Advocating for government support of soldiers trying to start families might seem like a political cakewalk unlikely to generate pushback. Yet, veterans across the country are repeatedly denied access to assisted reproductive technologies.
Defense Secretary Ash Carter announced in January that the Pentagon would cover the often prohibitive costs of reproductive cell preservation for active-duty service members. There is a serious need for a program like this. Almost half of officers are between the ages of 26 and 35 and find themselves away from home during these prime reproductive years. With the option to freeze their eggs, female members no longer feel the same pressure to leave the service to have kids. Additionally, it’s a horrible truth that many men and women suffer injuries that make it difficult or impossible to reproduce, including over 1,300 veterans of Iraq and Afghanistan. Active-duty personnel depend heavily on explosive devices in combat, which can permanently damage sperm production. Soldiers also commonly sustain brain or spinal-cord injuries that harm reproductive organs and extinguish sex drive. The cell preservation program can provide some solace to service members who are realistically worried about these possible injuries.
Of course, this does not help those veterans who have already lost the ability to produce children naturally due to injuries in combat. The preservation program is part of a larger campaign to convert the military a more family-friendly employer, which also promises expanded child-care and maternity/paternity leave options. Supporters hope that the program will usher in more expansive reforms giving military personnel access to a greater selection of reproductive technologies.
The most effective of these other technologies is in vitro fertilization (IVF). The Code of Federal Regulations promises veterans medical benefits necessary “to promote, preserve, or restore the health of the individual.” The Code defines “restoring health” as any care that “restore[s] the quality of life or daily functional level that has been lost due to illness or injury.” During IVF, a doctor collects mature eggs from a woman’s ovaries and fertilizes them in a lab for implantation in the mother, or a surrogate if the mother is unable to carry the baby. Donated eggs and sperm can be used if the parents cannot produce their own. A successful round of IVF treatments can restore injured service members back to their “daily functional level” when it comes to fertility. This seems to suggest that IVF fits squarely within the category of healthcare the government thinks veterans are entitled to.
Not so fast. IVF is one of the few procedures not covered by the Department of Veterans Affairs (VA). A wounded veteran would be forced to pay out of pocket for IVF, a cost of nearly $15,000 for each treatment. Active-duty members, on the other hand, are covered for IVF, but the program requires them to complete treatment before leaving the service. The injuries that designate individuals for the program are often the same ones that get them quickly discharged, which automatically transfers their health care to the VA. Because of this short opportunity window, only twenty people have been able to benefit from the program since it was initiated by the Department of Defense in 2012.
The Veterans Health Care Act of 1992, the regulation that prevents the VA from covering IVF, was passed at a time when people were skeptical of the new technology’s safety. The law lays out a plan that provides little support for the needs of female service members, implementing an outright ban on any “infertility services, abortions, or pregnancy care” for pregnancies without complications. The law is outdated at best.
Although these concerns are no longer persuasive, the high cost of the treatments, as well the fact that only half of them are successful, remain important factors in upholding the VA’s policy. However, there are ways to create a financially responsible IVF program for veterans, which could entail limits on the number of treatments a couple could undergo.
The IVF issue also gets folded into the politicized debate over abortion. Unused IVF embryos are often thrown out after the procedure. This gives pro-life Conservatives, who think the embryos should be treated more ceremoniously, incentive to oppose the bills overturning the ban and revamping the VA’s policy that have surfaced in Congress over the past five years. Opponents of coverage of IVF also argue that spending so much on fertility treatments when the VA barely has the resources to attend to its backlog of patients exposes a flawed sense of priorities.
This political climate has stalled the latest shred of hope for wounded veterans looking for financial assistance with IVF. HR 2257, introduced by House Veterans Affairs Committee Chairman Jeff Miller, would give paralyzed soldiers or those with injuries affecting their reproductive organs a payout of $20,000. The bill attempts to address political concerns about IVF by highlighting that the funds can be used for adoption or foster care expenses. Though the bill has stayed in the House Subcommittee on Health since May of last year, it has secured enough bipartisan support that Congress is likely to revisit the bill this fall.
That is to say, if Representative Andy Harris (R-MD) does not have his way. Two months ago, he sponsored an amendment to a House Appropriations bill that could devastate all of the progress IVF proponents have made. The bill prohibits the use of frozen embryos, requiring doctors to implant all viable embryos at once, a medically dangerous choice that squashes any chance at responsible family planning. The amendment will have incredibly detrimental effects on the ability of active-duty members or veterans to have access to IVF. Doctors will be reluctant to perform the procedure and the federal government will be prohibited from spending money on various assisted reproductive technologies.