trump’s supposed generosity. Senate Majority Leader Chuck Schumer (NY) scheduled a vote on The IVF Protection Act yesterday. The bill was introduced by Sen. Tammy Duckworth (IL) who used IVF to have children. In remarks on the Senate floor last week, Schumer said, "Republicans can't claim to be pro-family only to block protections for IVF. The American people deserve another chance to see if Republicans are for access to IVF or against it — it's that simple." It will come as a surprise to no one that the GOP blocked the bill again. More Women Getting Their Tubes TiedA research letter published in JAMA last week found that the number of women seeking tubal ligation rose after the Dobbs decision in June 2022. Not surprisingly, states with abortion bans saw a steady increase in the number of surgical sterilizations. A team at Columbia University’s medical school looked at insurance claims data from 2021 to 2022 for 36 states and Washington, DC. They categorized states into “banned,” “limited,” and “protected” based on the current abortion laws. In the 18 months before Dobbs, tubal ligation rates remained stable in all three types of states. After Dobbs, the procedure rose in all three groups. In states that banned abortion, the analysis found that the number of tubal ligations performed grew 3% each month after the decision. These findings confirm previous research which found that the demand for both tubal ligation and vasectomy (tube tying for those with testicles) went up dramatically after Dobbs. As always, data lags behind real life. It will be interesting to see if the number of surgical sterilizations continues to climb as the reality of living under abortion bans becomes even more clear (see below). At the same time, we have to figure out if the women who have their tubes tied are as protected from pregnancy as they think they are. The surgical procedure that ties, clips, or removes fallopian tubes is sold as permanent and pretty much 100% effective, but last week I wrote about a study that calls that into question. It found that an estimated 2.9% of women who underwent a tubal sterilization procedure got pregnant within the first 12 months and that 8.4% percent got pregnant within 10 years. If true that would make surgical sterilization less effective than either the contraceptive implant or the IUD. This seems like something that women in states with or without abortion bans would like to know. Propublica Report on a Young Mom Who Died Because of Georgia’s Strict Abortion LawThis one will make you cry and rage, but everyone should read it. Sex on Wednesday is free today. 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Donald Trump is No Nick Cannon
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