In the wake of the Supreme Court’s June 24 decision to overturn federal protections for abortion access, the Pentagon is scrambling to parse what it all means for troops and families.
First and foremost, the Dobbs v. Jackson Women’s Health Organization ruling doesn’t change anything about the legalities of obtaining an abortion covered by military health insurance, according to a June 28 memo from Gil Cisneros, the defense undersecretary for personnel and readiness. It does, however, raise questions about their availability, and the added effort it will take for many to secure legal abortions in general.
“I am committed to taking care of our people and ensuring the readiness and resilience of our Force,” Defense Secretary Lloyd Austin wrote in a statement June 24. “The Department is examining this decision closely and evaluating our policies to ensure we continue to provide seamless access to reproductive health care as permitted by federal law.”
But while DoD takes it time reviewing policies, and lawmakers explore ways to ease this new burden, there are real implications for not only women in uniform, but the female dependents of all service members.
This leaves two primary questions: What to do when seeking an abortion that complies with federal regulations, and what to do when one doesn’t.
Recently compiled DoD data shows that military treatment facilities performed 91 abortions between 2016 and 2021, a small fraction of the thousands of pregnancies military facilities provide care for every year.
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Tricare beneficiaries, those whose health insurance is sponsored either because of their own service or the service of a family member, are only able to receive covered abortions in the case of rape, incest or if their lives are threatened by carrying the pregnancy to term.
This is governed by the Hyde Amendment, a federal legal provision that prohibits federal funding from being used to pay for abortions. DoD has handled this regulation by simply not performing uncovered abortions at military treatment facilities, requiring any beneficiary seeking an abortion outside of Hyde’s confines to do so out of pocket, with a private provider.
Notably, Planned Parenthood is also subject to the Hyde Amendment, because it receives federal funds to underwrite the cost of the myriad sexual health resources it provides.
For abortions outside the confines of Hyde, patients have to pay out-of-pocket, an option DoD doesn’t offer.
For covered abortions, either an on-base provider will perform the procedure, or the service member will be referred to a private facility off-base. Generally, even in states where the repeal of Roe v. Wade opened the door for heavy restrictions on abortions, states are still making exceptions to bans in the same cases Hyde allows.
But not all of them. For example, troops and dependents stationed at Fort Rucker, Alabama, Fort Leonard Wood, Missouri, or Ellsworth Air Force Base, South Dakota, whose pregnancies are the result of rape or incest, may not be able to obtain abortions in those states at all.
Existing regulations allow troops seeking covered abortions to take medical leave and file their travel expenses for reimbursement.
The Defense Department did not provide a requested list of military treatment facilities that offer covered abortions as of Tuesday.
Crossing state lines
For all other pregnancy terminations ― including those involving fetal abnormalities that are likely to result in miscarriage or certain to end in a short, painful life if the pregnancy goes full-term ― troops and dependents have always been required to pay out of pocket, on their own time.
For tens of thousands of service members, either women in uniform or the female spouses of service members, the end of Roe v. Wade has made that much more difficult for a population who doesn’t get to choose where they live.
“Even before the draft Supreme Court opinion became public, service women were discussing how their lack of choice of duty location exacerbated many of the barriers to abortion care,” Kyleanne Hunter, a former Marine Corps pilot and current political scientist at Rand Corp., wrote in June. “Since the draft opinion was leaked, this discussion has intensified, and women are concerned about access not only to abortion care but also to care after miscarriages.
Though some states are exploring legislation to make it illegal to cross state lines to obtain an abortion, in this moment, that’s theoretically an option. In practice, though, it can be more complicated.
In order to take time off and travel, even using vacation time and their own money, leave requests require a commander’s approval.
In a memo released Monday, the defense under secretary for personnel and readiness reiterated that personal leave is available for those who choose to have uncovered abortions.
But he did not go as far as to say that commanders must grant these requests.
The Army and Air Force recently updated their own policies, removing the requirement for commanders to grant pre-approval of leave to terminate a pregnancy, though troops must inform their chain of command that they will be absent.
Importantly, soldiers and airmen don’t have to tell their commands what they’re having done, only that they will be on leave for a medical procedure.
Still, Hunter wrote, changes in state laws and the way that female service members address their health concerns can have wide-ranging effects.
“A lack of privacy and the presence of stigma could facilitate potential retaliation, abiding by new policies may reinforce harmful gender stereotypes, and misinformation about the Defense Department’s policies may circulate and create false impressions about a service woman’s health care options,” she said.
For example, service members are required to report a pregnancy to their commander within two weeks of confirmation.
For someone planning to end their pregnancy as soon as possible, they may not be able to arrange out-of-state travel and care within that two-week period, requiring then that they inform their commander that they have both become pregnant and ended that pregnancy.
Legislative relief
Any action by Congress on protecting abortion access for service members is likely months away.
House appropriators included language in their fiscal 2023 budget draft earlier this month which would prohibit military commanders from denying leave to troops need time to travel to get an abortion. Republicans protested the move during committee mark-up, but fell short of the votes needed to strip the language from the measure.
But that budget bill isn’t expected to be finalized until sometime this fall at the earliest.
Similarly, Republican members of the House Armed Services Committee in their mark-up of the annual defense authorization bill tried unsuccessfully to include language that would stop troops from requesting transfers out of states that have restrictive abortion requirements.
Democrats called the idea impractical, both from personal choice and force readiness standpoint.
But more aggressive measures to provide abortion access to troops remain stalled on Capitol Hill at the moment.
Legislation introduced by Rep. Jackie Speier, D-Calif., and supported by more than 80 other Democrats would repeal rules that prevent Tricare from covering the costs of abortions at private-sector clinics and allow more abortions to be performed at military medical facilities.
That measure could be added to the defense authorization bill when it comes up for a full House chamber vote in late July. But the bill will still face months of negotiations with Senate officials before it becomes law, likely late in the year.
So even if the abortion language is included in the final compromise bill, the provisions would not go into effect until late 2022 or early 2023.
Meghann Myers is the Pentagon bureau chief at Military Times. She covers operations, policy, personnel, leadership and other issues affecting service members.
