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Congress wrestles with providing fertility benefits for injured veterans and servicemembers

by Karoun DemirjianThe Washington Post
July 27th, 2016

An image of Senator Patty Murray. She is smiling, looking directly at the camera.Behind her is the US flag.

This was the year the government was going to start helping injured veterans and members of the military maintain their ability to start families by offering unprecedented fertility preservation programs.

In January, Defense Secretary Ashton Carter announced the Pentagon would soon launch a pilot program to help active-duty servicemembers freeze their eggs and sperm, as a precautionary measure to ensure soldiers who suffer fertility-ending injuries can still have children. Then last month, Congress took the unprecedented step of agreeing to overturn a longtime ban against covering in vitro fertilization treatments for veterans whose ability to have children was compromised by injuries suffered in the line of duty.

But political fights in Congress are now threatening to halt these efforts before they have a chance to begin.

A Senate-passed defense policy bill would zero out funding for the Pentagon program and a spending bill that would expand fertility benefits for veterans is currently caught up in a separate fight over how much funding Congress should approve to counter the mosquito-borne Zika epidemic.

“The current policy is outdated, it’s wrong, and it’s a disservice to the men and women who’ve sacrificed so much on behalf of our country,”‎ said Sen. Patty Murray (D-Wash.), a leading supporter for lifting a longtime ban on covering in vitro treatment for veterans. She also has been leading the push to ensure the Pentagon’s pilot program is funded.

The subject of fertility coverage for current and former soldiers is tangled up in the politics of both the abortion debate and the budget battles over Pentagon programs.

The in vitro fertilization (IVF) treatments that most Democratic and many Republican lawmakers want to cover for veterans have long been provided for active-duty soldiers and other federal employees. But a 1992 ban has kept the Veterans Affairs Department from following the Pentagon’s lead.

Conservative opposition to covering IVF treatments stems from a conviction that discarding unused embryos is effectively abortion. But after years of the procedure becoming common practice, many leading Republicans have come on board and this coverage was included in a veterans spending bill finalized by House and Senate negotiators earlier this summer.

But that bill is now on hold while lawmakers work out bitter differences over how to fund the government’s Zika response — an issue that was attached to the legislation.

Until lawmakers can agree on how to pay for Zika prevention efforts, it’s unlikely that the changes to the VA’s fertility treatment coverage policy can move forward.

Still, the inclusion of language ending the 1992 ban was the first bipartisan win on the issue since Murray started pushing for a legislative change in 2012. Her measure won out over proposedlegislation from Veterans Affairs Committee Chairman Jeff Miller (R-Fla.) that would have given veterans with damaged reproductive organs a $20,000 payout to use however they saw fit rather than earmark funding directly for IVF treatments.

According to the American Society for Reproductive Medicine, the average cost of an IVF treatment in the United States is $12,400.

But there is also the matter of ensuring that injured veterans needing the treatments have reproductive cells they can work with — and that too can be cost-prohibitive for soldiers with limited income.

The cost of a single round of freezing eggs – considered “experimental” until late 2012 – is comparable to a round of IVF, depending on the level of medication involved, while the cost of freezing sperm is usually under $1,000.

Those price costs – especially for people who have to go through multiple rounds of cryopreservation and/or fertilization – can add up. And not just for individual service members – for Congress too.

The administration asked for $38 million to fund the egg and sperm freezing program Carter announced during the winter, promising it would be available to any active-duty service member who wanted to take advantage of it. The pilot program appeared to win the House’s tacit approval — its annual defense policy bill, passed this spring, made no mention of the matter.

But the Senate’s version of the bill zeroed out the $38 million the administration had tagged for the Pentagon program. That began a heated debate in Congress over costs, even where there was otherwise consensus that offering current and former service members the best in available fertility treatments is important.

“We are still facing sequestration, and these are the hard things: we often look at the issues separately, but we can’t do that,” Sen. Joni Ernst (R-Iowa) said of funding family planning initiatives in a recent interview. The former Army National Guard commander pointed out that while “we do need to do the right thing for our families,” it was difficult to rationalize spending money on fertility care when with tight sequestration budget caps “not every soldier on the ground is provided with the basic necessities.”

Murray put forward a proposal to restore the funding, but her plan was opposed by Senate Armed Services Committee Chairman John McCain (R-Ariz.). He argued it would pull money away from an increase in funds for a reimbursement program to cover the costs of autism therapy for military families. Murray denies that her amendment would make that change.

Still, McCain maintained her proposal deserved to be put before the full Senate for a vote.

But Murray never got the chance to attempt to restore that funding on the Senate floor after Sen. Mike Lee (R-Utah) effectively blocked votes on all amendments. Now, the issue is in the hands of negotiators currently at odds over how to apportion more than $600 billion in defense spending, under the threat of a presidential veto.

Should the House and Senate defense policy bill negotiators decide to follow the Senate’s lead and divert the $38 million underwriting the Pentagon’s pilot program, it could stymie efforts to test the “potential recruiting and retention benefits for providing this medical service,” as the Pentagon laid out in a fact sheet accompanying Carter’s announcement.

It means “they don’t have to worry about choosing between defending their country or a chance at having a family someday,” Murray said last month on the Senate floor, arguing for her amendment. “It is hard to imagine any of my colleagues standing up to say that men and women who are willing to make the ultimate sacrifice for their country and for all of us should be denied a shot at their dream of a family.”

Image via Wikipedia



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