The Department of Veterans Affairs wants to make it easier for some veterans to get fertility services, as well as drop birth control prescription copayments, beginning next fiscal year as part of its 2023 budget plan.
The VA's proposed budget requests legislation that would allow the department to expand a program that provides advanced fertility treatments, including in vitro fertilization, or IVF, to seriously injured veterans by including those who are single or in a same-sex relationship.
The department also has asked that it be allowed to cover treatment for seriously injured veterans who need donor sperm or eggs or require a surrogate to have children. And it is seeking the ability to reimburse adoption-related expenses for eligible veterans.
VA officials said the legislation and related $10.5 million request for funding in for 2023 would "fill the gap created by the legal requirements, exclusions and limitations in VA's current program," according to the proposal.
The VA has covered the cost of in vitro fertilization and other infertility treatments since 2016 for veterans whose infertility resulted from a service-related injury or illness. But the benefit is restricted to married couples who are able to provide their own eggs and sperm.
Funding for the program must be reauthorized each year.
Sen. Patty Murray, D-Wash., who championed that initial benefit, has fought for years to make the program permanent and expand it. She has introduced additional measures during every Congress since that would loosen what she calls the "unnecessarily restrictive" eligibility requirements of the current benefit.
"It's very hard to help our veterans plan for the families that they deserve. They served our country. They were injured, which made limited opportunities for them to have children -- a dream people ought to have, including our veterans," Murray said in a June 23, 2021, hearing on her bill, the Veteran Families Health Services Act.
Conservative groups have fought the proposals because IVF can result in the creation of multiple embryos, which may be destroyed if a veteran no longer needs or wants them. Organizations such as the Family Research Council, a conservative Christian group, advocate funding for IVF only if embryos are not destroyed.
No Republicans have supported Murray's legislation or a similar bill introduced in the House by Rep. Rick Larsen, D-Wash.
The VA fertility benefits program differs from the Department of Defense's program, which offers fertility resources such as hormone treatments, diagnostic services, corrective surgery for infertility related to a physical condition and erectile dysfunction care, but pays for IVF only under certain circumstances, providing it to service members who have experienced a urogenital trauma or had cancer treatments that can cause infertility, to include cryopreservation and storage until procedures can be undertaken.
IVF is available at six military treatment facilities at a cost per cycle for service members and their families whose infertility is not directly related to a combat injury.
The VA's budget also calls for dropping copayments for veterans for birth control prescriptions -- a less controversial measure that would bring the department's pharmacy benefit program in line with the Affordable Care Act.
Under the Affordable Care Act, often referred to as "Obamacare," major insurers other than religious employers or nonprofit religious organizations are required to cover contraception and counseling without charging a copayment or coinsurance.
Federal health providers were exempt from the provisions of the Affordable Care Act. In a call with reporters March 28 on the VA budget, officials said the move would recognize contraception as "more of a general health provision as opposed to a special prescription."
It would affect veterans who currently must make copayments for any prescription as part of their eligibility criteria.
"Because we are [the] government, because our copayment requirements are set by statute, we need legislative authority to exempt a particular subset of pharmaceuticals this way," said Laura Duke, chief financial officer for the Veterans Health Administration.
According to the budget, the proposal would cost the VA $24 million the first year and $328 million over 10 years.
Also in the VA budget proposal regarding veterans' health, the department has asked for legislation that would allow it to provide physical and mental health care related to military sexual trauma to former members of the National Guard or Reserve who have never served on active duty and therefore are currently ineligible for medical care from the VA.
The legislation, which the VA anticpates would cost nearly $30 million in the first five years, would provide sex assault-related care for former Guard and Reserve members discharged under any conditions, except those who received a dishonorable discharge or were dismissed from the service as the result of court-martial.
The VA has requested a record-high $301 billion for its budget, second only to the Department of Defense among federal agencies in discretionary funding. The administration's proposal is now under review in the House and Senate authorization and appropriations subcommittees responsible for setting policy and funding the VA. Each will craft legislation that ultimately will determine the outcomes of the measures contained in President Joe Biden's fiscal 2023 budget plan.
In one of the first hearings on the proposed budget, lawmakers on both sides of the aisle pushed VA Secretary Denis McDonough to justify the expense, with the Democrat chairwoman and ranking Republican on the House Appropriations subcommittee that oversees the VA raising concerns over funding patterns.
"What's the long-term plan here? Clearly, we must provide for our veterans' health care, and we all are passionate about that. … But if we're going to keep seeing these exponential increases year after year, we need to build a consensus on an allocation adjustment so that other discretionary priorities are not affected, including the non-health care priorities within VA," said Chairwoman Rep. Debbie Wasserman Schultz, D-Fla.
"When we met last April to discuss the VA's fiscal 2022 budget request," said Rep. John Carter, R-Texas, to McDonough, "I remarked that its 82% increase was not the largest I had seen, but still quite large. This year, a 99.7% increase for discretionary programs, along with the $7.5 billion for the second bite, is another eye-popping request. Year after year, you've given increases that may have been substantial; We need to look at the big picture."
-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patriciakime.