All Troops Could Have IVF Covered by Military Health Care Under Proposal in Must-Pass Defense Bill

Lab staff at fertility clinic prepare petri dishes holding 1-7 day old embryos
Lab staff prepare small petri dishes, each holding several 1-7 day old embryos, for cells to be extracted from each embryo to test for viability at the Aspire Houston Fertility Institute in vitro fertilization lab Tuesday, Feb. 27, 2024, in Houston. (AP Photo/Michael Wyke)

Service members and dependents would be able to get fertility treatments such as in vitro fertilization covered by military health care in any circumstance, under an amendment added to the Senate's version of the annual must-pass defense policy bill.

Under the amendment sponsored by Sen. Tammy Duckworth, D-Ill., Tricare Prime and Tricare Select would be required to cover a range of fertility treatments, including IVF, regardless of the beneficiary's medical diagnosis, sex, sex characteristics, gender identity, sexual orientation or marital status, according to a summary obtained by The measure was added to the bill during a closed-door debate last week.

If passed into law, that would mark a major expansion of benefits for service members and their families. Right now, only service members who are severely ill or injured or those service members' partners can get fertility treatments covered by the military.

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"Even before I was wounded, I had made the difficult decision to delay building a family because I knew getting pregnant would impact my ability to be an Army aviator -- and to advance in the career I loved," Duckworth, a retired Army National Guard lieutenant colonel who lost both of her legs in a helicopter crash in Iraq, said in a statement last week after her amendment was included in the Senate Armed Services Committee's version of the National Defense Authorization Act, or NDAA.

"Because of the miracle of IVF -- and my access to reproductive health care through the VA -- I'm now a mom to two beautiful girls," she added. "The reality is that members of the uniformed services face unique challenges when trying to start or build a family, and studies show that service members and veterans have higher rates of infertility compared to the general population."

    Similar language was included in the House's version of the NDAA through an amendment proposed by Rep. Sara Jacobs, D-Calif., during the House Armed Services Committee's debate about the bill last month, increasing the odds that language expanding access to IVF will be included in the final version of the bill that becomes law.

    The measures come amid a larger debate in the country about access to IVF after an Alabama court ruled earlier this year that frozen embryos could be considered children. While not outright banning IVF, covering embryos under wrongful death statutes makes the procedure unfeasible.

    Democrats, who have made reproductive health-care rights a large part of their 2024 campaign messaging, have argued the Alabama ruling demonstrated that all reproductive care is under threat following the 2022 Supreme Court ruling that allowed states to ban abortion.

    Republicans have raced to declare their support for IVF after the Alabama ruling, but have often sidestepped questions about how to handle frozen embryos and have argued that Democratic efforts to ensure nationwide rights for IVF and other reproductive care amount to election-season political stunts.

    The same day the Senate Armed Services Committee approved Duckworth's amendment behind closed doors, Republicans in a vote on the Senate floor blocked a separate bill from Duckworth that would enshrine the right to fertility treatments -- including the right to decide how to handle embryos -- in law, as well as expand service members' and veterans' access to the care.

    The vote was part of a series Senate Democrats have held in recent weeks highlighting their support for reproductive health care, which included a vote earlier this month on a bill to protect access to contraception and an expected vote next month on a right to abortion.

    While blocking Duckworth's bill, Republicans instead tried to pass a bill from Sens. Katie Britt, R-Ala., and Ted Cruz, R-Texas, that would discourage states from outlawing IVF by withholding Medicaid funding if they do but would do nothing to address the embryo issue. Democrats objected to passing the GOP bill.

    In the military, the Alabama court ruling also raised concerns about service members' access to IVF.

    The Pentagon recently expanded its coverage of IVF following a lawsuit that argued the previous policy discriminated against unmarried service members and same-sex couples. As of March, marital status is no longer a barrier.

    But the benefit is still only available to those with injuries or illnesses that cause infertility. The ailment also has to be a "Category II" or "Category III" illness or injury, defined as serious enough that a service member is unlikely to return to duty and is likely to be medically separated.

    In addition to expanding coverage of IVF and other fertility treatments, Duckworth's amendment would require the Pentagon to create a fertility treatment coordination program, according to the summary.

    The vote breakdown on Duckworth's amendment was not immediately available, but the NDAA as a whole advanced out of the Senate Armed Services Committee in a 22-3 vote.

    "I'm so proud my colleagues joined me to expand access to IVF and help more of our uniformed service members have access to the fertility treatment they need to start the families they've dreamed of," she said in her statement.

    The full Senate must still pass its NDAA, and the House and Senate then need to reconcile their respective versions before the bill can become law. While the House version of the NDAA includes an expansion of IVF coverage, it also includes language to roll back service members' access to abortion, injecting uncertainty in what the final negotiated outcome of the bill will be.

    And though Republican messaging since the Alabama ruling generally has supported IVF, some far-right lawmakers have gone in the opposite direction.

    "In a world where alternatives to IVF are plentiful, it is unacceptable that this year's NDAA made the American people liable financially for the expansion of this life-destroying practice," Rep. Matt Rosendale, R-Mont., said in a statement last week, explaining his vote against the House NDAA.

    Related: New Pentagon Policy Expands In Vitro Fertilization Options for Severely Ill or Injured Troops

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