Transcripts For CSPAN3 Hearing On Health Care For Women Veterans 20220928

Ask for unanimous consent. Have your staff email the document to Veterans Affairs dot hearings dot male. Gov. Without objection members will be recognized for seniority for cresting witnesses today. This will make it easier to ensure that all members participate and have an opportunity to be recognized. Does any member have any questions with procedures to this meeting . Hearing none we will proceed. I now recognize myself for an opening statement. Over the last several years we have often cited women as the Fastest Growing cohort among veterans. Our hearing today will examine Women Veterans access to the full spectrum of medical care and colluding Reproductive Health care to the Veterans Health administration todays hearing also offers an opportunity to reflect on the meeting of freedom. Since the days of the revolutionary war Women Veterans have signed up to fight for and defend our countrys founding ideas of freedom. That is why they served. That is why they continue to serve. Listen closely to my colleagues on the other side of the aisle womens veteran choices that are best for their own personal health and medical providers freedom to exercise their own clinical judgment are under attack. Pay attention to the kind of legislation that they support. There are so extreme that all but one of our republican colleagues on this committee have cosponsored hr 1011 a bill that would criminalize Womens Health care. It would effectively negate womens bodily autonomy once a sperm reaches an egg, with no exceptions. The practical effect of this is Womens Health care choices become murder and they have no right to pursue lifesaving Cancer Treatments or use iuds or emergency contraception. It also takes away the choice of women for science based women building treatments such as infertile fertilization. Since the Dobbs Decision we have seen a stark contrast between those who planned to be prolife and those that actually want to defend life the freedom to choose and the freedom to respect the right of privacy Women Veterans have worn the uniform of our country with pride that is why it is an insult to their service that they would be denied for making the most personal choices about their bodies in their lives in reflecting on the effect on the recent Supreme Court decision, one of the witnesses on our second panel said in their written testimony, quote the moral injury of having served a country to protect our constitution that no longer protects me and the ones i love was and still is absolutely devastating and quote fortunately President Biden and secretary mcdonough are taking bold action to prevent eminent and future hard to better inspire restoring certain Reproductive Health care freedoms that were eliminated in the wake of the Supreme Courts recent decision six days ago va published an interim final rule that remains longstanding provision on abortion counseling and authorizes va medical facilities to furnish abortions in cases of race incest and the health of the woman this ruling is a strong first step to finally puts the va on par with all other federal Health Care Programs this rule will also promote better equity between the men and women who receive care at the va by removing the gag order of what doctors can discuss with their women patients no such gag order has ever existed for man it is unacceptable that it should ever be exercised against Women Veterans who served alongside their brothers in arms and deserve the full care they have earned and need most importantly this rule will save womens lives and protect their house for decades the va providers have had to call in favors in the community to procure lifesaving abortion care for women before this interim final rule pregnant veterans with lifethreatening pregnancy complications returned away in the wake of dobbs abortion bans have been triggered in multiple states and Community Care is no longer an option now the va can provide the abortion care necessary to save womens lives when their communities and states wont they can save veteran women live when their communities and states want to be a came to this decision after came to this decision after listening to veterans across the Country Congress needs to listen to veterans and providers to over the last several decades i and Committee Woman brownley have including fellow Committee Call allred and reuben diego have been doing just that. Since early august we have traveled with our staff to four different states we drove more than 1600 miles visiting six different medical facilities and conducted several sessions for here from women to hear about their experience in the va i came away from these visits in light about the challenges of ba currently facing awestruck by the determination and strength of Women Veterans we met with Critical Care teams and Women Program members like stephanie in Oklahoma City cindy in las vegas pat in phoenix in va employees who are serving veterans in creative ways doing many hours of doing outreach and thinking new ways to show Women Veterans at the va is a place for them we have seen what leading in Womens Health care means including at va facilities with dedicated Women Clinics with separate entrances, lactation facilities, integrated Mental Health care and an overall experience designed and delivered for Women Veterans with unique needs. I will tell you that among the va providers and the veterans i met with over the last week, the news of the secretarys recent regulatory action was met with approval applause and hope. We ask and they answered on equivocally Women Veterans want them to be able to provide a full spectrum of care. They provide more health care provisions. There was a clause with the va to finally join other federal have care programs to provide lifesaving reproductive care. Hope that this critical step is a sign the va is ready to truly welcome Women Veterans. Really provide the full spectrum of care. After one listening session with womens veterans last week a young veteran named jessica shared her reaction. Quote, i felt seen, i felt heard. I felt hopeful for the future of Womens Health care at the va, and quote. We also have been fielding an Online Survey to hear from veterans across the country about receiving Reproductive Health care, contraceptive care and infertility commitment at the va. As of this week we have received over four and 50 responses from veterans. The overwhelming majority of whom support the va support counseling and abortion care in circumstances like those covered by the secretarys new regulation. So far, 90 of survey respondents have said the va should provide abortion counseling. 73 of respondents said the va should always or sometimes provide abortion care. This survey is still alive at the committees website. I encourage any veteran who is trying to access Reproductive Health care at the va to complete it. Visit veterans dot how stock of. Click the button at the top to share your story. Your responses will remain anonymous should you wish them to be. I also want to thank secretary mcdonough and President Biden for their courageous, strong, regulatory action that will save womens lives. That will save womens veterans lives. I look forward to working with the secretary to ensure the ba has everything it needs to implement this rule successfully. I know much more needs to be done to improve Women Veterans experiences at the va. I see the implementation of this rule as a big leak moment for the department. If implemented well i hope that this will attract even more providers to practice at the va. More Women Veterans to seek care at the va. This is an opportunity to improve the whole spectrum of health care for Women Veterans. Indeed, while i have heard a lot of hope in my conversation with Women Veterans in the last week, there is also a frustration about longstanding challenges. A majority of care is sent out to majority. And caseload from women Care Coordinators make it hard and difficult for Women Veterans to reach their providers and get scheduled appointments in a timely manner. Some va primary care providers are not as welltrained or as committed as they should be in caring for women. Deficiencies in private, privacy and antiharassment measures still exist within va facilities. However, these are all challenges that can be addressed if we collectively commit to doing so. In phoenix alone over 11,000 women have chosen to receive their care at the va. This is a truly astounding in laudable number. It means that we owe these 11,000 women the best experience possible. The health care they have earned and deserve. I am pleased that the newly confirmed undersecretary for health dr. Sharif all the hall is appearing before this committee today so that we can discuss with him and other leaders on the panel how the va can truly put a plan into action that can serve Women Veterans. We will also hear directly from veterans and Women Health Care providers about their experiences so we can learn more about the vas challenges and develop ways to address them. Women veteran leaders have served this country. It is past time that we do right by their service. They are watching today, listening to what we all have to say. They are listening closely to who wants to deny them the most basic respect and autonomy and who wants to support the freedom that they fought for. Thank you, i now recognize Ranking Member bost for his opening comments. Ranking member bost. Thank you mister chairman, i appreciate today to discuss the care that the va provides to Women Veterans. I would like to start off with a couple stories. I know this young man that is 42 years old, he actually serves as a judge in my hometown. He also is a Lieutenant Colonel in the United States marine corps reserve. He is an outstanding citizen. He has been a blessing to the people in his community he has worked hard he has served this nation 43 years ago a young 17 Year Old Girl had to make a choice. About three teachers told her, dont ruin your life. This is a very inconvenient to be pregnant. She made the choice to keep that child. That child is my son. That woman is my wife. Fast forward to 20 years ago, my daughter the day after my sons wedding as a matter of fact came to us, she had to be rushed to a hospital in st. Louis because she was pregnant with twins. The twins had what was known and as a conjoined communication, that is a shared umbilical cord. She was 25 weeks along, if they could just get her to 26, just 26 weeks along the babies would live. One of the babies, aliana, died in the womb. Causing her to go into labor at 25 and a half weeks. We held holly, she fought for every breath. You know, mr. Chairman, strengthening services to Women Veterans is a priority of mine. He should not question that or anyone else on this panel. You know me. You know that we want to fight for womens rights and their ability to be served by our va to deal with any issue that they might have. Those who honorably have served our country in uniform deserve the best health care and support that we can provide, regardless of gender. I have a granddaughter that just joined the navy. As a marine that is kind of hard on me but i will get over. We teaser a lot about it. You know, getting the house care that they need that start to include support, it starts families on their own way. That does not include abortion. I am proudly prolife. I believe it is a matter of my face that abortion is wrong. I also believe an emitter of law that the va does not have the authority to offer abortions. Congress made that clear in 1992 by prohibiting the va from providing abortion. 30 years later, the prohibition remains in place. It is not it has not been repealed. It has not been replaced by subsequent congressional action. That is why i am so outraged by the announcement that the va will begin providing abortion to certain veterans and va beneficiaries. Abortion counseling to anyone in those groups. This is not only wrong, it is illegal. Let me say it again, it is illegal. The president and his cronies are willfully ignoring the constitution by acting like laws are mere suggestions. The Biden Administration has made a downright habit of it. It is shameful. It is undemocratic. It mocks the duty members of congress have to represent the will of the American People in washington with our actions, with actions like this the president is doing exactly what he falsely accused duly elected republican representatives of doing just last week. Following the law is not an option, it is a requirement. By ignoring the law the va is violating the wishes and values of millions of americans who do not want to tack dollars used to pay for abortions at va or anywhere else. I am one of those americans. The law is clear and it is on our side here. I will never stop fighting to ensure that the sanctity of life is protected at the ba and everywhere else. I am working with my colleagues on the Appropriation Committee and the senate to consider sanctions against would be a for violating the anti efficiency act. Abortion is not health care, no matter what those on the other side of this issue may feel. The right to life is sacred. American value enshrines in the declaration of independence. It is one of the Rights Service members and veterans throughout history fought and died to defend. I am committed to defending it now for them and for their own born children. Mister chairman, with that i yield back. Thank you Ranking Member bossed. I just want to point out before we begin the questioning that the 91 law, the 1991 law that you tsai was superseded by a 1996 law that authorized the va to create its own medical benefit packages. Its own package, the Hyde Amendment is not applied to the va. The secretary has the authority to create the medical benefits package that characterizes the entire range of services that happens under the Veterans Health administration. I will now recognize myself for for questions. Five minutes. Oh, im sorry. Im sorry. Good it would be helpful if i introduce the witnesses. The witness panelist. Lets begin, we have with us today i am very pleased to see with us doctor sharif ellen hall, newly confirmed secretary, undersecretary for health for the Veterans Health administration. Accompanied by patricia hayes, chief officer Womens Health, but earn Health Administration for the u. S. Department of veteran affairs. Doctor Amanda Johnson director for womens Reproductive Health for the Veterans Health administration, the u. S. Department of Energy Affairs and dr. Julian flynn, acting assistant undersecretary for health care Community Care for the Veterans Health Administration Department for veteran affairs. Doctor sharif on the hall, you are recognized for your opening statement. Good afternoon mister chairman, ranking meter, and members of the committee. I appreciate the opportunity to discuss womens veterans access to health care. Im accompanied today by doctor patricia hayes, our chief officer at the office of Womens Health, dr. Amanda johnson, director of Reproductive Health, and dr. Julian flynn, our acting deputy under assistant secretary of health for the office of integrated veterans care. On behalf of the department i want to thank this committee for its laser focus and continued collaboration on the whole health of all Women Veterans. This critical relationship is reflected in the resources that congress has repeatedly secured and seen in President Bidens budget requests of billion for fiscal year it is paramount that we continue our progress together for the fastestgrowing demographic of veterans, women. One important access of this work is delivering the reproductive Access Services that they need when and where they needed. The services we offer is Maternity Care and life saving treatment related to pregnancy. As a result of the Supreme Court decision that overturned roe v. Wade, certain states have begun to enforce abortion bans and restrictions that create urgent risks to the lives of their for the va modified its regulations to expand Reproductive Health care. When medically necessary, be will provide abortions when the life or health of the veteran would be endangered if the pregnancy was carried to turn, or when their pregnancy was the result of rape or incest. Such reporting from a pregnant veteran constitutes sufficient evidence that an act of rape or incest has occurred. This advancement is a Patient Safety decision to ensure and result can access lifesaving Reproductive Health Care Services at the no matter where they live. Protecting the health and lives of pregnant veterans as the primary concern of via. It is important to emphasize that ba is taking these steps with our primary mission in mind. To preserve the lives and healthy veterans. There is nothing more important than that. This Emergency Authority and assess to save lives as we progress toward implementation. As this will be a new service, we recognize that significant steps will need to be taken across the system to implement it. Well a formal Implementation Plan is under development i want to note a few areas that were working towards. For example, we believe medication abortion will be first available and most common type of proportion provided. We are working to ensure providers have access to training as well as medications. Pregnancy testing will be provided at all sites and we will survey the ability of pelvic ultrasound who says early pregnancy. Ensuring staffing and necessary equipment is at sites its critical to provide the services. In cases where va is not available to provide needed care, veterinarians will need to travel to community or other va. Sets in circumstances where veterans normally qualify for transportation benefits so to will bedrooms qualify for transportation to sites that can safely deliver this care. We will continue to follow existing policy requirements to ensure that practitioners that every are permitted to provide Abortion Services had to be a sense of care where the services can be delivered safely. Prior to this expansion of services abortions and abortion counseling were considered an exclusive service in cc am contracts. The cc ntia will provided have to be adjusted by the champions to allow for abortions and abortion counseling as covered services. During this interim period, veterans care agreements will be developed and who sets a bridge until the are completed for the services. Finally, the physical safety of our veterans, providers, and staff is always in critical consideration. And managing the potential divisiveness and emotional response to this issue, va is alerting security to cross the system to develop strategies for highrisk sites. In conclusion, the amendment to include Abortion Services and abortion counseling in cases that threaten the life or health of pregnant veterans or va beneficiaries reflects our relentless focus on better and safety. We are committed to providing veterans to access to world Cats Health Care and Services Including Reproductive Health care that theyve earned in their service to our nation. The ba is determined to stand by that commitment. Mister chairman, this concludes my remarks. My colleagues and i are prepared to answer any question that you or your colleagues may have. Thank you doctor, its a pleasure to have you before our committee. I now recognize myself for five minutes of questioning. Ill begin with you doctor, you are most your most recent employee was a non va community hospital. Based on that experience and your knowledge about the state of Reproductive Health care access in this country post pandemic and post dobbs, can you tell us a little bit about the capacity of Community Providers to care for pregnant veterans and to provide abortions and how that influences vas decision to issue last fridays interim final rule . Thank you mister chairman. I indeed lead a hospital in newark new jersey. That is a state that does for the services, permit these services, i should say, to him in across the state. And so, there are ways for veterans to get that care outside of va in new jersey. That simply is not the case across the country. Especially after the Dobbs Decision. Part of the emergency that we are responding to it is related to the fact that states have leveled restrictions, certain states across the country, in terms of access to these services. In many of those states, the baseline availability of Reproductive Health Care Services was much less than it is and other parts of the country including new jersey. And so, we, between ten and 20 cases of veterans in here, the office of Womens Health as told me about, weve had to send our veterans for lifesaving care to community facilities, ask them to do these services, to save veterans lives, and then come around and say we cant pay for these services. And so, given that that baseline available of the services was variable across the country, and certainly more limited in certain states, we could not contend with the Safety Environment after the Dobbs Decision in terms of the restrictions to the Services State by state. These 10 to 12 Women Veterans that you speak of, more or less per year, these are Women Veterans who are facing life threatening health conditions. Is that correct . Thats right mister chairman. And for them to not be able to have the option to seek an abortion procedure because its not available at the va because of the rules that we have in place, their lives are in danger . Or, they were in danger . In these cases, yes, mister chairman. And also, we were particularly concerned about the environment after the Dobbs Decision. Whereby some states are restricting these Services Even more than they were before. We could simply not contend with that environment of safety for veterans. Another point i want to mention mister chairman is we feel this is needed care in this context. As a general matter, these veterans are under a care, and we know we can save their lives, we have to do it. Under the previous regulatory environment, a va practitioner, theoretically, was not even able to talk to a woman veteran about procedure that consider life, that correct . Thats correct mister chairman. To what extent are Community Providers overextended, and what is the effect of Health System consolidations and hospital closures and better in access to lifesaving care . Having led an institution outside a va recently i can tell you that access to Health Care Services more broadly is being streamed across the country. I can tell you that the wait times for a lot of critical pieces of the care in the hospital that i was providing restrained not only by new and evolving Public Health issues as we proceed into the endemic phase of the pandemic, but also the fact that we were catching up to the delayed and deferred care as a result of the pandemic. And so those things are layered upon our concerns in va for access to the services outside a va. Part of that led to our decision to say that we have to respond to this emergency and offer these services to Women Veterans across the country. And, doctor, we can anticipate, just knowing the data of annual needs that arise, a 10 to 20 Women Veterans across the country who face lifethreatening pregnancies, we can anticipate that each succeeding year, were likely, given the number of veterans, that we would see 10 to 20 veterans, Women Veterans, facing lifethreatening situations Going Forward each year . Thats a reasonable prediction to be, right . Its true, mister chairman, that this is the Fastest Growing veteran demographic that we have. We have hundreds of thousands of Women Veterans of childbearing age. I think if those trends continue and we expect them to, you may see even more of those veterans requiring lifesaving care. Yet another reason that this is an important move. My time is up, but i certainly see i want to confirm and validate to the basis, the evidence of the emergency and i commend you for taking Decisive Action along with the secretary. I now recognize hey mister chairman. Doctor, if you would, please respond yes or no, and only yes or no to the following questions . First, yes or no, did congress expressly prohibit va and law for providing abortion in section 106 of public law, one of two dash 585 . Bas interpretation of that law, sir is . Yes no youre . The true answer is yes, that law was passed. Youre not using that law to try to undermine this one. Okay . Second, yes or no . Was congress ever expressly repealed prohibition in the law . Im not aware of that, congressman. The answer is no. The correct answer of course and all of this, congress did prove it prohibit ba for providing Abortion Services in 1992. That prohibition has never been revealed. Even though second comments have been made that are using another twist on a different section of the law to try to get their. So it still in law today. Where i come from, we try to follow the law. It disturbs me that one of your first acts as undersecretary for health is to disobey the law so blatantly. Especially on an issue that is quite literally a matter of life and death for most innocent, helpless, and defenseless among us, that the Previous Administration of both parties have been declined to pursue in the absence of a legal mandate a legal mandate that the va certainly does not have today. My office sent a series of questions, detailed questions last week about how va would operationalize this rule. My question should have been more basic. We didnt get it back until yesterday, for example we asked if va planned to allow a term abortions for women in their third and final week of pregnancy . Their trimester and final week of pregnancy . We asked to be a if they would perform abortions on minors because of champ va and if so if the parental consent or notice would be required . We asked how va provides providers with moral objections would be excused for providing abortions, counseling, or performing abortions. Va blew past the questions deadline to respond to our questions. When we did receive the answer to my questions, as i said, yesterday, many of the responses were half answers. Setting aside the basic illegality of this effort, how can you justify proposing such a significant change without being able to provide timely responses to basic questions about it . Doctor . And then im going to ask this question as well with that. All youve talked about so far with the questions that came up earlier is about emergency situations. Here are proposals and what youve answered us has gotten way past emergency. And also passes well past the so do you have a response . Yes congressman. I understand that you are taking this position around our authority. I want to say that we respectfully disagree with that. Our council, our consultation with the department of justice. What i can tell you is that when we were trying to be responsive to the urgent situation that faced veterans across the country, after the Supreme Court decision that overturned roe v. Wade what did we want to do was be sure that our clinicians could exercise their judgments without having to take extra steps to determine whether something they felt was needed to preserve the life and health of veterans we wanted to make sure they were free to exercise their clinical judgment to ensure that veterans needs were cared for. So then you are admitting that it goes a lot further than just emergency situations . We trust our clinicians, congressman, to make the right decisions for veterans. Can you answer what i said . You decisions and the way that youre putting the rules together goes much further than just the safety of our veterans . I think all of it has to do, congressman, with the safety and health of our veterans. Lets go with one of the questions that i ask and then im already overtime okay. I would like to just find out so, at first we got a verbal answer on if a clinician for more reasons wants to not perform this. The answer, verbally, whereas yes. Then the answer that we received was, well each case would be weighed out, whether or not they would have. That theres a lot of issues that youre going to have with this. Across the spectrum. And more than this hearing is going to take to figure out where were going with this. And the question of legality will, i think, found out in the course at some point. And so without, im out of time, i yield back, thank you mr. Chairman for letting me go over. Thank you, Ranking Member bost. I now recognized chairwoman roundly our health subcommittee, five minutes. Thank you mister chairman, thank you all for being here. Doctor elnahal, thank you for our previous conversation earlier this week. I was glad to be able to have a longer conversation with you on this issue. I certainly thank you and the secretary for moving forward with this important rule and Service Within the va. And i applaud the fact that the way you describe it is not just life, but the health of the Women Veteran. I think thats very important. I will say in response to mr. Bost, some of mr. Boasts bost comments, i respect his position on this, my problem is i dont think he respects mine. I do respect a certainly honor and respect his. I think its more likely then va will find many more than ten or 12 women a year requiring emergency for life saving abortions because up until this point there was a va gag rule. The a providers couldnt even discuss abortions with veterans experiencing, sometimes major complications in their pregnancy. I think it will be more, and i think we will save more lives as a consequence. I do want to say that i will continue to advocate that i believe a womens rights to choose and make decisions around her own body should be a part of the Overall Health care provided by the va and i will continue to advocate for that. Because i feel very very strongly that it is the right thing for the va to do. So, having said that, i wanted to go and ask, first of all, to dr. Elnahal, if theres anything that you need from us in terms of trying to execute this rule. If you need something, a decision by a congress and so forth. I hope that youll speak with us and let us work as a team. I did want to ask dr. Johnson a question, because the last time we discussed my veterans and fertility treatment act, it was at a legislative hearing and it was two days before the dobbs Supreme Court decision. Now in a postroe world, i believe its crucial that we make ivf care a part of the va medical benefits package, and related to a Service Connection, marital status, gender identity, wreaths or ethnicity. So doctor johnson, do consider ivf to be part of essential health care . My apologies. I think Family Building services are part of essential health care. I think it follows our responsibility to promote, and restore the health of the veterans that serve our country. Very good. Doctor elnahal, this is something to that i want to work with you. Again, this is putting our right foot forward. As you say in your opening comments, Women Veterans are the Fastest Growing cohort within the veteran community. I think we can all recognize that we have a ways to go to bring equity to services for our Women Veterans. Weve made some strong steps, but we have many more steps to go. Particularly in a postroe world now, i think its important, as you thought about access to abortion, in the event of life, health, rape, or incest. I think its also important that we look at a full benefits package and including ivf without a Service Connection barrier to it. That it is just part of the Womens Health care. So, if you want to make a comment, i would love to hear it. My thoughts aligned with dr. Johnsons exactly on. This part of the reason that we lag among Women Veterans in terms of trust has to do not only with what you mentioned around with these previous restrictions, on being able to discuss the full scope of Reproductive Health care, but also the services that follow that. I look forward to working with you, congresswoman, on this. Thank you very much. Last but not least with a second to spare, i know in the second panel, reading the testimony at the second panel, theres a strong, consistency and a message that goes through all of the testimonies, to say, still, that the va is generally not an open, inclusive place for women to walk into. And to be served without harassment. And so weve got to continue to work on that. I know the Deborah Simpson bill took a giant step in that direction. But we need to make sure its executed and scaled across the enterprise, as you said in year testimony, its unacceptable and otherwise. I sent a letter yesterday regarding the motto. The motto is not going to change overnight, the culture of the va, but it is a first, very important step to really signal, and communicate, to our Women Veterans that we respect and are grateful for their service to our country. For the lgbtq community, were grateful and recognize their service to our country. I think the motto would be, a long way going to say the va is very much committed to inclusivity. Thank you very much. Ill yield back mister chairman. Thank you, chairwoman brownley. I now recognize general bergman for five minutes. Thank you mister chairman. Today a scenic day for a lot of reasons. Im gonna start with its 54 days before an election. I was very uniquely surprised by the little slideshow in your opening remarks. And the military i dont know if there is an order for this but in the military it falls under article 1 33, which conduct unbecoming. I would suggest to you that the slideshow is not something to be used in a campaign commercial. Thats just a personal viewpoint about how we open this meeting. I would also suggest, as a correlation to that, conduct unbecoming goes to all levels of leadership. The two marines standing behind President Biden in the speech a couple weeks ago, that was conduct unbecoming. Now lets get to the point at hand. Doctor elnahal, vas response to questions from Ranking Member bost, states that the v8 will allow Mental Health providers to provide abortion counseling and Abortion Services to veterans. Yes or no . Yes, congressman, they would be parts of a number of Mental Health providers . Yes. Our va Mental Health providers trained in obstetrics, maternal health, how do you conduct an abortion procedure or the risks of such a procedure . Well, congressman, i think are they yes, or no, are they trained . In the military we dont send anybody into a billet to ask something to do something that they are not trained to do. Are these people trained . Their Mental Health counselors. Theyre probably pretty good, but are they trained . Yes, they are trained in discussing clinical options for care and theyre often okay, if they are trained in discussing clinical options, who provides the Expert Opinion to the person sitting with them who may not understand what the options are . What is the trainee given to the people who work for you to be able to provide that veteran with a really realistic risk assessed decision for them . Whats the plan . Its a fair question, congressman. We have great programming that dr. Hayes can speak to on comprehensive training and Womens Health across multiple sets of classes of providers. Im talking about specifically, Mental Health providers, talking to women, veterans, who are already under a great deal of stress. Your Mental Health care providers are trained to deal with that stress. But who is going to be the subject Matter Expert sitting with them when that veteran has a question . Have we lay that out . Is there a plan . Can we see it . The plan for how this will be best introduced, in order to make sure that we put the veteran at the center of this decision would be that we will conduct training. First, its necessary to understand that what happens is somebody gets a positive pregnancy test from their gynecologist, or their primary care provider youre missing the point. Youve got people on your staff. Mental Health Providers, who are going to provide this. We are not talking, now, about the veteran who has a result of a pregnancy test, or whatever it is. Were talking about the people that you train, and deploy, to help these veterans who are under stress. Whats the plan . Yes sir, the Mental Health council would only be part of a team that would be working with a gynecologist so theyre going to sit in this counseling session . They may well be. Well if they may well, again, if im under stress in a situation, and ive got someone advising me, i want to make sure that ive got answers right there, right then. Is this something that we kick the can down the road, come back next year . Because im not qualified to answer the question . Is there a plan . We cannot provide the plan the directly today. I would suggest, lets keep the court behind the horse, lets get the plan together before we start putting Women Veterans at risk for making a decision that they could later regret because they got bad information. With that a yield back. Thank you thank you general bergman. I want you to know that the same committee will get another two weeks from today, to hold a hearing on veterans suicide prevention. I will now i will not entertain for any second that Mental Health is not health. We know Mental Health challenges are related to sexual trauma. They also occur with unwanted pregnancy and pregnancy complications. Va testimony today, doctor elnahal noted that 60 pregnancy associated deaths among Women Veterans in va care related to suicide, homicide, and overdose. Mental health, Mental Health conditions affected 78 among veterans who died in pregnancy associated events. These the statistics are horrendous, but they reflect very real dangerous for burial women, many of you may not know that interpersonal violence can get as much much more worse when women becomes pregnant. So suicidal thoughts and behaviors also accompany that. Pregnancy is a risk factor for violence. Obviously, a reasonable person can understand that Mental Health considerations are every bit as important as physical Health Factors in weighing decisions. Pregnant veterans and their clinicians must be able to consider and make decisions on the basis of all help factors, full stop. I now recognize we have presented underwood for five minutes. Thank you mister chairman. Earlier this summer, americans lasts the constitutional right for the First Time Ever when the extremist Supreme Court overturned roe v. Wade. Legislators have been working for bestcase to impose extreme now theyre succeeding, sometimes without exceptions for rape or incest. Thats why its so important that bs taken a critical step in the opposite direction this month. Finally, providing veterans with access to abortion counseling and abortion care in cases of rape, incest, or when the life of her pregnant veteran is in danger. As a registered nurse, i applaud this rule from the va which is grounded in medical evidence and is critical for Patient Safety. Doctor elnahal, in announcing this rule, you said the va came to the decision after listening to Health Care Providers and veterans cross the country that abortion restrictions are creating a medical emergency for those who serve. Can you share some of the stories you heard from veterans and va Health Professionals that underscore the need for this policy . Absolutely, congresswoman. I want to start by saying thank you for your advocacy and your work on maternal mortality, especially for women of color. Thats a priority we share as well. Dr. Hayes and dr. Johnson let those discussions with the clinical teams, id like to ask them to weigh in. I think its important to understand that the way in which we work very individually with veterans is at the heart of this matter. We need to be able to talk with veterans, talk about their personal responses to their own pregnancy test and be able to go with that in terms of what do they need. The kinds of things that we encounter, then, are these went to one tragic situations often where person has to make that decision for themselves about their own lifethreatening medical conditions. And the pregnancy that they have. And so its a 1 to 1 kind of situation. We can give detail after detail, but most importantly, its an individual veteran who is in the situation that we need to be able to help at that point to preserve her life, to restore her health. Thank you very much. We know that bad actors are spreading false information about Reproductive Health, often deliberately, with the goal of discouraging abortion, or limiting access for. There has va planning to combat disinformation and misinformation around this rule . I think, congresswoman, the discussions that are providers can now have about Abortion Services as an option to veterans is the most important and significant opportunity to dispel any misinformation or misunderstanding about these services, the risks, the benefits, and i think a lot of that will be borne out in the latitude that are clinicians now finally have to be able to have these discussions. Doctor johnson, i dont know if youd like to add to that from your experiences . I completely agree with you. Will we strive to do, and what we do do well, is practice evidence based medicine. Part of that is the care that are providers pride to veterans. Its also part of the communications that we develop for veterans directly about the care and their options for the care they receive. Excellent, i encourage your office to be in close touch with those communication professionals within the va, and with your Outreach Team that at the very work at the vso. That is an opportunity to make sure that the veterans that you serve understand the facts about this rule, and this will change. Have you seen a lot of confusion around whats legal and whats not in the wake of roe being overturned with actions what actions have the va to proactively communicate to make sure theyre aware other Reproductive Services first are now eligible . I think the dynamic youre describing was a big factor in our assessment of the risk after the post after the Supreme Court decision that overturned roe v. Wade. The degree to which the services can be provided in states with restrictions very. You have some states for example that have this affirmative defense mechanism for clinicians which essentially means they have to be charged with a crime in order to justify the clinical decision. So that weighted heavily in our assessment of risk against these state laws. I think, more generally, were going to be communicating as much as we can across our population of Women Veterans about the availability of the services. And the parameters by which are clinicians wherever them. Doctor in your testimony, you talked about plans to strengthen maternity programs. I was proud to lead the protecting moms who serve act, provides new funding for initiatives to prevent among pregnant postpartum veterans, i will these investments and enhance the care provided to veterans during and after pregnancies . Thank you for those thank you for that legislation. It allows us to expand our efforts in this important area. Ill ask dr. Johnson to discredit more detail. I echo dr. Elnahal gratitude for that. Primarily what our goal is to excuse treatment and expand our Maternity Care coordination to the 12 months postpartum which is a vulnerable time for families, particularly in areas of perinatal Mental Health, interpret nerve violence, food and housing security. In addition, were looking at targeted ways to intervene for those veterans who are most at risk for complications of peck pregnancy. For example, veterans with ptsd, veterans with hypertensive disorders, or just so that we can further support pregnant people. Thank you for testimony today. I yield back. Thank you representative underwood. Mr. Rosen dale, i rescued 92 for five minutes. Thank you mr. You caught me off guard. As each of you have been sent here by the administration which is the most proabortion administration that has ever been elected, quite frankly i have no question for you. Ill only make a statement. Millions of americans, millions of americans have relied upon the Hyde Amendment, and the Veterans Health care act of 1992 to be assured that their tax dollars would not be used to fund abortions, abortifacients, or abortion Counseling Services. They felt a current assured because it was in law. Law. Now the Veterans Administration s and a bunch of unelected bureaucrats who dont have to answer to the voters of this country have cast a rule im sure we owe understand in this room the difference between a rule and a law. To use tax payers dollars for abortions. Its my understanding that the state of alabama has already filed a lawsuit. To stop this overreach of power by the Veterans Administration. Quite frankly, i look forward to being overturned by the courts. I plan to do whatever i can to support that effort. I yield back. Thank you mr. Rosen dale. We will now recognize chairman purpose for five minutes. Thank you mister chairman. Thank you to our panel for what youre doing to meet the needs of our Women Veterans. I just wanna mention a project in my district. The manchester v8 Medical Center is slated to open in 2023 i know are veterans are looking forward to that. Its going to go a long way to provide equitable care to Women Veterans an environment that suits their needs. A key barrier for Women Veterans, which theyve cited and accessing gender specific its a poor experience of general safety and comfort with the environment at va facilities. In accordance with they require our facilities to follow certain standards. Policies specify privacy, dignity, sense of security, and safety considerations that all clinical spaces nba Medical Centers must meet. So to ensure compliance with the standards, vhs directs via champ cease to conduct regular inspections. But ba relies on facilities to self respect their compliance. G. A. O. Found in its two most recent reports that facilities dont always accurately self report about their compliance with the standards. Va lacks a mechanism to independently validate a facilities self reported compliance. Maybe, i can ask this a view, what oversight accountability mechanisms exists for ba. 2 bells day the accuracy of facilities self reported data . Thank you. I really appreciate the major concern that you voice about the betterment experience, the Women Veteran experience in walking into a va. We have been concerned about the harassment. We have a major focus because the layer level of harassment, ever veterans, male or female, is an excess double. Were going to continue to have that effort before. Most when you talk about the environment of care. Youre correct. There is a self report. Weve done two things in the last year. One is firm up the palace policy about what must be, again, required to be in each facility. That is matched now with what is the walk around, tablet based survey. Those tablet based surveys are now looped up to a higher level. We will continue to have those reported at the level, with deficiencies noted. Terrific. And maybe i can say with you, doctor hayes, despite the growing number of womens veterans theyre utilizing health care, a minority of them choose to receive their gender specific currently a. Some of the issues that youve already covered our barriers, and i want to commend va for its campaign to assigned as ignited Womens Health primary care providers to at least 85 of Women Veterans. These are critically important to ensure that ba can provide quality, accessible, gender specific care to Women Veterans and its facilities. Many Women Veterans lack the calm finance in the clinical competence of these particularly for whom Womens Health is not their focus or specialty. Im wondering if you could address that and share some oversight or oversight accountability tools that va is utilizing to monitor the situation . Im actually concerned, you say, as you found, Women Veterans are not confident with the competency other Womens Health providers . We conduct significant training. We surpassed, this week, yesterday and today, having trained 10,000 Womens Health provider specifically and gender specific care. We put it as a very high priority that folks go through the training but continue their competencies through continuing education and practice, by seeing a number of Women Veterans. So, i want to make sure that we reassure you that we are focused on the competency, and the fact that our women are reporting a High Satisfaction and high trust and comfort in our care. Id like to work with you on your concerns there and see what we can do to meet any additional gaps that are being identified. Maybe we can continue to communicate. If theres details of specific cases we can relay that to you. Just to reiterate. After nutritional training, there were professors, theres continuing education thats provided . Its not only provided but required for them to be continue to be a Womens Health provider. We monitor that yearly. Thank you for your responses. I yield back. Thank you chairman pappas. I now recognize bill for five minutes. Thank you very much, i thank our panel for being here. Im a physician and im a veteran. And a female veteran. And im somewhat confused by some of what im hearing here today. So if i understand correctly, the va feels that it has to make a rule that violates law, that is been passed by members of congress who the public feels is the body that makes lives because the urgency of the Dobbs Decision and the potential for state laws restricting abortions for a lifesaving Emergency Care of women. So exactly how many states prohibit abortions in the life of the mother . Congresswoman, the concern is exactly how many states prohibit abortions for saving the life of the mother . Im assuming you research this because thats the reason for you rule . Its not just permissiveness, congresswoman. Its their practicality. Its giving women the care that they need in the states. You also said that these are lifesaving procedures. In wet trimester of pregnancy through these lifesaving procedures conducted for the 10 to 20, women female veterans that contacted . He is certainly very. This all asked dr. Hayes if she has a summary. It certainly varies do not know the trial minister . We do. He also said that Mental Health providers would provide counseling. To Mental Health providers, did they discuss cancer care with veterans, either male or female . Do they discuss cataract surgery, and ive perform surgery in va hospitals . Do they discussed joint replacement, some of these, im sure veterans that have had their joints replaced, or cataract surgery, also have Mental Health issues. Did they discuss hysterectomies . Do they discuss Cancer Treatment . Mastectomy . Chemotherapy and Radiation Therapy for Breast Cancer patients . Are they involved in counseling of these patients . Congresswoman, the multi disciplinary care model that dr. Hayes and the office of Womens Health have implemented across the spectrum for Womens Health care does include Mental Health providers. We have Mental Health providers in your continuum of care . Mental Health Providers are giving counseling for all of these issues . As you know, congresswoman, these are often its a simple yes or no . Are they involved in counseling for all other types of care for Women Veterans, or a male bedrooms . Theres involved with sensitive discussions on the gravity so only sensitive discussions. He also said that youve had an approach of 10 to 20 female veterans who needed life saving abortions. And so im expecting that you think this would be limited the number of abortions that would be performed. We protect, congresswoman, that about 1000 Women Veterans here would receive the service. Theres medical research and medical literature that the more procedure that it a physician does, the better quality of care they deliver. Do you think that if 10 to 20, or thousand procedures are performed in a here in the entire United States, in the entire v. System, that they would have the level of expertise that they need to provide women quality of care . Because if i were that Women Veteran, i would ask the same thing that people ask me of cataract surgery which is how many have i done . How many have i performed . In what trimester have outperformed . Do i have the expertise and knowledge in order to perform that . So i would be extremely concerned has a female veteran to be approaching a va facility to be canceled by a Mental Health provider even in your continuum of care, for a provider who has performed very little procedures, my personal view point is that theres exceptions for rape, incest, and the life of the mother, but i think for the ba to go on a rulemaking tacked against the wishes of congress and the public is unconscionable. Thank you, a yield back my time. Thank you representative millermeeks, i know recognize representative allred for five minutes. Thank you mister chairman. For holding this critically important hearing. My home state of texas has the most Women Veterans of any state in the country. It has one of the nations strictest laws banning abortion from the moment of fertilization with only a narrow exception for the health of the mother. This is a law that was written in 1925. That came into effect after the Supreme Courts recent ruling. That means that every texas womans better, and where we have the most of any state in the country who is raped, women who serve our nation, who is raped, it has a pregnancy as a result of that would be forced to carry that pregnancy to term, or find a way to leave the state if the v8 werent able to offer this care. That means that every texas woman veteran whose life is in danger because of a complication with her pregnancy, which in your testimony, you know that veterans are at greater risk to increase risk of Chronic Health conditions. Everyone who has a complication, would be subject to the legal whims, basically, of some of the hospitals or places they may seek care. This is not a hypothetical scenario. There are texas women whove been turned away with life risking conditions because the hospital was worried that if it provided this care, that they would be subject to criminal penalties. And finally, in fact, under our 1925 law. A felony. Thats why i support the vas decision here. Yes it is certain in the best interest of protecting the va Womens Health, physical and mental. I want to talk about how this law will interact with our laws in texas. I appreciate that the irs clarifies that Va Health Care professionals are preempted from state and local laws surrounding abortion, as its a federal agency. States like texas, where providing abortions is felony, and theres the possibility of being sued in addition for providing them, do you anticipate ba providers may still have concerns about their liability, when providing cares to patients . How does the va intend to address those concerns and make sure the providers are comfortable with providing Abortion Service to our Women Veterans . Congressman, its a good question. We anticipate that. Thats why were trying to clarify as much as possible have federal supremacy plays into this. And the fact that when these clinicians are doing their work on federal property, or referring veterans for care in the community, we are doing so with the authority federal law. Which is interest by the i have far. It will do everything we can to communicate that they are protected and will be protected by the federal government. I do want to talk about e Community Care, wound veterans have received their gender specific carey as you mentioned in the testimony, in the community, you said that the va will pay for abortion counseling and services for providers in the community where available. And states like texas where abortion is banned, and Abortion Providers have been driven out of providing care in that state, how does the va intend to ensure veterans have access to abortion care . Its correct that Community Providers and states where there are restrictions will not be able to treat our veterans because of the state laws. And so, that is why, by adding it to the medical benefits package, were making clear that benefits such as travel to sites of care where they can get this necessary care, will be offered by va where it is offered for every type of service where they otherwise qualify. Thats the strength of adding it to the medical benefits package. I agree with you, thats a really important point. The cost and difficulty associated with having to do the travel yourself is often prohibitive for many women. And i want to quickly in the minute that i have left just address how were going to inform our texas veterans about these services and let the ba plans are for a reach in this case and how we can ensure that they have access to the services. Its a big priority, congressman, to make sure that we communicate as far and waited as possible to our Women Veterans the service that are available and new being offered as a result. We also have in place the access that they need to give them the care that they need. Thank you for your testimony. In states like texas, womens lives are at risk because of a 1925 law thats in place because of the narrow exceptions that are in place. Because of the fear that if they provide the services, you could be facing a felony or be sued. Thats why its so important for texas Women Veterans that you are. This i want to thank you for reaching this decision. Thank you for your testimony. Thank you representative allred. I now recognize representative ellzey, for five minutes. Thank you mister chairman. The question came up, which states prevent or prohibit abortions in the case of the mothers life is at risk . There are no states that do that. There are no states that do that. Please dont continue to use that framework as a reasoning for this. Its disappointing to see. Doctor elnahal, how do you consider the possibility that this rule that it will put them into legal jeopardy, but with criminal and civil, for violating state laws . Well congressman, there may be attempts from state to state by other jurisdictions to do that. So what were trying to do is make clear that our authority under federal supremacy, which is a constitutional authority, as well as the secretarys authority with the emergency rule, protects those clinicians and the full force and the federal government will be there for them. I thought youd say that. All right, describe for me, and the American People, the procedure by which youre allowing va facility to and the life of an eight and a half week girl unborn child . Described in medical detail . Congressman, the services that we will be providing under this rule by definition in the language of the rule, are in place to protect the life and health of the veteran. I can see that that question is not going to be answered, so ill be happy to accept your written answer for the record. Thank you doctor. In the case of medical emergency, the va would be for those who dont understand whats actually happening here, this is a work for jobs, and for the individual states, which only send it back to the state. Dobbs sent it back to the state. This is a workaround for the federalization using the va as a mule to legalize abortion paid for by the federal government. Knowing that the va is not beholden to the Hyde Amendment. I think thats pretty cynical. I look forward to appropriations language next session which will further clarify that. I think, overall, the vague language that youre free to 1996, it doesnt say anything about abortion. But the 1992 law is very specific. If someone wants to repeal the law of 1992, theyre going to use specific language. That was not done here. I leave the rest of my time. This seems pretty cynical on the part of the va. As a veteran of 20 years who cares for my sailors, soldiers, airmen, and marines who lead into combat. Nobody has been prevented from prevented from receiving medical care and itll be a, im very proud of what we do in this committee im very proud of what the va generally does. This rulemaking is yet another example of this Administration Using an elected bureaucracy to make law where it has no power to do so. I yield back my time. Thank you, representative ellzey. I know we are recognize representative frankel. Let me start by thanking you, and representative brownley, and youre department for your efforts for advancing abortion counseling and care for veterans. I speak for the majority of americans when i say a woman should be in charge of her own Reproductive Health care. Her future, her life, and that medical decision should be made by a woman with her doctor, not by politicians. Especially politicians who have no idea of the circumstances of her life. To say simply that abortion is part of health care. Now, its sort of today we are, i believe in access, obviously, to full reproductive care for women. Today were talking about women and veterans. Think about it. Some of them were willing to risk their lives. They were standing up for our freedom. Dont they deserve their freedom . Isnt that what we are talking about . The freedom of Women Veterans . To determine their own future . So thank you, thank, you thank you. Representative allred had some questions. I want to follow up on them. Just in terms and how distant gets implemented because the concept to me is the right one. The package, the benefit package, now, does that mean that the va will pay for counseling and for abortion care for all veterans . Congresswoman, abortion counseling will be made available to any veteran. Abortion services would be limited to situations clinically. Where the life or health of the mother would be put at risk if they carried to term. New cases of rape and incest. Okay, im assuming thats up to a doctors determination. Yes. Just, im from florida, representative already, i have to deal with a very oppressive autocratic governor, and state legislator, they think they should be in charge of womens lives. I think they would do anything to try to stop, to put obstacles in front of this new policy. A new year program when women be able to go to a doctor would be say say from the legal restrictions and a va clinic . What about at a private Doctors Office thats doing work for the va . Well congresswoman, where you have our federal employees doing clinical work on our property, va property, they would be protected under federal supremacy. The full force of the federal government will be there for them should they be challenged on. That when it comes to Community Providers, those protections would not necessarily be available. So that is where we have to factor in, with their Implementation Plan, ways that we can deliver care to those veterans in the states, including possibly transporting them should they qualify for travel benefits under medical benefits speck its more generally. Two va sites or Community Providers that can do this where. I think thats especially going to be challenging for women who live in states like in florida. If you live in miami florida, the next day that allows abortion care is literally hundreds of miles away from florida, and you probably find that around the country. There certain parts of the south, parts of the country, parts of the midwest, women who live in rural areas, those are all going to be problematic. I hope you are going to focus in on that and i have 46 questions to ask one more question. Is contraception now going to be fully paid by the va . Are we still requiring copays . Ill defer to dr. Hayes to answer that question. Thank you. There are contraception copays still in a distance. We can give you Additional Details on how that runs under the regulations, and why that is still pending within the va. We did submit a supportive legislative requests to have contraceptive copays removed. I think thats a good idea. Does it have to be done by congress . Can your congress do that . Thats handled in a written response to land for you how exactly that may take place. May i respectfully suggest thats a good idea to get that done. Thank you, i yield back. Mister chairman, thats another initiative for you. Mission accepted. Thank you representative frankel. Mr. Biased, i would like to go to a second round of questions. Okay, great. I want to discuss briefly before i ask dr. Hayes a question, a situation in which counseling about abortion is essential to Womens Health and safety my colleague on the other side would love to you and are insisting that is no legal basis for the interim final rule that has been put forward. If that is true, they want, they dont want to see even counseling for abortion happening. Lets imagine a scenario that unfortunately is not so uncommon. A woman with a wanted pregnancy discovers that she has cancer. Her physician must be able to cancel her about the risks of chemotherapy to the fetus and talk to her about difficult races to save her own life. Or my colleagues really suggesting that a physician should be able to convey life and death information to a veteran, a woman veteran, in this situation . Again, a physician in the situation at the va, prior to this rule would not even be able to discuss this situation with a woman cancer patient who we definitely want to know whether or not certain medications and the chemotherapy would affect her health and her life. A woman with a bipolar diagnosis is prescribed lithium. Which often leads tragically to suicide but the very same medication is toxic to a fetus, and requires a long lead time. Its in the bodily system. Women in the situation may face difficult decisions about their own physical and Mental Health and the health of the fetus. Of course, they should be able to talk to a physician and a Mental Health provider. Are so left may be linked to a variety of birth defects. Women must be able to have important conversations about these medications and risks to their pregnancies. The medication must often prescribed for epilepsy has a 10 risk of causing birth defects. Women with seizures have potentially lethal seizures without this medication causing lifelong harm to the fetus. I cant believe my colleagues want to get between a woman and her physician. I can go on, there are several examples of Mental Health and physical situations where it is essential that women, that our government not get between a woman and a physician in veteran a veteran who is fighting for the freedom of all of us is not able to get even Life Saving Health saving counseling. This is absurd. Doctor hayes, you have served veterans tirelessly for decades. One of the things you have had to do that weve only recently learned about is big for lifesaving care for veterans in the community because via arent allowed to do so, in fact they could not even talk to veterans about lifesaving procedures. I understand it theyre only a dozen or so these cases a year. My colleague, chairwoman brownley, believes that there are more. I believe im with her on this. Counseling about Abortion Services that could save a womans life are permitted to be talk about, but theyre abbreviate physicians who put the life of our Women Veterans ahead of even their own potential livelihood. I understand that there are only can you explain to the committee with these cases entail, and what the frontline staff in your office have had to do to get women the help they need . Chairman, yes, thank you for pointing out what are essentially, very tragic, stressful situations for a veteran who may require the kind of counseling that you outlined in terms of having their own Mental Health provider involved. Were looking at just exactly the kind of very rare, very critical, lifethreatening situations when someone has cancer, when someone, later in their pregnancy, the pregnancy itself is causing a medical condition that the women will die without the medical intervention. So its a case by case situation. There is any number of medical complications that could make this happen. When they do happen, we have to be able to find a way to have that win and decide what is your choice about this tragic situation . What does she want to have done . But if you want to do . And frequently that may involve her own Mental Health counselor has been working with her to help her through those decisions. So it is the veteran at the center and it is also the medical information thats provided about her life, about her health, about her Mental Health, that will help her incoming to her choice. Only recognize reckon rosen dale for five minutes. Mister chair im glad that the state of alabama if i imagine my hope is that they will be so we can keep this rule from being i act as good, and give determinations over which women women are offended to hear my information. I have no further questions. Thank you mr. Rosen dale. Chairwoman roundly. To follow up on representative frankels around protection for Community Care providers. Is this something you looked into and do you know definitively that they wouldnt be protected under federal supremacy im not a lawyer, this is something that could be looked into that a change in the contract terms could protect them under federal supremacy . I just say because in essence, the rule comes into effect immediately, correct . Yes, very good, so, i think you said in your opening comments, at least it was in your written comments, that a larger percentage of the abortions that would take place would be through medication abortions, is that correct . Yes it is, thats what we anticipate based on our Womens Health teams analysis. If you like to speak to that analysis, dr. His, or dr. Johnson . Yes, we anticipate about 1000 abortions throughout the enterprise annually. The majority of abortions are first trimester abortions. The majority of those abortions are medication abortions. Very good, i know that during the covid pandemic the va worked with fda to really expedite some additional drugs to be in the portfolio of drugs available to the va. I hope you look at what they did there and replicate that to bring these drugs onboard as soon as possible. I would say that we will, congresswoman, we working with both the fda, and manufacturers of these drugs, and ultimately through our Pharmacy Benefits Management Program make sure that we are complying with the rules in doing so. Terrific. And i want to go back to the Maternity Care coordination. In my travels, i spent time in oklahoma and texas. I talked to of the va Medical Centers in every city that we visited. We talk to them eternity care corners within the be a. I think in some areas it was working pretty effectively, and other areas it was very inconsistent, i would say. From Medical Center to Medical Center. One thing that seemed to be consistent, and i will say both oklahoma and texas, if women are the largest growing cohort theyre growing exponentially. In all cases, every place that i visited, medical care corners were handling 2 to 300 cases. Its a huge caseload. You know, some of them were only able to meet with a veteran at the beginning of the pregnancy and maybe once after their pregnancy. Some were doing more than that. I just think weve got to take a hard look to make sure that the Maternity Care coordinators will be in a place where they can do their job and be a partner to the woman whos going through her pregnancy can be an advocate with a Community Care dark who is handling it. I bring this up because, with Maternity Care it is all in the community. We have to have full authority and be able to advocate for clinicians who are in veterans who are out there getting here. With the caseload of hundreds its virtually impossible to do so. I will yield link totally. Thank you chairwoman bradley. I would now like to dismiss the panel, the first panel, i want to thank you again for being here. We will now move to our second panel. We now call upper second panel. Appearing before us today on our second panel is doctor jeanne ryan whos with us virtually. She is the professor of reproductive and archaeology and fertility, at the university of washington Medical Center she has earned degrees from several universities. Dr. Ryan was once named a womens Reproductive Health Research Scholar and comes with a plethora of knowledge on todays hearing topic, she does have to get to a surgery so she will be testifying and will not be available for questions. Lindsay church is a u. S. Navy veteran and is no stranger to this community as a strong advocate for veterans. Shes testified before this community on numerous occasions. We look forward to hearing from lindsey today. And we also have with us caleb and williams, army veteran, she is a senior policy researcher at the Rand Corporation shes at the department of Veterans Affairs. She has also authored the memoirs, love my red for more than you, young and female in the u. S. Army, and plenty of time when we get home. Love and recovery in the aftermath of war. I want to thank all of our panelists for being here. We look forward to hearing from you. I remind our witnesses to pause for 2 to 3 seconds before speaking. Dr. Ryan, i know that you have to get going soon. You are recognized for five minutes to deliver your testimony. Thank you, my interest in betterings Reproductive Health began with a study of midwestern women that revealed an alarming this trauma was associated not only with sexually transmitted infection and ptsd but also with higher rates of infertility and postpartum depression. Most remarkably, women for rape survivors reported they delayed having a family or decided against it because of the rape. Chairman to kind of, ranking measure rose dale, and distinguished members of the community, thank you for the opportunity to testify on behalf of my patients and your families. Thank you for the work youve done in the past is support better in this health care needs. My name is dr. Jeanne ryan, im here on behalf of the and in my capacity as a physician and an ethicists. Im currently division chief, and ive worked since 2015 as a clinician and researcher at the iowa city va, and putins nba, and at times as a subject matter a expert to Womens Health services. The views expressed in this testimony are my own, do not necessarily reflect the official policy or position at the university of washington, or the va, where the u. S. Government. In order to better understand the connection between trauma and later Reproductive Health, we followed our pilot work with a five year interview study of veterans from around the country. We found significantly higher rates of infertility in veterans that in community samples. Two and five Women Veterans, and one and three veterans trying to get pregnant were unable to do so after 12 months. Infertility seems to be a particular problem for those with ptsd and more toxic environmental exposures during their service. We are just beginning to understand all the elements of military service that make predisposed veterans to hire rates of infertility. Its become increasingly frustrating and concerning that the veterans i see suffering from this infertility i rarely receiving the seamless comprehensive Reproductive Health care that they need and deserve. I can find examples every week of patients exhausted, and discouraged, by a structural issues and unfair rules that exacerbate disparities and inequities. I hope the hearings and other stories will start us on a path towards bridging these gaps. Theres a quadruple amputee whose testicles were irreparably damaged by the eye e. D. That took away his limbs, yet he didnt qualify for any because he didnt have any viable sperm remaining. There is a veteran couple that successfully navigated long path of ivf treatment, then received high bills which impacted their theres a woman, whos trans womens gdp using anonymous donor sperm rather than having because gender in currency is not a Service Connected disability. There is every woman whos went undiagnosed during their military service, and unable to access the full spectrum of infertility care that they need because they were not disability related for these diseases during the va and every veterans whose lifetime trauma has infertility is a disease, and just like for any other disease, the va should provide access to full spectrum carrot without restriction. As has been mentioned multiple times, women of reproductive age or the fastestgrowing subset of ear users. For many such as those whose stories ive shared, the ability to become apparent hinges on access to ivf and care for their non veteran partners. What restrictions do this axis are discriminatory, unnecessarily complex and onerous. They alternately perpetuate the status quo with inadequate Reproductive Health care for Women Veterans. I am also deeply concerned as a Reproductive Health provider and former Abortion Provider that accessible abortion care is not a part of Reproductive Health care at the va. Abortion cares Reproductive Health care and every person should have the right to decide whether, when, and how they become a parent. This is vital to showing our veterans the respect they deserve. No veteran should have to couple their repeated to Service Health together piece by piece, not knowing where they can aspect which part of their care, legally, affordably, and without judgment. Every patient and their story stays with you, the ones you remember longest are the ones you wish you couldve helped more. Has services been more available, and so this is more functional. Today you have the chance to help us help our patients by removing roadblocks. Our veterans know what they need to survive and thrive. Were here as researchers and Health Care Providers still listen to them and get them what they need with your support. Thank you again for this opportunity to testify and thank you for taking steps towards better serving our veterans whove been so much to this country. Thank you doctor ryan, i wish you well on the surgery you need to perform. Im sorry you cant be with us to answer questions. Your expertise would have been greatly enlightening. I now turn to lindsey church. Lindsay . Five minutes. Chairman takano, Ranking Member rosen, dale member of the community. Im with you generation veteran of the United States navy. Assert from 2008 to 2012 appeared before this committee before as the executive are here today to share my personal story. As a veteran and military child im no stranger to sacrificing for the greater good. In uniform it was my duty to protect and defend the constitution of the United States. I served as a career person under dont ask dont tell and understood that there was some rights i wouldnt enjoy it while serving. But that i would be afforded, when i became a civilian. Among them was the right to an abortion, and to live a safe and healthy life is a career person. During the service an experienced complications that caused minimum to be inverted. As a result of a failed corrective ive had nine surgeries on my ribcage on my spine, im missing all the cartilage of my chest, was hospitalized for 60 days, and have a stimulator that control my pain. I had to face that my physical disabilities meant i couldnt carry a child. I was medically retired in 2012 and have received care three b is womens clinics for the past ten years. Last year, my wife jessie and i began planning to start a family. We were excited and nervous, but it was clear we couldnt turn to the eighth for support for two reasons. First, the offers fertility treatments to veterans when its caused by Service Connected disability, but only some, and mind and qualify. Second, were in a samesex marriage. Va limits our ui and ivf to legally marry veterans with opposite sex gametes. In spite of it all, we decided to start a family last fall. We worked with a fertility clinic and developed a care plan, most of which we care for a pocket. In april, we attempted our ui for the first time. While waiting to learn of justice pregnant, the Supreme Court opinion was leaked. Four days later, we learned just was pregnant, and celebrated the happiest and scariest moment of our life. The decision and dobbs was delivered on june 24th, two weeks later, we learned during a routine ultrasound, our childs abdomen was distended to the point of concern. It took 33 days, and into the 16th weeks of pregnancy to understand that our child had a fetal bladder deformity and couldnt produce amniotic fluid. Through it all we felt like we were racing against the clock. We knew the day we had twoday decision, or we might have to leave the state to get an abortion. The moral injury of having served a country to protect a constitution that no longer protected my family when we needed it most was devastating. We made the most painful and most compassionate decision for the child we love so much to end the pregnancy. We wanted our baby more than anything in the world. But we couldnt imagine a life where all they knew was suffering. I was born with a severe genetic deformity and i couldnt imagine this life for them. A justice period for a we learned our baby had no heartbeat, and head past days prior. The procedure for a second trimester miscarriage was the same for abortion, the only thing that change with the urgency for care. She accessed which just qualified for, but through a Community Based clinic in richmond virginia. She accessed care because state insurance cover the procedure, we had not we live in a state that didnt restrict access. Pas new Reproductive Health Service Policy will allow veterans and caretakers to access abortion counseling, and abortion care in the case of rape, incest, and win the pregnancy this policy will save lives. It will save the lives of veterans and families across the Country Living in states that limit or completely ban abortion. My family couldnt turn tva for care. For the policy to serve the veterans who are most likely to need access to care at least likely to have it, including racial and ethnic minorities and those living in poverty, this imparity imperative that Congress Pass another Reproductive Health services. Finally, as i mentioned earlier in this testimony, i received nearly all my career through va for terry years. For a decade, ive navigated a Health System thats unable to e, understand, or serve veterans like me. I expect that if i choose ba. 4, carol be considered consistently misgendered, treated like i dont belong, and i wont be safe in va facilities. Last year i was harassed by richmond va staff manner well using it womens restroom. It wasnt the first time ive experience to be a harassment, but it was which pushed needed to seek care outside a va. And one of many veterans leaving ba because the department isnt equipped to provide positive Patient Health experiences to women and gender minority veterans. From autos, to pronounce, two bathrooms, many fear using ba because it continues to be traumatizing. No one should have to endure what we do for health care. Thank you for the opportunity to testify look forward to your questions. Thank you for that very moving testimony. And now call on williams distinguished members of the community, thank you for the opportunity to discuss womens access to the full spectrum of medical care. And testifying today as a senior policy researcher at rand. I also formally served as the director for womens veterans at the department of Veterans Affairs. And also be a patient. I choose to get comprehensive and integrated care from haitian im carotene where they provide to meet the fundaMental Health care needs of womens veterans, its important for va to provide a full spectrum of Reproductive Health care. On july 1st, 2020, i testified for the interact subcommittee on health about this topic. Recognizing the is areas of strength, also noting that there were deficits related to provision of in vitro fertilization, contraception, and abortion. Since that time, va has announced significant changes in its provision of Equitable Life saving care, on which i will focus my remarks today. The recent dobbs v. Jackson Supreme Court decision overturned the constitutional right to abortion. This ruling will limit some Women Veterans access to the full scope of Reproductive Health care, as those living in many states will no longer have access to abortion care in their communities. This could have a direct impact on their health, since abortion can be medically necessary. The final role on unproductive the va published last friday supports Women Veterans access to need abortion treatment, by removing the exclusion on abortion counseling from the medical benefits package, and allowing enrolled veterans to obtain abortions, if determined needed by a health care professional, when the lie for the health of the pregnant veteran would be in danger, if the pregnancy were carried to term or the pregnancy is the result of an act of rape or incest. While not expensive enough to cover all situations, in which abortion could be beneficial for enrollees, this rule will protect the lives and health of vulnerable veterans. The a estimates that 72 of current veteran vha users, who are capable of pregnancy, having Service Connected disability of 30 or higher. They have high burdens of chronic disease and a significant rate of Mental Health conditions. Some of these are associated with worst pregnancy outcomes. Women veterans with ptsd, for example, are more likely to experience gestational diabetes, preeclampsia, and preacher birth. Accordingly, it is exceedingly important that they be able to access the care their providers deem to be medically necessary. Recent restrictions on Reproductive Health care at the state level means that Women Veterans in certain states are no longer able to access such care from non va providers, therefore to ensure Optimal Health outcomes for Women Veterans. Va must be able to provide that care. Although all states have exceptions for the life of the mother, and most allow abortions for the Womens Health, restrictive abortion policies are having a Chilling Effect that can delay needed care, including treatment for cancer. Providers in some states, they face prosecution and jail for providing abortion treatment, and may delay or deny needed health care for pregnant women, given these risks. Access to medication needed for other services can also be affected, as pharmacists are reluctant to fill prescriptions for drugs that can have multiple uses, including, but not limited to, medical abortions, such as managing miscarriage or treating chronic disease. Vas interim final rule allows veterans to access care there va providers determine is necessary to promote health or protect life. It is also important that va be able to provide these services directly, because va provides high quality, have a dance based, culturally competent care. For example, the eight trains providers to provide trauma informed Public Examinations for Women Veterans who have experienced military sexual trauma. In addition, fragmented care can lead to worse health care outcomes, ensuring that the is able to provide the whole spectrum of reproductive care to the vulnerable pregnant patients is an important part of comprehensive and integrated care. In conclusion, veterans and beneficiaries who need abortion counseling and will benefit from being able to receive these Services Within the va system, optimizing their continuity of care, and access to needed support. Thank you again for inviting me to testify before you today on this important topic. I look forward to answering any questions you may have. Thank you for your testimony, miss williams. I will now recognize myself for five minutes, for questioning. Lindsay, in your testimony, you outline how current reproductive assistance through va is exclusively offered to heterosexual couples. Can you talk about why access to Reproductive Health care for services, for all gender identities, and sexual orientations, is so important to veterans . Thank you for your question, chairman. As an lgbtq person, we, as a community, are required to look to the services such as donated sperm. I knew i, ivf to be able to actually have children. And so, being able to access this service as a queer family will empower us through the only method that we are going to be able to start a family. My family was fortunate, in the sense that we were able to pay out of pocket. But there are so many folks in the community that dont have those resources. Much of the Korean Community experiences economic barriers, housing, employment, but continue to make their experiences around Family Planning multifaceted. And va has the opportunity to step in and provide hope to our community, especially folks that cant move their Service Connection. As i mentioned, im one of many people that can prove Service Connection to be able to access those benefits. They are removing some of those regulatory bars offer us hope. Im someone who believes that Service Connection should not be a reason, should not be predicated. We should not predicate the availability of Reproductive Services. The full array of Reproductive Health, including fertility, in the big scheme of things, is not cost prohibitive. Very few people, very few veterans are going to encounter that. And as you said, you had the ability to pay out of pocket. But typically, typically i would say a big, big share of our veterans that he was the va system are the working people. I think miss williams, can you comment on that . You know, the type of women, the veterans that use our system for the veterans in general tend to have limited incomes. Research has shown that v h a users tend to be of lower socioeconomic status than veteran nonvha you zero. So yes, that is correct. And so, a veteran that needs Reproductive Health care, fertility services, and whom i might need ivf, veterans are essentially deprived of access to fertility services. I think most americans would be outraged that people who have worn the uniform of our country and who may have difficult to prove connections to, i mean, that theyre infertility is connected to their service, that we should just give them the benefit of the doubt like we have done with the packed out. We give the veteran the doubt and dont deny them services such as fertility services, so that they can have children. I think most americans would say, that is the fair thing to do. I dont know, i mean, would you just opine on what i said . I will just note that when my spouse and i were struggling with infertility, we were unable to access fertility care either. And at that stage in our lives, we were unable to afford it. So, from a very personal perspective, i do agree that anybody who needs to be able to access needed care to expand their families should have that opportunity. Lindsay, you look like you wanted today something. I did, Service Members give their reproductive years, the best years of their lives, between, i mean, a person that hires at a military is going to get 18 to 38. By the time and outlined to doctor ryans testimony actually included stories of Service Members, Women Veterans, who flew helicopters for this country and make sure that we were staffed at war, came back, and then were too old to be able to access care. Or unable to start a family naturally. They should have access. If you give your years of effort to lead to this country, you should be able to access those benefits after the fact. Thank you for, you know, bringing forward that example. Lets understand that the 170 members of this congress, most all of them, on the other side of the aisle, including nearly, actually, all of the members of this committee who are republican members of this Committee Say have signed on to hr 10 11, which would make access to ivf impossible. It would make it illegal. I think most americans would say that is extreme. And i would say it is unpatriotic. I would say its unpatriotic that we would deny that fertility opportunity to the men and women, actually, applies to men, men and women to reform the country worn the uniform of the country. I will now call to recognize representative roosevelt for five minutes. Thank you very much, mister chair. I would just like to start off by saying that the continued proclamation by the pro abortionist witnesses today, that the Dobbs Decision, which was recently decided by the Supreme Court of the United States, overturns the right, the constitutional right, to an abortion is false. And your continued use of that statement does not make it so, unfortunately. It might make the evening news, but it doesnt make it so. Miss williams, if i heard correctly, even after the Dobbs Decision, even after the Dobbs Decision, okay, as has been released, if a mothers life is in danger, she will still be able to receive the standard of care to save her life under the laws of every state. Isnt that correct . It is my understanding that while the right may be there, many providers are so concerned that they are hesitating. I have lots of anecdotal information. If i heard you correctly, im going to go ahead and tell you. I mean, you answered, i just want to make sure to cut it off right at the answer. If a mothers life is in danger, she will still be able to received the standard of care to save her life under the laws of every state, correct . In terms of the standard of care to save your life. The laws do not prevent saving a womans life. The laws do not prevent a medical professional from saving the life of any woman. Correct . Are you telling me that the medical industry, okay . Cannot go out under any circumstance, have an accident on the highway, you are in the hospital, whatever it is. That if a mothers life it is in danger, she will still be able to receive the standard of care to save her life, under the laws of every state. Sir, im sorry. You phrase that let me ask you this simple way. Could you tell me a single state thats going to prohibit saving a mothers life . Sir, i had no point said that. I at no point said that. You testified that abortion bans are having a Chilling Effect on providers who would be the ones who provided this care. It seems to me that the pro abortion discourse it is instrumental conflating standard of care with elective abortion. Not a single republican here opposes cared for mothers whose lives unfortunately are threatened. But all of us oppose abortion. Conflating the two is irresponsible fearmongering, and i would suggest that the pro abortionists consider that if they are concerned about this Chilling Effect. So, mister chair, earlier you stated that you dont believe that the services should be predicated on Service Connected disabilities. And lindsey, you stated the same thing. Miss williams, i guess you probably feel the same way. The problem is that we have laws in this land. And while you all may have opinions about what services should be delivered and when they should be delivered, and who they should be delivered to, we have guidelines. We have laws, and its based upon Service Connected disabilities. So, this is what all these hearings are about today. And that is at the Veterans Administration is trying to bypass those very laws. And use the rulemaking process to be delivering services that the law specifically prohibits, specifically prohibits, and calls the taxpayers of this nation to be paying for that. And that is what our job is. That is what our job is. So, mister chair, with that, i will yield back. Thank, you mr. Roosevelt. I will remind you that i believe that you are someone who is a cosponsor of h are 10 11, which would, in fact, if passed into law, prohibit life saving procedures for women who have a lifethreatening pregnancy. I repeat, and, you know, what you are saying is, with regard to certain state laws, may be true for a woman whos in an active emergency and actively dying. But make no mistake, many, many of these states that have prohibited abortion and narrowed the exceptions for when abortion might be permitted, do not attempt to women who are at risk of dying or of disability. Remember, the va could not even council a woman about lifesaving procedures prior to this enter a final rule. They cannot even do the counseling. So, i know recognize miss brownley for five minutes. Thank you, mister chairman, and just why we are on this topic of ivf and fertility, i just want to put in my two cents on it as well. You know, fertility is a medical condition. You know, full stop. Just like everything else, every medical condition that the va, you know, serves veterans for the health care. Fertility is just a condition. And it is also very, very hard to accurately diagnose the cause of infertility. And currently, the va addresses infertility and treats women and men for their infertility throughout the va. And many times, they are successful in treating that. But when you get to a place where all else fails, then ivf is the only option. And so, it is abundantly clear to me that we need to treat this as just a part of our Health Care Services and infertility as, like, cancer, as, like, appendicitis, its like anything else. It needs to be addressed. By a medical facility and a medical provider. So, i just wanted to add that. I think miss church, your testimony, thank you for sharing your personal story. I know its not easy. You came and testified and are advocating for veterans all the time. Not sharing your own personal life, and so, i thank you. It takes a lot of courage to come forward and do that. So, i guess my question to you is, you know, what can the department do to make the va more positive environment for gender minorities, women, and lgbtq plus veterans . Thank you for your question and your thank you. For my perspective, va has to take this as the large and the small. Large cultural symbols like the motto emblazoned on every single building is not helping anybody feel more comfortable. In fact, it might as well say, we only serve men here. Our communities need access to care and every time they walk through a facility they are denied the belief that they understand that. So, while it doesnt seem significant, if we cant even start with a model that is an exclusionary, then we are on a bad place. So second, its the small things. Its also, like, training and education, not just saying, we have training and education, but mandating it. Bystander interventions that also does not harass trans people would be really awesome. You know, facilities should be safe. We should not worry about what bathrooms we go into. We should not worry about very necessary functions. I was on my way to get an xray and all a needed to do was use the restroom. So, training and education, thats not just offered, but mandatory by every va employee, and women, gender, minorities, the Broader Community and understanding who we are, its not controversial. Its just better care. And then the last is, i think it was representative paris that was talking about Data Collection and asking questions about where that data is being collected. I can honestly tell you that is not being collected correctly. I, my wife had to give a pronounced conversation to the patient advocate, who is one of the reportable, like, folks of the facility that i should be able to go talk to. Who am i going to tell . So, its the big things and its a small things. Its about culture that seesaws, recognizes us, and centers us when building care and facilities, and everything that they are doing. Thank you very much for that. And miss williams, you know, in your testimony, you really sort of built a very strong argument why abortion counseling is really important. You talk about the fact that va users tend to be secure and lower socioeconomic lee status. You say that Women Veterans who use the va have high burdens of chronic disease and a significant rate of Mental Health conditions. You go on to say that, you know, pregnant Women Veterans have extremely high rates of depression and often discontinue medications for this, and other conditions. So i agree with you. Its very important to have abortion counseling where the woman and her doctor can talk about who knows their condition and can talk about what their options might be, and what their risks might be. But do you always, also think that because of those factors, amongst our Women Veterans, that the likelihood of more lifethreatening situations will occur that may, indeed, require an abortion to save once life . One reason that i think its important that va be able to provide this care is to be able to collect that type of data. If the a is unable to know about the full scope of Reproductive Health care that Women Veterans may require, if Women Veterans, pregnant veterans are seeking this type of care in other settings, it may not be communicating back to their providers, we not be able to ever truly know the answer to that question by having the data required to track it thoroughly. And so, i could guess the answer to your question, but i would rather be able to come back and tell you in five years. As a data driven person representing a data driven organization, yes, i do understand. So, thank you for that. But i also want to add, just on this argument about, you know, all state will provide abortions in the event of a womans life or death, you know, again, we dont have the data on this, but we are anecdotal stories and ive heard anecdotal stories within the va as well that women will come and have a condition. You know, she may be bleeding out of some sort, whatever. But she will get stabilized, doctor will send that women home. And wait until it is, you know, it becomes an emergency. And then under those conditions, may be treated to save her life. But the physician knowingly does this, sends her away knowing that the eventuality of all of this is shes going to be back. And her life is going to be threatened, and she will need to be treated. That is just unacceptable. I mean, its just absolutely unacceptable. So, it is, again, i just, you know, i think i thank the va for taking these steps and moving forward, and without a doubt, lives are going to be saved, without question. And that is the least of what we can do to service our women. And i will just close out here by saying that i wanted to just, you know, thank doctor hayes for all the work that youve been doing and continuing to do. And i know this has created a lot of work for you and your office. And i know you are working around the clock to make all of this happen, and to have clarity. Across the country with regards to this new rule on va. So, i really do thank you. Ive enjoyed so much working with you over the years. As we have worked together to better serve our Women Veterans and i just thank you for all the hard work that you continue to do. With that, i yield back. So, thank you. I am going to do one more round of questioning. And so, miss williams, i want to give you some time to respond more fully to the questions that mr. Rosen ill asked you about, i mean, i quibble with his assessment that states will allow, you know, always, in all cases, you know, abortions in a lifesaving situation. Lets talk about, you are on a train of thought when you said a Chilling Effect. Can you explain more what you were thinking about the Chilling Effect that various states, state laws, have had and what you are about to say . I think that your colleague, representative brownley, also talked a bit about this and the fact that providers can feel so strongly the need to be confident that it is an imminent risk, that they may delay procedures to a point where there could be other effects to long term fertility for long term health. And i personally really, strongly believe that we should be able to rely on the expertise of our Health Care Providers, and trust that they are going to be able to make decisions based on what is in the best interest of our health and our life. And not on what their fears are of whether or not there could be consequences to them beyond focusing on health and life. And if i may be so bold as to also share, i mentioned that we had struggled with infertility in the past. We went on to adopt our son. I then eventually did give birth to my daughter. I have also lost a pregnancy to miscarriage. And needed medication very similar to those used for abortion, to pass the product and prevent sepsis, which would have caused Serious Problems long term and possibly threaten my life. I also went on to donate a kidney to a stranger. And i want to just note that my belief in the inherent dignity and life of all people is very deep and unwavering. Thank you. Well, thank you, miss williams. As i said in my opening statement, Women Veterans such as you and lindsey fought for our freedom and fought for womens freedom to be able to make choices and protection of their own health. In the interest of their own health and life. And also, for the freedom of medical professionals to be able to exercise their best judgment and to use their knowledge. I dont believe the government or politics should get in between medical providers and their patience. Women veteran patients. And so, i thank you very much, both of you, for your courage. And your testimony, and sharing your personal experiences. I may just want to ask you also about your research that links ptsd diagnoses to a higher risk of pregnancy complications like preeclampsia and preacher birth. Can you walk us through how the new the quality of care for veterans such as ptsd . Let me be very clear that i unfortunately are not skilled enough to have done that research myself. Im citing other research by fantastic medical professionals, who are much more qualified to do that specific type of research. But the hard work by these holly quote of qualified providers has shown that ptsd diagnoses are associated with these negative outcomes. And preeclampsia can lead to claims, which is, in fact, a very threatening life conditions. Thats why its so important that the a providers be able to counsel their patience on risks and be able to make the right decisions about what kind of care to offer them if they do reach a stage where abortion may be needed to promote health or protect life. Well, thank you. Ranking member rosen dale. Thank you, mister chair. Just a little comment. When you have health care that is provided by the government and funded by the taxpayers all across the nation, the reality of it is that Congress Makes the decision about what is and what is not covered. That is how it works. Whether you are talking about medicare, whether you are talking about medicaid, or whether you are talking about the Veterans Administration, that is just the way it works. And while we had some anecdotal stories and some fears that one might experience, what we have not had is a single example of a state that would cause the va or any facility to prohibit the standard of care that would save the life of a mother. If it was in jeopardy. No one has been able to state that. And in regards to the Veterans Administration, congress has made the decision that care would be delivered when there is a Service Connected disability. Congress made that decision. No different than we all got together this year and we passed the pact act. And im really pleased that we will be able to support that, okay . We made the decision to make that investment, but when it comes to health care delivery, congress has to go through that process and so, until they do, what we are witnessing today is a complete disregard for congress and the rule of law. So with that, i yield back. Well, mr. Rosen dale, i have a simple disagreement. In the 1996 law that Congress Passed empowered the secretary to define the benefit package for va. And therefore, the benefit package that has been set forth in this final rule is rooted in law, rooted in statute, and rooted in congressional action. I now recognize chairman brownley. Im going to change the subject a little bit. So, miss williams, my question i wanted to ask of you is really sort of through your research. Youve done a lot in terms of shedding light on both the challenges experienced by Women Veterans accessing care and the importance of a smooth military to civilian transition for all veterans. So, trying to merge those two component pieces together and, you know, if you could share with us what you think are ways in which we could better support our Women Veterans and our womens Veterans Health as they transition from the military to civilian life and what we could be doing better. In terms of supporting the transition of Women Veterans, i think that the program that started out as a pilot to provide women specific and has now been expanded nationwide is an incredibly positive development in being able to support that transition. Ensure that Women Veterans know about the full scope of health care that v is able to provide because so many veterans dont know that v eight provides the maternal Care Coordinator program, for example, and when i think back of how much i spent on pumping supplies to know that the a provides free breast milk storage bags, free nursing bras, free nipple cream. I mean, these are things that are incredibly helpful and for transitioning servicewomen to know that they can go to va and get that level and standard of care is incredibly helpful. And its also been official for them to be able to know that they can expect the same standard of care now within va that they could in d. O. D. If, for example, they have experienced a Sexual Assault and leave the military, previously it wouldve been able to expect abortion care and d. O. D. , walk out the door, enter a va facility, and not be able to access the same level of care for that traumatic event. And for them to be able to be informed that they will be able to expect the same level of care within the department of Veterans Affairs, they will also help give them the comfort to know that they can roll in va and expect that high quality care should also support them in their transition. Their willingness to come to va, coming to va is important because we know that the quality of care is high, the va providers have more cultural competence, especially in military specific issues, such as the pact act that has been mentioned today. A big expansion. We want to make sure that women that are coming to get this evidence based care, this culturally competent care, this high quality care that they have burned through their Honorable Service and in the department of Veterans Affairs. Thank you very much. I have a few more questions, mister chair. Thank you. I would like to ask, thank you very much. I would like to ask Ranking Member rosen ill if he has any closing comments. Thank you so much, mister chair. I appreciate it. Im distraught today, as we listen to the Veterans Administration attempt to justify using a broom making process to completely disregard the rule of law that people have relied upon for years, which prohibited abortions, and abortion Counseling Services by the Veterans Administration. And paid for by the american taxpayers. Its clearly an overreach by the Veterans Administration and a lawsuit has already been filed. Im hopeful that the courts will overturn this rule and i hope that they are able to obtain a stay, so that this rule is never implemented. Thank you, mister chair, and i yield back. Thank you, Ranking Member loser. I shouldve thanked our panel before i recognize our file comments. But thank you very much, both of you for your service to our country, for your courage, and sharing your own personal experiences. As well as your expertise. And so, you know, i would like to excuse the second panel. And i will now go to my final statement. Lets be clear that the rule that the acting Ranking Member seeks to stay and hopes will be state would return us back to the days, i mean, just want to say days its just a week ago, before this rule took effect, when v a could not treat for lifethreatening conditions when an emergency abortion may be necessary. This is what my colleague, Ranking Member, acting Ranking Member goes until, it would seek to do. V a, prior to this rule, could not treat severe preeclampsia early in pregnancy. It could not treat heavy bleeding leading to hemorrhagic shock. It could not treat placental abrupt shin causing hemorrhage. It could not treat water breaks early in pregnancy, causing the infection. And it could not treat ectopic pregnancies. These conditions, by the way, could be treated at a Department Defence medical facility. They could be treated in a federal prison for women who are incarcerated in federal prisons. But for the women who wore the uniform of the United States of america, who, again, i will say fought for our freedoms, they could not be treated for these for lifethreatening conditions. When an abortion may be necessary. To me, this is an insult to all the women who have worn the uniform of our country and i think secretary mcdonough and President Biden for standing up, for the women who have served our country proudly. I think all those women who have served our country and put their lives at risk for all of us. And we know have a step forward in having their backs, and offering them the care that they deserve, that i believe the American People will agree that we should not be hoping for a stay, that we should be hoping for an affirmation that this rule is very much necessary, its very much fair, and, you know, it is time that we afforded our Women Veterans the same level of care that our acting duty Service Members receive, and the women in our federal prisons receive. So with that, i will adjourn this hearing and thank every participant today. All members will have five legislative days to revise and extend the remarks, and include extraneous material. Again, thank you for appearing before us today. This hearing is now adjourned