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Reporting Highlights
- A Dangerous Denial: Cmdr. Elizabeth Nakagawa was denied a D&C for a miscarriage by military insurer Tricare in 2023, even though it had paid for the same procedure two years earlier.
- Barriers to Care: Federal law prohibits the military from paying for most abortion services. Some doctors say Tricare has delayed even permitted procedures, putting women at risk.
- Future Fallout: Nakagawa’s experience raises questions about whether the overturning of Roe v. Wade has created a chilling effect that has further complicated access to these procedures.
These highlights were written by the reporters and editors who worked on this story.
The night the EMTs carried Elizabeth Nakagawa from her home, bleeding and in pain, the tarp they’d wrapped her in reminded her of a body bag.
Nakagawa, 39, is a Coast Guard commander: stoic, methodical, an engineer by trade. But as they maneuvered her past her young daughters’ bedroom, down the narrow steps and into the ambulance, she felt a stab of fear. She might never see her girls again.
Then came a blast of anger. She’d been treated for a miscarriage before. She knew her life never should have been in danger.
Earlier that day, April 3, 2023, Nakagawa had been scheduled to have a surgical procedure called a D&C, or dilation and curettage, to remove fetal tissue after losing a very wanted pregnancy. But that morning, she was told the surgery had been canceled because Tricare, the military’s health insurance plan, refused to pay for it.
While her doctor appealed, Nakagawa waited. Then the cramps and bleeding began.
In recent months, ProPublica and other media outlets have told the stories of women who died or nearly died when state abortion restrictions imposed after the Supreme Court’s 2022 Dobbs decision impeded them from getting critical care.
But long before Roe v. Wade was overturned, military service members and their families have faced strict limits on abortion services, which are commonly used to resolve miscarriages.
Under a decades-old federal law, the military is prohibited from paying for abortions except in cases of rape, incest or to save the life of the mother. This applies even to service members based in states where abortion is legal; Nakagawa lives in Sonoma County, California.
There’s also no exception for catastrophic or fatal fetal anomalies. In such cases, service members either have to pay out of pocket for abortions or carry to term fetuses that won’t survive outside the womb.
Tricare does allow abortions in cases like Nakagawa’s, in which the fetus has no heartbeat. But even then, some doctors who treat military service members say that Tricare requires more documentation and takes longer to approve these procedures than other insurers,