The incoming 116th Congress will contain not only the highest ever number of women, but also a record number of women veterans. As they consider what issues to take on, expanding reproductive health care access for women veterans should be a priority: currently, women veterans do not receive equitable care on multiple fronts. Increasing their coverage goes beyond symbolic moves to change VA’s motto by providing tangible benefits.
There are three key areas requiring Congressional attention: in vitro fertilization (IVF), contraception, and abortion.
IVF – Infertility affects roughly 12 percent of married women, but VA’s medical benefits package specifically excludes provision of in vitro fertilization. Overriding this VA regulation, in 2016, Congress authorized VA to cover assisted reproductive technology for veterans and their spouses solely when a service-connected disability caused the infertility. As written and implemented, this authorization does not cover unmarried veterans, same-sex couples or veterans who are experiencing infertility for other reasons – including, for example, women who delayed pregnancy during military service due to previous policies that did not adequately support parenthood.
VA has previously expressed concern about the projected cost related to expanding IVF coverage, which could be reduced by following Quebec’s lead and requiring single-embryo transfer in most cases, thus dramatically reducing the number of expensive and dangerous multiple births.
Contraception – The Affordable Care Act required private health plans to cover contraceptives with no out-of-pocket costs. It also considered VA health care “minimum essential coverage” and did not make any significant changes to VA health benefits or out-of-pocket costs. Accordingly, VA can – and does – still charge many women veterans copayments for birth control.
Access to affordable contraceptives is an essential component of comprehensive health care for women, and since VA patients tend to be sicker and poorer than non-veteran patients, making women veterans pay a copay that other women are not required to pay is particularly galling.
Abortion – The Hyde Amendment blocks federal funds from being used to pay for abortions except in cases of rape, incest, or life endangerment of the mother. Historically, some federal agencies have chosen to enforce an even stricter ban: until the Shaheen Amendment expanding coverage to victims of rape and incest was signed into law in 2013, for example, DOD only covered abortions when a pregnant woman’s life was at risk.
VA’s medical benefits package goes even beyond this, excluding abortions and abortion counseling with no exemptions.
This means women veterans do not get comparable abortion coverage to other women receiving health care through the federal government, such as the Indian Health Service, Medicare, TRICARE, the Peace Corps, Federal Employees Health Benefits Program, or even women in federal prisons.
VA’s Advisory Committee on Women Veteran recommended formally removing the exclusion of IVF and abortion from VA’s medical benefits package in their 2016 report; however, VA has not provided an update on the status of these recommendations, which was alluded to in the 2018 report.
VA’s longstanding inaction on these issues makes it crystal clear that Congress must step in and act.
Women veterans stepped forward to serve our nation at great risk to themselves. Now Congress must step forward and ensure that they can access the full spectrum of health care that they deserve.
NOTE: This post has been updated from the original to add unmarried veterans to the list of those not covered for IVF and to clarify two other points.
Kayla Williams is a Senior Fellow and Director of the Military, Veterans, and Society Program at the Center for a New American Security. She previously served two years as Director of the Center for Women Veterans at the Department of Veterans Affairs, serving as primary advisor to the Secretary on policies, programs and legislation affecting women veterans. Prior to that, she worked at the RAND Corporation, where she did research related to veteran health needs and benefits, international security and intelligence policy. She is the author of “Love My Rifle More Than You: Young and Female in the U.S. Army,” a memoir of her deployment to Iraq.