S-4225-119
Read twice and referred to the Committee on Veterans' Affairs.
Sponsored by Cory Booker (D-NJ)
What it does
This bill would require the VA to establish a five-year pilot program providing up to 10 doula support sessions to pregnant and postpartum veterans enrolled in VA health care, at select VA regional networks. It would create a Doula Service Coordinator position at participating facilities, cap doula payments at $3,500 per veteran, and require annual reports to Congress on outcomes and whether to expand the program.
Who benefits
Pregnant and postpartum veterans enrolled in VA care, particularly the roughly 228,000 women veterans of reproductive age, veterans of advanced maternal age, Black veterans, and American Indian/Alaska Native veterans who face higher maternal health risks; doulas and community-based maternity care organizations that would receive VA payments; VA Office of Women's Health staff overseeing the program.
Who is hurt
Taxpayers who would fund the pilot's authorized appropriations; veterans in VA networks not selected as pilot sites who would not have access during the trial period; VA administrative staff who must implement new coordination and reporting requirements without specified additional funding certainty, given the "such sums as necessary" authorization.
Supporters argue
Supporters argue that women veterans are the fastest-growing veteran demographic and face elevated risks of maternal morbidity and postpartum mental health conditions, including PTSD, yet the VA does not provide prenatal or delivery care directly. They contend that doula support has been shown in other contexts to improve birth outcomes and mental health, and that a time-limited, geographically targeted pilot with mandatory reporting is a measured way to test whether this model should be expanded VA-wide.
Opponents argue
Opponents argue that the VA already struggles with backlogs and staffing shortages in core medical care, and that creating a new coordinator position and payment bureaucracy for a service the VA does not directly provide (prenatal/delivery care) diverts limited administrative resources. They contend the open-ended "such sums as necessary" appropriation lacks a firm cost estimate, and that a five-year pilot with a $3,500 per-veteran cap may not generate data robust enough to justify eventual permanent, program-wide implementation.
Constitutional context
Congress's authority to establish veterans' benefits programs derives from its Article I, Section 8 spending power; this bill raises no significant constitutional question, as providing a discretionary health service pilot to a defined beneficiary class falls squarely within Congress's long-recognized power to structure veterans' benefits.
Checks and balances
Congress directs and funds the pilot program through statute while delegating implementation details—site selection criteria, payment recommendations, and training guidelines—to the VA Secretary and Office of Women's Health, with oversight maintained through mandatory annual reports to congressional committees.
Historical precedent
The VA has previously run maternity-related and Whole Health pilot programs, and Medicaid programs in several states have separately begun covering doula services, though no prior federal veterans-specific doula program exists.