For most insured American women, paying for birth control is a thing of the past. But a key demographic is still missing out: non-active service members, veterans, and their families. It is essential that the military healthcare system swiftly and effectually correct this oversight, an action which can be accomplished through an act of Congress.
These women have been overlooked because a key part of the Affordable Care Act, or ACA, does not fully extend to Tricare, the military health system. Nor does the law fully extend to the Department of Veterans Affairs, which administers healthcare to veterans.
Despite the fact that the ACA initiatives have been shown to effectively reduce unintended pregnancy, the military health system’s exemption from the law’s legal mandates to require insurance plans to fully cover all FDA-approved birth control methods causes women in this system to still face financial barriers to access. They have to pay copays for birth control and other services unless obtained through a military treatment facility, or MTF.
MTFs are not often the chosen health care setting for military beneficiaries. In 2018, the 9.4 million beneficiaries of the military health system were admitted to private hospitals 3.2 times more often than military hospitals. Beneficiaries also went to private offices for health visits twice as often and filled 1.6 times more prescriptions in retail pharmacies than at military pharmacies.
This absence of support is an increasing issue. Women are the fastest growing demographic within the veteran population, and according to the VA, they’re at slightly greater risk of an unintended pregnancy than civilian women. Despite this risk, and that these women often face unique reproductive health challenges such as a high prevalence of mental health issues, under the VA healthcare system they have to pay copays for their contraception. Evidence suggests that one significant way to support this group and accommodate the needs of our female veterans is to lower the cost barrier to contraception.
Fixing both the Tricare and VA coverage gaps for birth control has been needlessly difficult. For nearly a decade, members of Congress have tried to remedy these gaps through legislation. The Access to Contraception for Servicemembers and Dependents Act, which aims to ensure service members and their families on TRICARE have access to contraception with no health insurance copay, has repeatedly stalled. Legislator attempts to route reform through the massive National Defense Authorization Act, or NDAA, have also failed in recent years.
Much like the potential Tricare reform, some members of Congress have also tried to advance the Equal Access to Contraception for Veterans Act for many years, which aimed to provide no-cost contraceptive care for women veterans. So far, it has yet to pass. The reason for VA and Tricare reform failure is unclear, but insufficient education on the issue and a perceived lack of urgency are likely significant contributors to the issue, as is the lack of bipartisan buy-in.
Extending no-cost contraception to a small group of women that serve our country is a no-brainer. Beyond the inherent fairness of offering female veterans and members of military families the same reproductive health support that is provided to the rest of the insured population, removing any cost associated with birth control can allow cost-conscious birth control users to select the specific method that works best for them, increasing patient choice and satisfaction.
As it stands, a Tricare reform amendment is currently included in the current House version of the FY24 NDAA that was narrowly passed on July 14. This doesn’t mean that the Tricare reform is a sure thing, however. In years past, the Tricare amendment has made it this far only to be stripped out of the final version of the bill. Separately, there are no proposed changes to the VA system in this version of the NDAA. An amendment relating to veterans can still be added at this stage on the floor, and though this may seem challenging, it is a good idea.
Providing birth control access for active military women and veterans wouldn’t cost much either. For example, in 2022, the Congressional Budget Office, or CBO, estimated that contraception coverage parity under the Tricare program would cost $20 million over the one year period. Though this may seem steep, it is a small fraction of the NDAA, which consistently has a price tag north of $700 billion a year.
Congress has the opportunity to advance no-cost sharing for birth control for the members and families of our military. Making sure women in the military have contraceptive coverage is worth accomplishing for our nation’s troops, their families that support them, and the many veterans who have sacrificed so much for all of us.
Allison Jaslow is an Iraq War veteran and Chief Executive Officer of Iraq and Afghanistan Veterans of America. Sophia Heimowitz is a research associate at the R Street Institute.
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