Department of Veterans Affairs:
Abortion Policy
July 21, 2022
Congressional Research Service
https://crsreports.congress.gov
R47191

Department of Veterans Affairs: Abortion Policy

R47191
Department of Veterans Affairs:
July 21, 2022
Abortion Policy
Jared S. Sussman
The primary mission of the Veterans Health Administration (VHA) of the Department of
Analyst in Health Policy
Veterans Affairs (VA) is to provide health care services to veterans. To accomplish this goal, VA

has promulgated regulations to create a standard medical benefits package. The medical benefits
package expressly excludes abortion services and abortion counseling in all instances, effectively

prohibiting VA providers from providing those services to veteran patients. VHA provides
medically necessary health care for the management of a miscarriage.
It is unclear whether this prohibition on abortion services is required by statute or solely by regulation—a result of potentially
conflicting language in the Veterans Health Care Act of 1992 (P.L. 102-585) and the Veterans’ Health Care Eligibility
Reform Act of 1996 (P.L. 104-262). In recent years, Congress has considered bills to require VA to include abortion
counseling in the medical benefits package.
VHA also provides health care to dependents, spouses, and caregivers of veterans who meet certain eligibility criteria through
the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Under CHAMPVA, VA will
pay for the cost of abortion services only if a physician certifies that the life of the mother would be endangered should the
fetus be carried to term. This differs from the provision of health care for veterans in which abortion services are prohibited
under any circumstance.
This report describes VA’s prohibition on abortion services and related counseling, including the legal authority upon which
the prohibition is based. It also details considerations for Congress related to the legal authority for VA to provide abortions.
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Department of Veterans Affairs: Abortion Policy

Introduction
The Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) operates
the nation’s largest public integrated direct health care delivery system.1 VHA provides care to
approximately 6.5 million unique veteran patients on an annual basis.2 VHA’s primary mission is
to provide health care services to eligible veterans.3 VHA generally provides care directly through
over 1,700 sites of care, including hospitals, clinics, and health care facilities.4
VHA is primarily a direct provider of care. It directly operates associated facilities and employs
clinicians.5 This model differs from the predominant health care financing and delivery model in
the United States, in which there is a payer for health care services (e.g., Medicare, private health
insurance plan), a provider (e.g., hospital, physician), and a recipient of care (the patient). VHA is
not a health insurance financing program that provides reimbursement to providers for all or a
portion of a patient’s health care costs.
VA has established, through regulation, a medical benefits package to standardize care provided
to patients enrolled in the system.6 The medical benefits package includes, among other things,
inpatient care, outpatient care, and prescription drugs.7
VHA also provides health care to dependents, spouses, and caregivers of veterans who meet
certain eligibility criteria through the Civilian Health and Medical Program of the Department of
Veterans Affairs (CHAMPVA).8 Unlike the provision of health care for veterans, which follows
the standard medical benefits package, CHAMPVA is required to provide benefits similar to
Department of Defense (DOD’s) TRICARE Standard plan.9 Furthermore, CHAMPVA is
primarily a health insurance program where enrollees receive care from private sector health care
providers and CHAMPVA pays for a portion of the cost of care. This is in contrast to the
provision of health care for veterans, which is generally provided by VA clinicians.
On June 24, 2022, the U.S. Supreme Court issued its opinion in Dobbs v. Jackson Women’s
Health Organization, a case challenging the constitutionality of Mississippi’s Gestational Age
Act, which generally prohibits an abortion once a fetus’s gestational age is greater than 15 weeks.
A majority of the Court not only upheld the Mississippi law but also overruled the Court’s prior

1 Department of Veterans Affairs, FY2023 Congressional Submission, Medical Programs and Information Technology
Programs, vol. 2 of 4, March 2022, p. VHA-21.
2 Ibid., p. VHA-39.
3 38 U.S.C. §7301.
4 Department of Veterans Affairs, FY2023 Congressional Submission, Medical Programs and Information Technology
Programs, vol. 2 of 4, March 2022, p. VHA-21.
5 VHA does pay for care in the community (i.e., non-VA providers) under certain circumstances. The VA Maintaining
Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION Act; P.L. 115-182)
established the Veterans Community Care Program (VCCP), which requires VHA to provide for care in the community
to all enrolled veterans who meet specified criteria.
6 38 C.F.R. §17.38.
7 For more information on VA health care in general, see CRS Report R42747, Health Care for Veterans: Answers to
Frequently Asked Questions.
8 For more information on CHAMPVA, see CRS Report RS22483, Health Care for Dependents and Survivors of
Veterans.
9 38 U.S.C. §1781(b).
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Department of Veterans Affairs: Abortion Policy

decisions in Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania v. Casey,
concluding that the U.S. Constitution does not confer a right to an abortion.10
Shortly after the Supreme Court’s decision in Dobbs, Adam M. Robinson, Director of the VA
Pacific Islands Health Care System, stated that VA will continue to deliver reproductive health
care consistent with the department’s legal authority.11 VA is currently prohibited from providing
abortions and abortion counseling.12 Questions have been raised regarding VA’s authority to
provide abortions particularly since March 2021, when VA Secretary McDonough stated that the
provision of abortion services is a “regulatory matter” in a hearing before the House Committee
on Veterans’ Affairs.13 Secretary McDonough’s statements on the topic have generated responses
from some Members of Congress stating that VA’s prohibition on abortions is required by
statute.14
This report (1) describes VA’s current abortion policy and authority to provide abortions, (2)
presents considerations for Congress regarding VA’s authority to provide abortion services, and
(3) summarizes recent legislation related to VA abortion policy being considered in the 117th
Congress.
VA Abortion Policy
The VA medical benefits package expressly prohibits both abortion and abortion counseling.15
VHA does not provide abortions, abortion counseling, or medication to induce an abortion (e.g.,
mifepristone, also known as RU-486).16
Section 106 of the Veterans Health Care Act of 1992 (P.L. 102-585; Title 38 U.S.C. 1710 note)
expressly excluded abortions, among other services, from the health care services it authorized
the VA Secretary to provide. Furthermore, VA explicitly excluded abortion and abortion
counseling from the medical benefits package when it was initially established through the
rulemaking process in October 1999.17 Medically necessary procedures for the management of a
miscarriage are covered under the medical benefits package.18

10 For more information on the Dobbs decision, see CRS Legal Sidebar LSB10768, Supreme Court Rules No
Constitutional Right to Abortion in Dobbs v. Jackson Women’s Health Organization.
11 Adam M Robinson Jr., Director, “Directors Message,” press release, July 1, 2022, https://www.va.gov/pacific-
islands-health-care/stories/directors-message-july-1-2022/.
12 38 C.F.R. §17.38(c)(1).
13 U.S. Congress, House Committee on Veterans’ Affairs, Restoring Faith by Building Trust: VA’s First 100 Days,
117th Cong., 1st sess., March 25, 2021.
14 Office of United States Senator Jerry Moran, “Sen. Moran: VA’s Prohibition on Abortion Services is the Law,” press
release, August 4, 2021, https://go.usa.gov/xJK4k.
15 38 C.F.R. §17.38(c)(1).
16 VA, VHA, Health Care Services for Women Veterans, VHA Directive 1330.01(2), February 15, 2017.
17 Department of Veterans Affairs, “Enrollment Provisions and Medical,” 64 Federal Register 54210, October 6, 1999.
https://www.govinfo.gov/content/pkg/FR-1999-10-06/pdf/99-25871.pdf
18 A miscarriage, or pregnancy loss, is also called a spontaneous abortion, which is “the unexpected loss of a fetus
before the 20th week of pregnancy, or gestation.” (Source: https://www.nlm.nih.gov/medlineplus/miscarriage.html.) For
clinical purposes, “spontaneous abortion often is subdivided into threatened abortion, inevitable abortion, incomplete
abortion, missed abortion, septic abortion, recurrent spontaneous abortion, and complete abortion.” (Source: Craig P.
Griebel et al., “Management of Spontaneous Abortion,” American Family Physician, vol. 72, no. 7, October 1, 2005,
pp. 1243-1250). In some cases, the procedures used for management of a miscarriage are the same as those used for an
abortion (i.e., dilation and curettage). Health Care Services for Women Veterans, VHA Directive 1330.01(2), February
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The VA prohibition is more restrictive than prohibitions required by Hyde-type amendments to
appropriations measures, which generally restrict federal funds from being used to pay for
abortions except in cases of rape, incest, or life endangerment of the mother.19 The VA medical
benefits package does not cover abortions or abortion counseling in any circumstance.
CHAMPVA Abortion Policy20
Unlike the medical benefits package for veterans, the CHAMPVA program – providing health
care to certain dependents, spouses, and caregivers of veterans – covers abortions and abortion
counseling in limited circumstances. Specifically, the CHAMPVA program will cover the cost of
abortion counseling or abortion procedures only if a physician certifies that the life of the mother
would be endangered should the fetus be carried to term.21 In those cases, CHAMPVA will
provide coverage for (1) spontaneous, missed, or threatened abortions and abortions related to
ectopic pregnancies, or (2) fetal death due to natural causes.22 Dilation and evacuation (D&E) and
dilation and curettage (D&C) procedures may be covered when done surgically for a
gynecological diagnosis or covered abortion.23 CHAMPVA will not cover any abortion related to
incest or rape.24
Legal Authority for VA Abortion Prohibition
It is unclear whether VA abortion services are strictly prohibited by statute or solely limited
through the regulations establishing the standard medical benefits package. The lack of clarity
stems from two laws enacted in the 1990s: (1) Section 106 of the Veterans Health Care Act of
1992 (P.L. 102-585; Title 38 U.S.C. 1710 note), which expressly excluded abortion services,
among other services, from the health care services it authorized VA to provide,25 and (2) the
Veterans’ Health Care Eligibility Reform Act of 1996 (P.L. 104-262), which requires the VA
Secretary to provide medical services determined to be “needed.”26
Section 106 of the Veterans Health Care Act of 1992 (P.L. 102-585; 38 U.S.C. 1710 note)
authorizes the VA Secretary to provide certain specified health care services for women, including
general reproductive health services. The section excludes the provision of infertility services,

15, 2017.
19 For more information, see CRS In Focus IF12167, The Hyde Amendment: An Overview . Annual VA appropriations
measures generally have not included a Hyde-type amendment restricting funds from being used for providing abortion
services.
20 This section was written by Sidath Viranga Panangala, CRS Specialist in Veterans Policy.
21 38 CFR §17.272(a)(67),(68). Also see Department of Veterans Affairs, Office of Community Care, CHAMPVA
Operational Policy Manual, Chapter: 2 Section: 14.2 Title: Abortions, available at https://www.vha.cc.va.gov/
22 38 C.F.R. §17.270(a). 38 C.F.R. §17.272(a).
23 Department of Veterans Affairs, Office of Community Care, CHAMPVA Operational Policy Manual, Chapter: 2
Section: 14.2 Title: Abortions, available at https://www.vha.cc.va.gov/.
24 TRICARE covers the cost of abortion when there is a threat to the life of the mother or in cases of rape or incest, as
directed by 10 U.S.C. §1093 (a) and (b). For more information, see CRS Insight IN11960, FY2023 NDAA: Military
Abortion Policies.
25 Section 106 authorized general reproductive health care, including the management of menopause, but did not
include infertility services, abortions, or pregnancy care (including prenatal and delivery care), except for such care
relating to a pregnancy that is complicated or in which the risks of complication are increased by a service-connected
condition. 38 U.S.C §1710 note.
26 P.L. 104-262 §101, 38 U.S.C. §1710(a).
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abortions, and most pregnancy care.27 VA has since included pregnancy care in the standard
medical benefits package. VA has also included infertility services to a certain extent.28
The Veterans’ Health Care Eligibility Reform Act of 1996 (P.L. 104-262) provided new eligibility
criteria for VA hospital care and medical services. Previously, VA’s general authority limited the
Secretary to providing hospital and outpatient care deemed “needed for the care of a ‘disability.’”
The 1996 law removed this barrier and allows the Secretary to provide health care determined to
be “medically needed.”
The medical benefits package was created through rulemaking following enactment of the
Veterans’ Health Care Eligibility Reform Act of 1996 (P.L. 104-262). VA included some fertility
services and maternity care in the original iteration of the standard medical benefits package.
There is little in-depth discussion or rationale as to why VA included or excluded certain services
from the medical benefits package when it was established. However, VA provided the following
rationale for the inclusion of pregnancy and infertility services:
The Secretary has authority to provide healthcare as determined to be medically needed. In
our view, medically needed constitutes care that is determined by appropriate healthcare
professionals to be needed to promote, preserve, or restore the health of the individual and
to be in accord with generally accepted standards of medical practice. The care included in
the proposed ‘medical benefits package’ is intended to meet these criteria.
Commenters asserted that infertility services, pregnancy and delivery, surgical
implantation of penile prostheses, and membership in spas and health clubs should be
included in the medical benefits package. As noted above, the medical benefits package
would include care that is determined by appropriate healthcare professionals to be needed
to promote, preserve, or restore the health of the individual and to be in accord with
generally accepted standards of medical practice. Upon reconsideration, we conclude that
pregnancy and delivery services (to the extent we have legal authority to provide such
services) meet these criteria and should be included in the medical benefits package. We
also conclude that membership in spas and health clubs does not meet these criteria and
should not be included. Further, under these criteria, we have determined that reproductive
sterilization, surgery to reverse voluntary sterilization, infertility services (other than in
vitro fertilization), and surgical implantation of penile prostheses should not be excluded.
Appropriate changes are made to the medical benefits package to reflect these
determinations.29
This excerpt explains that VA included services prohibited under Section 106 of the 1992 law
because it deemed those services to be ‘‘care that is determined by appropriate healthcare
professionals to be needed to promote, preserve, or restore the health of the individual and to be
in accord with generally accepted standards of medical practice.’’
Regarding infertility services, which the 1992 law also expressly prohibited, Congress has
included funds for the provision of in vitro fertilization in annual appropriations language since

27 Section 106 of P.L. 102-585 authorized pregnancy care for such care relating to a pregnancy that is complicated or in
which the risks of complication are increased by a service-connected condition.
28 Pregnancy care: Title 38 C.F.R. § 17.38(a)(1)(xii). In vitro fertilization is excluded in the medical benefits package
[38 C.F.R. § 17.38(c)(2)] but Congress has authorized a narrow exception has in annual appropriations measures since
FY2017 (38 C.F.R. § 17.380).
29 Department of Veterans Affairs, “Enrollment Provisions and Medical,” 64 Federal Register 54210, October 6, 1999.
https://www.govinfo.gov/content/pkg/FR-1999-10-06/pdf/99-25871.pdf
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FY2017.30 This service is provided with narrow eligibility related to a service-connected
disability that prevents procreation.
VA’s justification for including pregnancy care and infertility services in its medical benefits
package suggests that VA could potentially interpret the 1996 law as similarly allowing VA to
provide “medically needed” abortion coverage.31 However, some maintain that the 1992 law
continues to prohibit abortion coverage.32
Legislative Activity in the 117th Congress
The Reproductive Health Information for Veterans Act (H.R. 345, 117th Congress), if enacted,
would require the VA Secretary to provide abortion counseling to a veteran who has an unwanted
pregnancy. As noted above, abortion counseling is currently prohibited by the standard medical
benefits package, though it is not specifically prohibited by the 1992 law.
The legislation would specify that abortion counseling must include (1) options for veterans with
unwanted pregnancies, including abortion; (2) accurate health information based on the health of
the veteran regarding those options; and (3) information regarding the nearest location where a
veteran can safely receive an abortion.
The House Veterans’ Affairs Committee held a hearing on H.R. 345 on June 22, 2022.33 In written
testimony, VA expressed support for the bill with technical amendments. VA noted that VA
providers currently face an ethical challenge, as they must adhere to professional standards and
clinical practice guidelines regarding abortion counseling while also complying with VA’s
regulations prohibiting such counseling.34

30 Section 260 of the Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies
Appropriations Act, 2017, and the Zika Response and Preparedness Act (P.L. 114-223) permitted the VA to use funds
from the Medical Services account for this purpose for FY2017. Section 236 of Division J of the Military Construction,
Veterans Affairs, and Related Agencies Appropriations Act, 2018 (P.L. 115-141), continued this policy for FY2018
and FY2019. Section 235 of the Energy and Water, Legislative Branch, and Military Construction and Veterans Affairs
Appropriations Act, 2019 (P.L. 115-244), continued this policy for FY2019 and FY2020. Section 235 of the Military
Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2020 (Division F of the Further
Consolidated Appropriations Act, 2020; P.L. 116-94), allows the VHA to use FY2020 appropriations and FY2021
advance appropriations to continue providing IVF services to certain veterans and their spouses. Section 234 of
Division J of the Consolidated Appropriations Act, 2021 (P.L. 116-260), continued allowing the use of FY2021
appropriations and FY2022 advance appropriations for this purpose. Section 234 of Division J of the Consolidated
Appropriations Act, 2022 (P.L. 117-103) continued allowing the use of FY2022 appropriations and FY2023 advance
appropriations for this purpose.
31 VA Secretary McDonough states that the abortion counseling prohibition is a regulatory matter. U.S. Congress,
House Committee on Veterans’ Affairs, Restoring Faith by Building Trust: VA’s First 100 Days., 117th Cong., 1st sess.,
March 25, 2021.
32 Office of United States Senator Jerry Moran, “Sen. Moran: VA’s Prohibition on Abortion Services is the Law,” press
release, August 4, 2021, https://go.usa.gov/xJK4k.
33 U.S. Congress, House Committee on Veterans’ Affairs, Subcommittee on Health, Legislative Hearing, 117th Cong.,
2nd sess., June 22, 2022.
34 Testimony of VA representatives, in U.S. Congress, House Committee on Veterans’ Affairs, Subcommittee on
Health, Legislative Hearing, 117th Cong., 2nd sess., June 22, 2022, p.2.
https://docs.house.gov/meetings/VR/VR03/20220622/114857/HHRG-117-VR03-Wstate-MillerM-20220622-U1.pdf
VA raised four technical issues with the bill as written: (1) the language does not limit counseling to veterans enrolled
in VA health care; (2) the bill does not define “unwanted pregnancy” and VA suggests revising the language as to not
limit counseling to certain types of pregnancies; (3) VA suggests revising the language to authorize VA to provide
counseling on the full range of options regarding pregnancy; and (4) it is unclear how it would obtain information on
the nearest location where a veteran can receive an abortion.
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An identical bill was introduced in the 116th Congress (H.R. 5568).

Author Information

Jared S. Sussman

Analyst in Health Policy

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