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ASRM Town Hall - What to Expect from 2025 Legislative Sessions

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The following transcript was automatically generated.

The session updates on the 2024 elections, noting Republican control in key positions and a divided nation. It discusses mixed state election outcomes, the need to monitor reproductive rights and healthcare policies, and encourages advocacy and communication with legislators. Concerns about budget cuts to federal science agencies and the risk of brain drain are highlighted, along with the dangers of political interference in reproductive health.

Thanks for joining us, everybody.

We just wanted to give you an opportunity for us to update you a little bit on, obviously, the 2024 elections are past us and elections do, in fact, have implications and mean things, and we're going to talk a little bit about that. I'm going to say just a couple words about the election itself, and then we will transfer from talking about elections to talking about what that means for policy, if anything, which we think it probably will mean something. And we will start that discussion with Jessie Losch to lead us through and talk a little bit about what we anticipate is going on in the states, what we know is going on in the states, and then after we get through with that, we will talk a little bit about what we think is going to happen with the federal government and Congress and the Trump administration.

If you have questions, we would ask you to use the question and answer feature rather than the chat, and we will get to as many questions as we can. And so hopefully that's all working right, but if it's not, let us know, and we will figure something out. I'm sure many of you on the call know how to get hold of either Jesse or me, so you can feel free to text us if nothing else is working.

All right, so what happened in November of 2024? I think there's some important takeaways. Obviously, for the national election, the most significant outcome was that the Republicans gained control of the House and the Senate. I think the House was probably the most surprising of those outcomes.

I think most people expected the Senate to go Republican, and I think most people knew the presidential election was going to be close, but the opposition party had an edge. So a couple things to note about that. I think it is very clear we still are a deeply divided country.

This after, I mean, the Democrats by themselves, I think, spent a billion and a half dollars on this election. So I haven't seen estimates of the total, but it had to be something like four billion dollars, and obviously was, you know, essentially a four-year campaign. Presidential elections are completely ridiculous in this country.

The fact that we spend so much time and so much money is unbelievably counterproductive. I've already seen lots of speculation about, oh, who's going to run next time? You know, we haven't even inaugurated President Trump again yet, and people are gearing up for the next election. So it's not very productive.

And even as a politics nerd, I don't find it very much fun. So it is important, though, to remember, despite the unified control the Republicans are going to have, it was one of the closest presidential elections in history. You know, that looks like the final margin is about a percentage and a half, you know, 200, 225,000 votes distributed around the country who that had switched would have changed the results.

And this is historically close. I mean, this is, you know, really, we haven't had this many close ones, you know, 2000, 2016, and 2020, and now we seem to be in an era where they're all going to be really close. Again, the margin in the House is one of the smallest in history.

I believe when they go to vote, the next votes are probably going to be Wednesday, I think. Maybe they're voting tomorrow on something. I believe the Republican margin right now is two and is getting ready to be one.

They will get that back up to maybe three after some of the vacancies get filled. But it's incredibly close, and that has potentially enormous implications. The House is really difficult to manage when one party is dealing with that small a margin and the other party is in no mood to cooperate.

So we'll get into talking about that a little bit in a second. In the states, I think it's hard to, they were a mixed bag. I mean, there were, and in fact, there's still some that are unknown.

The Minnesota House, for example, just turned back a court challenge, which means I believe, Jessie, I'm right, the Republicans now have a one seat margin in the House there. In North Carolina, show up in the air. There's a special election still to go in Minnesota, which could turn it yet again, or get it tied there.

I'm not sure states handle ties different ways. And in North Carolina, we still don't know, right? Right, right. And that's up to the courts as well.

Yeah. But it's hard to generalize. There were some states where the party in power stayed in power easily, some states where there were some changes, but not a lot.

So I think the states were definitely a mixed bag and hard to say, oh, this party did better overall in the states than the I'm not sure we can draw those kind of conclusions yet. So with that, Jessie, why don't you talk to us a little bit about what's happening? Bless you. Really opening up that transition before I sneezed.

I know I was trying so hard, but also I just want to make note that I am incredibly proud of this slide title. Because when I get anxious about policy, I turn to puns. So when bad bills happen to good states and vice versa, or here we go, people, we have seen the best bills of our generation destroyed by elected officials.

Anna, thank you for indulging me on that one. So as Sean said, you could skip this now that everybody's had their chance to really take that in and be impressed with me. I think the elections of November 2024, we can't just look at them in a vacuum.

I think they're part of the past few years really efforts. And that, as Sean talked about, we could talk about Citizens United forever, sort of financial implications of campaigns and lobbyists and a lot of different movements that have been really playing the long game here. So from 2022 to 2024, we've really seen interference in the practice of medicine from a federal level down to a local level.

So the big ones, Dobbs, we had FDA versus Alliance for Hippocratic Medicine, which rolled back REMS on abortion medication, LePage in Alabama, which we are all way too aware of, the Idaho case on Imtala, which again is going to come to the courts under the Trump administration talking about what constitutes emergency. And then in a more hyper-local level, not only did we see personhood measures introduced in 34 states, but we've seen so-called sanctuary city for the unborn ordinances. So those are even more than a state level.

These look at city and town ordinances and within the boundaries of those define life as beginning at conception. So the first one was in Amarillo, Texas. The most recent one was this past week in Missouri.

So really this concerted effort to define what a person is, when life begins and what doctors can and cannot provide to their patients. Thank you. So Ishaan is very good at keeping me from catastrophizing.

So no matter what, we win some, we lose some, we keep going. But I think no matter what November of 2024 made us do, and I was probably doing the crying, screaming, and the throwing up, when we look at the maps, the state landscape actually didn't change all that drastically. So as of yesterday, Republicans controlled just over 55% of all state seats.

Democrats held just over 43. Republicans have a majority in 57 chambers, and Democrats hold the majority in 40, and Alaska is sort of funky and is multi-partisan. And I think we're going to talk a little bit about when states are not friendly, what other things we can do.

And again, to Ishaan's point, this is not a new, this both hyper-partisan and also very, not a lot of airspace between votes is not new. And I think when we look at some trends, some of that is obviously is gerrymandering. Some is lack of voter excitement or engagement, and Anna did an incredible job for ASRM members working with VotER to sort of engage more of our patients.

And some of that truly is, for our folks in Alabama, there were a number of states where just nobody was running. So there are a lot of things that happen to cause this. I think the other one that I can sort of throw in is that in the last census, there was so little turnout and so little engagement with the census that we actually lost some seats.

There were some seats that were lost in the census makeup. So I think when we're looking at, it's not just a matter of, okay, everybody voted Republican. There's nuance there that we can sort of try to learn from a little bit.

Okay, so what do we do? I really, this is the only time that I wish there was a state that started with a Z because it would just make my slide look better, but fine. Who cares? From Alabama to Wyoming, from A to Z people, we are monitoring policy in all 50 states. And as a lot of you know, we're monitoring policy that is not just specifically IVF or fertility related.

We're looking at abortion restrictions or bans or protections. We're looking at attacks or protections on gender affirming care. We are looking at even contraception.

So we're really looking at the gamut of the reproductive medicine and reproductive freedom space. We communicate these happenings. I don't know why I use the word happenings, but we communicate when there is a bill that is either restrictive or proactive in your state that would affect your ability to practice or your patient's ability to access medicine.

We send out action alerts that are targeted to those states. So you will know what's going on and you will also have very easy sort of bite-sized ways of engaging with that bill. Opportunities to call, email, tweet at, or meet with your elected officials to urge them how to vote on these bills and why it matters to you as an expert in this field.

You are really, and your voice is really, the most important way that we affect change. You matter as a constituent and as an expert to your elected officials more than I do sitting in the office up here. You are also, to that end, our eyes and ears on the ground.

So we really, and a lot of you have done this, and we thank you. When you hear that a bill is going to happen or not, when you hear rumblings from your elected officials, you reach out to us. And that is incredibly helpful because we're looking at all these states in really allowing us to be as proactive as we possibly can.

Ah, okay. So personhood is the concept that life begins at conception. Sometimes, depending on the state, that's written at fertilization.

But for our intents and purposes, it confers equal rights to embryos. Sometimes, these are just straightforward personhood bans. Senator Frankenstein from Kentucky writes a personhood ban and it says, whereas life begins at conception, therefore you can't do IVF or abortion.

Those are very rare. We've seen, more recently, personhood concepts enshrined or hidden in a lot of other vehicle bills. So in sex education bans that mandate that students are taught that life begins at conception.

In so-called economic boycott bans that say that states cannot fund or work with anybody who, you know, does not ascribe to this particular practice. In abortion trafficking bans that say that anybody who aids and abets a human being or minor child, which again, in some states is defined at beginning of conception, has trafficked a human. So in all of these different ways, and we are – I keep saying to Sean, you know, here's this bill that ostensibly would fix roads, but it says that if you drive on that road, you have to believe that life begins at conception.

So we are incredibly hyper-aware of all of these. I think sometimes I err on the side of, oh no, everything is a personhood bill, just to make sure that we are really keeping track and cognizant and ready to go. But see what I did there? I did the bad, and then I wrapped it up with the good.

So thanks to a lot of you and thanks to our coalition partners and our colleagues, Resolve and AFP and our patients and our providers, there have been wins. So most recently, I think in December, but honestly time has gone so fast and so slow that I don't remember, but very recently Governor Newsom signed SB729 into law that provides IVF coverage for everyone in the large group markets in California. That is tens of millions of people who now have coverage who didn't.

That took a lot of time. So I think, what we learned from there is we really had to be smart in who we were working with, in who that coalition was made up of. And we could not give up when a session ended and we were told, no, no, no, everybody wanted to do this, but we kept going and we pivoted.

Last year in New Jersey, shout out to my neighbors, they expanded their fertility coverage. And our sponsors really said that it was because ASRM's new definition, this expanded definition of infertility allowed them to go back in to their perfectly competent existing law and use that to expand coverage even more. And now I just got an email 10 minutes ago, they're looking to sort of build on that win to expand coverage to the Medicaid population.

So I think in that case, and this is, I will admit, very hard for me because I want everybody to have all the things right away. We learned that incrementalism works, that if you must get your foot in the door, and if you're getting your foot in the door for one market, that's a win because you're going to build on that, build that momentum. And then we are still going in Washington and Oregon.

We've got a whole bunch of lobby meetings this week. Thank you for those of you in those states who are joining those calls. And again, I think we have really learned, I wrote mistakes.

I tend not to think that anything is a mistake. I think we learned from trial and error in those states. We incorporated those lessons and we came back stronger in these sessions.

So some really impactful wins. Okay. So this is the one that everybody hates and I get it.

And I also think that this is going to be the most important in this particular year. So sometimes doing nothing is doing everything. If your state, look at your state makeup.

If your state has an incredibly conservative governor and a super majority, and you have the most perfect bill ever, what are odds that that bill is going to get amended into something really dangerous or useless? Think about timing. Does it make sense to wait? And waiting doesn't mean doing nothing. Does it make sense to wait, not introduce that bill that could go sideways? Because once it's out of your hands, you have no control over it and right to life does have control over it.

But that's when you meet with all your legislators and you make those relationships and you let them know that you are the subject expert to call upon. What else does advocacy look like in those spaces? What kind of coalition do you want to build for the moment you are ready to introduce that bill? Do you have your storytelling ready to go? Can you do a storytelling workshop for the people in your coalition? And, and I will promise I will be careful saying this because of our tax status, look at the makeup of your seats. What can you do that if your super majority is not friendly this year, maybe there are one or two seats that are like flippable and how can you work on that? And that's it.

States are done. We did it. Sean, you're probably saying very brilliant things, but we cannot hear you.

Hold on. Now I am. Yes.

Okay. I'm having trouble getting my whole screen back up. There we go.

All right. So a couple of, just to clarify a couple of things that Jesse talked about. One is when she was talking about losing seats to the census, she's saying that I think primarily as a New Yorker, they don't just disappear.

They move to Texas and Florida. Correct. And so I think Jesse's roots as a New York state legislative.

Yeah, we lost the way that the way that works, you know, right now, the number of seats in Congress is fixed by statute at 435. Although there has been some recent discussion about it's been over a hundred years, maybe we need to change that. And therefore electoral college votes track that.

So that's how that works. The other thing is just on the personhood discussion. I think it's very important that we make the distinction between fetal personhood and embryonic personhood.

A lot of the times, and this is what we've seen in most of the abortion restrictions to date. And this is why we can say since Dobbs, nobody's had to change how they practice IVF. Hopefully you change some of your consent discussions because I think there are important implications there.

And that is because a lot of the abortion restrictions, they may say things like life begins at conception, but the whole statute is in the context of terminating an established pregnancy. Obviously if the fertilized frozen egg has not been used yet to establish a pregnancy, then it doesn't apply. Now, some of that is what our lawyers think, and we're not going to know the answers definitively unless the very bad stuff happens and somebody gets tasked to deal with this in a court case and the courts get a chance to actually tell us what the legislatures mean.

So we hope that actually never happens. So we hope we have this legal limbo for a while. That would actually be useful to us.

I'm still having some issues here. Okay. So what does it mean? I think the 2024 presidential election and actually the congressional elections in December, the state house elections, it was absolutely, go back please, and it was absolutely the year of the IVF election.

Right? So never before has IVF been mentioned in such a prominent way. We had an infertility patient parent running on the vice presidential, as a vice presidential candidate in the party. We had President Trump who said not just once, not just twice, but repeatedly expressed his support for IVF and said explicitly that he wanted to make sure IVF was available to people without co-pays and without them having to pay for it, have insurance pay for it.

He said insurance and government at the time, and now he's changed that to just insurance, which is okay with us for the most part. So we have been trying to make contact with the transition team. And as the political appointees get in place over the next month or so, we will be making contact to really and truly try to see how we help the Trump administration deliver on that promise.

And we are going to have a vehicle for that, which I'll talk about a little bit. I think, in general, United Republican control in DC certainly doesn't bode well for abortion care or trans care, in some ways for vaccines and for science in general, depending on how many of these appointees get in. Obviously, RFK Jr. nominated for secretary of HHS doesn't bode well for respect for science or empirical data or for vaccines.

And that's problematic for ASRM as a group who likes to think that political decisions should be made on empirical reality and on these technical subjects rely on subject matter experts to help make the policy. So that's going to be a little bit of a challenge for us. We have not taken a stand on any of the nominees pro or con at this point.

We may still, but to date, we have not done that. Obviously, RFK has this history of science denial. Dave Weldon, the nominee to run the Centers for Disease Control and Prevention, he's a physician.

And when he was in Congress, he led the efforts against hemorrhagic stem cell research. And I don't know that he's ever let go of his stance that autism is caused by vaccines, despite all the retractions of all that work. So he's another one that we got to probably have to be really careful about.

I do think there are some threats to parts of the Affordable Care Act, you know, including things like the vaccine mandates and even making worse the gutting that has already happened with sort of the contraception mandate. So I think we're going to have to keep an eye on those as well. I don't even remember what's on the next slide, Anna, so let's see.

Surprise me. Yeah. So as I said, Trump has been supportive.

We're going to translate that. One of the challenges that President Trump brings is he does not operate in sort of a traditional build-up message discipline, here's really what I want to get done kind of mode. And so I think one of the keys to working with this new administration is going to be, how do you get and maintain the president's attention? You know, we are seeing, you know, clearly he's got a pretty serious lock on the Congressional Republican Party as well.

And so I think one of the, you know, one of the things we're absolutely reaching out to do is to remind congressional Republicans what President Trump wants to do with IVF. And, you know, just want a little bit of sort of insider talk on how things happen in Washington. You know, the nominee for Secretary of Defense was up today and, you know, not a thing that usually ASR gets involved in.

However, we have been asked by some Senate offices to help them submit some questions for the record, which means questions not asked during the hearing, but that the nominee will have to answer anyway. And so we're going to ask questions like, how are you going to help the president live up to his campaign promise to deliver IVF availability for active duty service members and veterans? One of the things that we got at the very end of the last Congress in the National Defense Authorization Act was a pilot project to fund gamete cryopreservation for active duty military. And so one of the questions we're going to hope that this Senator will submit for us is, what are you going to do with that pilot project? And do you commit to making sure that works? So we'll be doing some of those kind of things.

Importantly, we are moving very actively and working very hard on, we expect we're going to have a bipartisan, bicameral reintroduction of the HOPE Act, the federal IVF insurance mandate. We're hoping we're going to get that done sometime next month. The signs are really good in a non-specific way just yet, but we were concerned that some of our Democratic friends would not want to work cooperatively with Republicans and maybe not want to have a somewhat, the HOPE Act's a little bit more limited than what the Democrats were pushing last year.

But it sounds like they're going to be on board. Our main champions are going to be, remain championing that bill. And the Republicans are very eager.

I mean, we heard from now the two main sponsors in the House of that bill, both the Democrat and the Republican, actually lost their election bids, unfortunately. So we've had to identify new champions. But one of the secondary sponsors on the Republican side contacted us less than a week, I mean, two days after the election.

And he was in a tight election to say he wants to continue doing it. So I think the signs are good that we're going to do that. You will hear from us as that introduction gets going, because we'll be reaching out, asking you to contact your members, encouraging them to co-sponsor and maybe support that bill if we can continue the momentum, get it some hearings and get it some floor action.

So I think signs are good. As I said, we never heard this much about IVF from anybody in the past. And so we're hoping that that's going to be a good, going to continue to work for us.

So what can you do? As I said, you're going to hear from us. So please pay attention when ASRM communicates. We're going to do, we do that via email.

We do it on social posts. We host these kinds of webinars and we do action alerts when circumstances warrant. We are having a competition again this year to the person who responds to the most of our action alerts.

And this year, since we're starting it early, hopefully there'll be even more opportunities than where we were last year. And we recognize that as an unfair competition, because those of you who are in states where we're asking you to do stuff, we'll have more opportunities to do things. It's not because Anna is a genius and she somehow waited it.

Don't ask me because I don't do math. But I was just going to say, we don't have the math skills to do percentages, but everybody's got a fair shot. And we have other things.

Those of you who are involved in any of our kind of our subgroups, the affiliates, the special interest groups, the professional interest groups, if you would like to have a briefing from the public affairs staff at one of those events, we're happy to do that. We're happy to do that. Even if you just want to do it at your institution or your clinic, we're happy to brief all your staff on these things.

If you would like us to do that, just reach out and let us know that. Very importantly is ASRM Resolve Advocacy Day, May 20th. We'll have the registration for that open very soon.

That'll be on the Resolve website. Always an exciting event. We are virtual again this year, so it'll be easy for you to participate.

You don't have to fly to D.C., although we may work on some other opportunities to do that later in the year. And of course, our primed advocacy scholars program now entering its second year, and they are currently reviewing the applications for the folks who will get to do that this year. The people in the inaugural class were very happy with that program.

I see a couple of familiar names on the participant list from that program, so I think that has turned out to be a very meaningful thing for those who get to participate in it, and I would encourage you to be looking at that. Obviously, the opportunity for this year has gone by, but watch out for it next fall, because we'll be back again with another session. So I did mention briefly the pilot gamete freezing project.

It's interesting, again, to work on that. We will be working. One of the things to understand about sort of the lobbying business is even in your PASA bill, the work is not done.

And so we will be working with the Pentagon as they go to implement that pilot project. It is difficult to know who's going to be in charge of that right at the moment, but we know in general where it's going to fall, and we're reaching out to those people. Similarly in California, the implementation of these mandates is very important, and we have some experience in other states where sometimes some of the insurance bureaucrats in the states are, you know, trying to soften the blow for their insurance companies, treating them like the clients instead of the citizens of the state.

So we will be paying close attention to try to make sure that that gets implemented correctly in ways that will bring some meaning. I was remiss in saying that our sponsor, Senator Carolyn Menjivar, who is incredible and we've had meetings set up, her district is currently being evacuated. So we are doing that, but just we are also sending so much love and all of our thoughts to Senator and her constituents and all of our members affected by the wildfires because it's pretty devastating.

And Jessie, I'm having trouble seeing the question, so if there's any in there we need to deal with. Yeah, is that our last slide? Because then we can un-share. Excellent.

Beautiful. So I will say there's a question on the Parent Act that's going to be introduced in California. I apologize, I'm not sure what that refers to, but please feel free to email me or contact me and let me know and I will absolutely respond.

There's a very important question about where my dog is, and the answer is he is next to me listening and very interested in everything we're talking about and all of advocacy. He's wearing his hipster Brooklyn plaid sweater. Yes, it's very cold.

He looks very dapper. And then, Jamie, that's a great question. That is a Resolve question because they own the advocacy registration, so I can direct you.

Let me just make a note and I will email you and the folks at Resolve to just put you guys together. And then some lovely things that people are saying, so thank you. Thank you, Barb.

Thank you, Rachel. That's it. Does that mean we answered everyone's questions and that's incredible? Just the other thing as we're looking at other questions that I didn't talk about that I think is going to be significant for ASRA members is, you know, I think all the federal science agencies are going to get budget cuts.

NIH, CDC, FDA, all the ones we care about are likely looking at some budget cuts, maybe looking at some mission adjustments, which may or may not be helpful to us. And I do think in addition to budget cuts at the science agencies, one of the things that's on my mind a lot, partly because, you know, I live inside the Beltway and my wife is a psychologist and so she has in her client mix a fair number of fairly senior federal staffers, people who work for the SES, which is a designation, so high-level career staff, and they are scared. And I think I worry a lot about a lot of brain drain from the science agencies, you know, I think probably more acute maybe at NSF and EPA, but I do think NIH and CDC are not going to be immune from those.

I think there's a lot of fear that it's going to be a less attractive place to work for scientists and I think they're going to be looking to leave, and that's going to have implications for what our government capabilities are. If too many smart, talented people leave government service, it's going to make government a lot less responsive and a lot less skilled, and that's going to be a problem. Do we have another question that came in just here? We're good.

What we're hearing is just messaging, and I think that's where all of you, your voices matter so much, that there's sort of this, like, somebody called it med creep on a call today, that, you know, the sort of shift between medicine is medicine and science is science to, well, you know, that creeping messaging of we can question this and we can question that and that really medical experts and scientific experts are the only way that we can successfully fight back on that and win that communication battle. And, you know, I think that it's really important for you all to message to your neighbors and your medical colleagues, your friends from medical school, people who work in other areas of healthcare. You know, our field is great because we're just trying to help people have babies first and foremost, right? And so who's not for that? And so I think it's important to talk about the danger of political interference.

And as will shock you to learn, most elected officials and legislators don't know anything about reproductive biology. And it's very easy as we have seen time and again, they're malicious intended. Those of them who have malicious intent, it's bad enough to deal with, but we all, sometimes we see things that goes beyond even, you know, they're trying to do an abortion thing, but they're writing it in a way that's going to hurt IVF.

So we have to keep talking about the danger of political interference because the knock-on implications, excuse me for using a rugby term, but maybe that's becoming common enough, can be significant. And sometimes it's not intended and we have to be really careful and really diligent. That's why Jesse has to read all these highway bills because they try to sneak stuff in there sometimes.

And sometimes the wording they use is not going to do what they think it's going to do. Sometimes it's going to be worse. Occasionally, maybe it's just, isn't going to work.

But my point is for you to be willing to talk about that and make sure your neighbors and colleagues understand the risks, because that's the only way people are going to get it. All right, then I guess we'll wrap it up and thank you all for your interest. This will be available on the ASRM website pretty soon.

So if any of your colleagues didn't get to watch it, we'll make sure that they can get a chance to see it if they want to. And again, if you have questions, comments, if you're hearing things, please reach out to us. This is, your dues pay for us to do this work to keep an eye on things for you.

And so we're happy to take those questions. And sometimes, often we can clarify things and calm people down. Sometimes you send a panic in us about something we weren't paying enough attention to, and those are both very valuable things to do.

All right, thanks everybody. Have a good evening. And for those of you who, like us, are socked in with the snow and about to get really, really cold, good luck.

Or if you're in the, you know, I really hope any of you, I doubt anybody who's watching is really in LA tonight because there's probably too much other stuff going on. But we, of course, are thinking about everybody out there, including our members and including the, you know, heard an interesting discussion of the embryologists in a panic about trying to come and try to keep their filters working. You know, there's a lot of bad stuff with that.

So we're thinking of all those people tonight. Thank you, everybody.

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