No expansion of military IVF coverage included in the final defense policy bill

This story was originally published by States Newsroom.

Congress will not expand access to in vitro fertilization for active duty military members and their families in this year’s National Defense Authorization Act, the annual bill that sets policy for the Pentagon.

The House-Senate compromise released this weekend follows months of debate between the two chambers over whether to broaden TRICARE’s coverage of assisted reproductive technologies like IVF, which are currently available only to troops whose infertility is linked to a service-related illness or injury.

Washington state Democratic Sen. Patty Murray said in a written statement she was “disappointed that the final NDAA didn’t include the provisions I pushed for to expand IVF access for veterans and servicemembers because of Republican opposition—women and men in uniform sacrifice so much for our country and should never have to sacrifice their right to start a family.”

“This bill was the result of tough negotiations with Republicans who were pushing to restrict women’s reproductive freedom in all kinds of ways—Democrats fought hard to make sure the final NDAA excluded all sorts of harmful riders that would have curtailed the ability of women in uniform to make their own health care decisions, including traveling for lifesaving abortion care,” Murray added. 

The House Armed Services Committee, controlled by Republicans, and Senate Armed Services Committee, run by Democrats, included separate but somewhat similar provisions expanding access to IVF in their original versions of the NDAA earlier this year.

The two chambers spent the last few months working out the differences throughout the entire bill before releasing the final 1,813-page version Saturday.

Congress is expected to vote to approve the package during the next two weeks, before both chambers leave town for the holiday break.

The joint explanatory statement, released alongside the final NDAA, notes that neither IVF expansion provision made the final cut, but doesn’t explain why.

“The House bill contained a provision (sec. 701) that would provide assisted reproductive technology services to servicemembers and their dependents,” it states. “The Senate committee-reported bill contained a similar provision (sec. 705) that would amend chapter 55 of title 10, United States Code, to require that fertility treatments be covered under TRICARE Prime or TRICARE Select without regard to the sex, sex characteristics, gender identity, sexual orientation, diagnosis, or marital status of a servicemember or dependent.”

A section in the Senate’s original bill that would have required the “Secretary of Defense to conduct an assessment of options for establishing within the military healthcare system a benefit program for in vitro fertilization and associated services for Active-Duty members of the Armed Forces and their dependents” was also rejected.

Barbara Collura, president and CEO of Resolve: The National Infertility Organization, said she was “very disappointed to see that expanding IVF coverage in TRICARE was not” included in the final NDAA.

“Once again, our servicemembers will lack basic healthcare for infertility, in a population that experiences higher rates of infertility than the general population,” Collura said in a written statement. “We will continue to advocate for comprehensive infertility medical treatments for our military and Veterans.”

TRICARE is the health care program “for active duty service members, active duty family members, National Guard and Reserve members and their family members, retirees and retiree family members, survivors, and certain former spouses worldwide.”

Alabama court ruling

Access to IVF became a nationwide issue earlier this year when the Alabama state Supreme Court ruled that frozen embryos constituted children under state law.

While its ruling didn’t explicitly ban in vitro fertilization, all of Alabama’s IVF clinics shut down until state lawmakers passed legislation providing criminal and civil protections for those health care facilities.

U.S. Senate Democrats, citing the Alabama ruling, tried to pass a bill in June to establish nationwide protections for IVF treatment, including provisions that would have expanded IVF services for military members and veterans. Republicans blocked the bill from moving forward. 

Senate Democrats tried to pass their IVF proposals again in September using the fast-track unanimous consent process, but were again prevented by Republicans.

The same day, Alabama Republican Sen. Katie Britt tried to use the identical procedure to gain approval for her IVF bill, but was blocked by Democrats.

Vet organizations push for IVF access

More than a dozen military and veterans service organizations, including Iraq and Afghanistan Veterans of America, Gold Star Wives of America and the National Military Family Association, wrote to Congress in early October encouraging lawmakers to expand access to IVF in the final version of the annual defense authorization bill.

“Our nation’s military families earn their health care benefit through immense service and sacrifice,” the organizations wrote. “The coverage offered under that plan should be consistent with what is available through top commercial plans.”

The groups wrote that lawmakers should expand access to IVF to keep military families on par with federal employees’ health care coverage and that enjoyed by members of Congress.

“TRICARE must meet the same standards — our service members and their families deserve no less,” they wrote.   

The federal government’s Office of Personnel Management writes on its website that starting in 2025 everyone in the Federal Employees Health Benefits program “will now have a choice of multiple nationwide plans that offer comprehensive IVF coverage.” Those plans, however, don’t cover active duty military members or their dependents, who get their health care coverage from TRICARE.

Duckworth, Jacobs write letter

Illinois Sen. Tammy Duckworth and California Rep. Sara Jacobs, both Democrats, penned a letter in October encouraging Armed Services Committee leadership to expand IVF access in the final House-Senate version of the NDAA.

“Two-thirds of servicemembers, who often spend their prime reproductive years in hazardous conditions and away from their partners, have reported family-building challenges due to military service,” Duckworth and Jacobs wrote. “Most TRICARE beneficiaries must pay out of pocket for fertility treatment, costing tens of thousands of dollars, all while navigating challenging duty station moves and a complex healthcare system bureaucracy.”

Duckworth and Jacobs added it would be “hypocritical for Members of Congress to enjoy high quality fertility benefit coverage next year, right on the heels of denying such IVF coverage to brave Americans willing to defend our country in uniform, and the dedicated military families that sacrifice to support their loved ones’ service to our great country.”

But not all members of Congress supported plans to expand IVF coverage for military service members.

Montana Rep. Matt Rosendale and Oklahoma Rep. Josh Brecheen, both Republicans, urged the Armed Services committees to leave IVF access for military service members as it is now.

“While we have great sympathy for couples who are having difficulty starting a family, IVF is ineffective, leads to the destruction of innocent human life, and does nothing to treat the root cause of a couple’s infertility,”  they wrote in a one-page letter they sent in November.

The two later added that “Congress must protect the most vulnerable in our country and reject any provision that leads to the destruction of innocent human life and expands our nearly $36 trillion debt.”