Speaker Mike Johnson worked behind the scenes to remove a provision from the 2026 National Defense Authorization Act that would've required TRICARE coverage for in vitro fertilization and other fertility services. The House and Senate had both passed versions of the NDAA with bipartisan support for the IVF benefit. Johnson stripped it from the final bill text released in December 2025.

The Congressional Budget Office estimated that implementing the IVF benefit would cost $3.3 billion from 2025 to 2029. That would cover roughly nine million people under TRICARE, the military's health insurance program. The provision would've covered all active-duty service members and their families.

Sen. Tammy Duckworth accused Johnson of being the driving force behind the provision's removal because of his firm anti-abortion views. Some anti-abortion advocates oppose IVF because it often involves disposing of unused embryos. Johnson hasn't publicly confirmed his reasoning for removing the provision.

President Trump signed the fiscal year 2026 NDAA into law in December 2025 without the IVF coverage expansion. The bill passed the House overwhelmingly but military families told reporters they were pissed after the coverage was cut. The final bill was negotiated in conference committee where Johnson had significant influence.

This is the second time Congress has dropped IVF provisions from the NDAA after initially including them in House and Senate versions. Military families face unique fertility challenges due to deployments, exposure to burn pits and other environmental hazards, and delays in family planning due to service obligations.

TRICARE currently covers some fertility services but doesn't cover IVF or other advanced reproductive technologies. Military families who need IVF must pay out of pocket, which typically costs $15,000 to $20,000 per cycle. Many service members can't afford multiple cycles needed for successful pregnancies.

The provision had bipartisan support in both chambers before Johnson intervened. Rep. Susan Wild and Sen. Patty Murray led the effort to include the IVF coverage. Military advocacy groups including the National Military Family Association had lobbied for the provision for years.