Score contribution per author:
α: calibrated so average coauthorship-adjusted count equals average raw count
Mandated health insurance coverage for expensive in vitro fertilization (IVF) treatment varies widely in generosity across the US states. We find that more generous coverage within the states that mandate any coverage causes a greater incidence of multiple births, which are costly and can be risky. While more generosity is associated with fewer embryos transferred, this effect is outweighed by greater overall utilization of IVF. In addition, more generous coverage is associated with differences in the composition of patients, where more older women with lower fertility pursue treatment. This is mirrored by lower rates of child adoption by older women in those states. Utilization and compositional effects imply that increased access without regulation might impose additional burdens on the health-care system.