Letter to Lloyd Austin, Secretary of Defense - Department of Defense Healthcare Coverage of Infertility Treatment

Letter

Dear Secretary Austin:

We write to express our concerns over family building challenges that are currently being experienced by servicemembers. Our military families make a substantial sacrifice in service to our country. Being able to start a family should not be one of them. We respectfully urge the Department to make changes to TRICARE that would help servicemembers access family building options, bolster recruitment, increase retention and enhance diversity.

The Department should consider making baseline fertility testing available to individuals finding traditional "watch and wait" techniques inadequate. This way, the traditional "time trying" currently prescribed by TRICARE does not continue to disproportionately burden military families due to frequent time apart. Additionally, the TRICARE language limiting care to "coital reproduction," can have a discriminatory effect on military members who are physically separated due to training trips, deployments and other job-related separations, as well as LGBTQ servicemembers. We also encourage the Department of Defense to provide education and guidance to human resources commands to expand compassionate reassignment eligibility to include family building challenges. Finally, we encourage the Department to commission a study on infertility in the military to fully understand the concerning results of the Blue Star Families survey more deeply will be essential to ensuring that Congress can begin to address the effects that lack of family building care and coverage has on retention and readiness.

We can look to the most recent Blue Star Families Military Family Lifestyle Survey (aMFLS) released in March for insight and data on the prevalence of family building challenges experienced by our servicemembers. As you know, the aMFLS has been providing a comprehensive understanding of the experiences and challenges faced by military families since 2009 and this year, with the assistance of the Military Family Building Coalition a question regarding family building was added to this year's survey. According to the survey, 67 percent of military connected families have experienced at least one family building challenge, including a lack of medical coverage for fertility-related treatments, which often contribute to financial difficulties and stress. Over four in 10 active-duty family respondents report that military service created challenges to having children, specifically the desired number and/or spacing of their children. Furthermore, family building challenges due to military service are much higher for female active-duty servicemembers than their male peers (57% vs. 28%). Many active-duty military family respondents note they incurred out-of-pocket costs when attempting to receive care due to lack of coverage for assisted reproduction under TRICARE.

The Kaiser Family Foundation estimates that out of pocket costs for fertility treatments can amount to over $10,000 depending on the services patients choose to receive. TRICARE limits fertility treatment coverage to service members for whom it is medically necessary and combined with natural conception, and can prove they: 1) are active duty, 2) have a serious illness or injury while on active duty, 3) lost their natural reproductive ability due to that illness or injury, 4) can provide their own genetic material to get pregnant, and 5) have a lawful spouse who can also provide their own genetic material in order to access care. This means that in the absence of insurance coverage, fertility care is out of reach for many of our servicemembers and their families.

By expanding access to fertility testing, counseling and to affordable infertility treatments through TRICARE, we can provide servicemembers with accessible family building options that bolster recruitment and retention and enhance diversity. Servicemembers deserve the right to build families regardless of deployment schedules, fertility challenges, or their financial situation.

Thank you for your consideration of this request and we look forward to hearing from you.