Broad coverage of fertility treatments, including in vitro fertilization for service members and their families, should be part of a compromise defense policy bill being negotiated now, a pair of lawmakers told negotiators this week.
In a letter to the leaders of the House and Senate Armed Services committees that was obtained by Military.com, Rep. Sara Jacobs, D-Calif., and Sen. Tammy Duckworth, D-Ill., pushed for the compromise National Defense Authorization Act, or NDAA, to include language that would significantly expand Tricare's coverage of fertility treatments.
"Service members are disproportionately impacted by infertility and face unique challenges in trying to start and build their families," Jacobs and Duckworth wrote in the letter sent Thursday. "Failing to provide high-quality IVF coverage through Tricare would perpetuate an unfair system that forces military families to confront an impossible and unjust choice between serving their country in uniform or starting a family without the risk of financial ruin."
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Right now, Tricare will cover IVF and other assisted reproductive technologies only if the infertility was caused by a serious injury or illness suffered in the line of duty.
Provisions that were included in both the House and Senate versions of this year's NDAA would drop that condition, allowing all service members and their dependents to get fertility treatments covered by Tricare. The amendments were sponsored respectively by Jacobs, who represents the large military community in San Diego, and Duckworth, a retired Army National Guard lieutenant colonel who lost both of her legs in a helicopter crash in Iraq and has spoken frequently of conceiving her children through IVF.
The chairmen and ranking members of each chamber's Armed Services Committee are in the process of ironing out differences between the two NDAAs, with a compromise version expected to become law by the end of the year.
The exact wording of the fertility coverage provisions in each bill is different. Jacobs and Duckworth's letter does not favor one version over the other, saying the final bill should include either provision or language that "merges and harmonizes" both provisions.
Having similar provisions in each bill increases the odds that language expanding access to IVF will be included in the final version of the NDAA that becomes law. A spokesperson for Jacobs' office told Military.com they have no information to suggest the provision will be removed during negotiations and that the letter to negotiators is being sent out of "due diligence."
The National Military Family Association, which recently organized its own letter to defense bill negotiators supporting the IVF-related bill language, applauded Jacobs and Duckworth's advocacy.
"It's hard enough to plan a family when you're dealing with deployments, long separations and other stressors of military life. It shouldn't also cost more," Besa Pinchotti, CEO of the association, said in an emailed statement to Military.com. "IVF and similar treatments aren't covered by Tricare, and are financially out of reach for most military families. We're grateful that Sen. Duckworth and Rep. Jacobs are championing legislation to allow our military to grow their families"
Political debates about access to IVF have grown heated in recent months 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.
Jacobs and Duckworth's letter does not focus on the partisan wrangling over IVF.
Rather, the letter argues that Congress should ensure service members have IVF coverage since lawmakers' own health-care plans next year will cover the procedure. Health insurance for civilian federal employees will also include IVF coverage starting next year.
"We strongly believe U.S. service members and military families deserve fertility benefit coverage in 2025 that is at least comparable to what members of Congress will receive," Jacobs and Duckworth wrote. "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."
A separate provision in the Senate NDAA would also create a "demonstration program" that would allow the Pentagon to reimburse service members for out-of-pocket costs related to fertility treatments and adoption. In order to participate in that program, troops would have to agree to sign up for at least another four years of military service. The provision would also explicitly ban payments related to abortion, human cloning, artificial womb technology and international surrogacy.
Duckworth and Jacobs urged negotiators to scuttle that provision, arguing it "falls woefully short" of providing military families with first-rate health coverage.
The demonstration program provision, they wrote, "injects controversial and divisive language relating to abortion services and embryonic personhood, which are contrary to the bipartisan tradition of the NDAA and distract from what should be our overriding priority: making sure that in 2025, U.S. service members and military families receive high-quality and affordable fertility services coverage that is on par with fertility benefits that members of Congress and federal employees will receive in the coming year."
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