Midway through Matt Keil’s second deployment in Iraq, he came home and married his fiancee, Tracy, in 2007.

He had two weeks R&R; no time for a honeymoon.

Before he went back to war the couple had the sort of conversation unique to newlyweds in the military. “I told her if you get a phone call that I’m injured, I’m probably fine,” Matt says. “But if they come to the apartment or to your work in person, then I’m dead.”

Six weeks later the news came — a phone call, thankfully. Matt had been shot in the shoulder. It wasn’t until Tracy got to Walter Reed Army Medical Center that she got the full story. The sniper’s bullet had nicked Matt’s spine.

“The doctor came in and told me he was paralyzed from the neck down, and he said it was a ‘Christopher Reeve’-type injury,” says Tracy.

Questions overwhelmed them about the future, including whether they’d ever be able to have children. It seemed like something they could figure out later.
“They were kinda telling us we’re putting the cart before the horse,” Matt recalls. “You guys got to get through a whole hell of a lot of rehab.”

Time was running out, though, and the Keils didn’t realize it.

To have children they’d need help: in vitro fertilization. But IVF is expensive, costing, on average, at least $12,000 per cycle of treatment, according to the American Society for Reproductive Medicine.

The Pentagon’s health care system for active-duty troops covers IVF for wounded soldiers like Matt Keil. The Department of Veterans Affairs for veterans doesn’t. By the time the Keils learned about the difference, it was too late.

“We were just swallowing the fact that he was never going to go back to work,” Tracy says. “But finding out that IVF wouldn’t be covered because we agreed to retire out so quickly, that was hard, because nobody told me that.”

A law passed in 1992 made it illegal for the VA to pay for IVF, which some people oppose because embryos are often destroyed in the process.

The only option for the Keils would have been to get the procedure done immediately after Matt’s injury. They had missed the window.

Matt was just starting to accept that with the limits of current science he might never walk again. But the limit on his ability to pay for IVF was put in his way by Congress.

“This is a direct result of a combat injury,” says Tracy. “Don’t tell me that his service wasn’t good enough for us to have a chance at a family. Because we’ve already lost so much. I just want to have a family with the man that I love and please don’t make this any worse than it already has to be.”

In the decades since Congress banned IVF for the VA, the procedure has become much more common. And about 1,400 troops came back from Iraq and Afghanistan with severe injuries to their reproductive organs. Thousands more have head injuries, paralysis or other conditions that make IVF their best option.

Bills to change the law come up periodically, only to be blocked at the last minute, says Sen. Patty Murray, a Democrat from Washington. “They don’t come out and say that directly, but there continues to be a backroom concern about the practice of IVF,” Murray says. Murray’s bipartisan IVF bill nearly passed last summer.

Republican Sen. Thom Tillis of North Carolina, who is staunchly against abortion rights, effectively blocked it. Tillis declined requests for comment, but said at the time that he opposed the bill because other problems at the VA need to be fixed first.

The Congressional Budget Office estimates a change in VA policy to pay for fertility treatment could cost more than $500 million over four years.

Murray says vets should get the same options as active-duty troops. “It’s really ridiculous that Congress would deny a widely used medical procedure to our veterans just because of their own … beliefs,” she says.

Rep. Jeff Miller, the Republican chairman of the House Committee on Veterans’ Affairs, said he’s working toward a compromise that “meets the needs of this special group of severely injured veterans while being sensitive to concerns surrounding IVF procedures.”

In the meantime, many fertility clinics across the country offer discounted rates for veterans who are paying out of their own pockets for IVF.

For the Keils, who spent the year after Matt’s injury figuring out how their new life could work, offers like that came too late.

“We weren’t at a good spot in our marriage at the time, and thought that if we’re going to bring kids into this world they need to be brought into a healthy relationship,” says Matt.

“What if we didn’t even end up staying together?” Tracy adds.

They took a year to work it out, and then decided it was for sure — their marriage would survive. They also wanted a family.

“We were ready, and it didn’t matter what it was going to take,” Tracy says.

The VA told them what they already knew — no coverage for IVF. The decision still seemed crazy to them, considering how much medical care VA would pay for.

“I served my country. I was injured,” Matt says. “All my medical supplies are paid for, but the one thing they won’t facilitate [by] paying — that I lost the ability to have — was a family.”

Paying for IVF on their own seemed impossible to Matt and Tracy.

The Keils play with their twins, Matthew and Faith, at their home near Parker, Colo., in 2012. Ed Andrieski/AP hide caption

toggle caption Ed Andrieski/AP

Matt’s condition meant that IVF would be even more of a financial strain than usual. Among other things, Tracy was her husband’s full-time caregiver, and they would need to hire help while she was getting treatments.

Their savings weren’t going to cut it.

But then a veterans charity paid for the Keils’ wheelchair accessible house, so they could target their money toward IVF. The local VFW held a fundraiser to help. Kids all around Denver and then Colorado set up lemonade stands and collected donations, too.

The couple’s twins, Faith and Matthew, were born in November 2010. They ride on the back of their dad’s motorized wheelchair. When he wants to lift them high in the air they jump on his feet and he reclines the chair until he’s upside down.

This winter the kids are outside building igloos and snowmen.

Thousands of vets have injuries that make IVF their only option for having a family. Matt and Tracy Keil say they want them all to get that chance.

U.S. manufacturers of medical devices started 2016 with a windfall — a two-year suspension of a controversial tax on their revenue.

Medical devices include a wide range of products and machines used in medical care, such as tongue depressors, endoscopes and MRI scanners, for example. Manufacturers say the tax on devices hurt their business. The Congressional Research Service estimates companies paid out $2.4 billion in 2014.

“When this tax went into place it forced us to make cuts and sustain those cuts,” says George Montague, chief financial officer of Minnesota-based Smiths Medical. His firm takes in more than $1 billion a year for its specialty medical products.

Smiths Medical had paid $10 million a year in medical device taxes, Montague says, “and so now we’re getting that funding back.” He insists the money will go into building the business.

“We’re making significant investment in our product portfolio — in improving our product portfolio,” Montague says. “And what this enables us to do is accelerate some of that investment.”

The medical technology industry has branded the device tax a job-killer. Montague says Smiths Medical will now be adding new jobs, but he doesn’t know how many.

Minnesota is home to a concentration of device makers, and U.S. Rep. Erik Paulsen, R-Minn., is a leading opponent of the tax. He says the law suspending it for two years could provide a major boost to Minnesota’s economy.

“There are estimates that because of Minnesota’s high concentration in this sector — essentially the largest in the world in a concentrated environment — that Minnesota would be paying 25 percent of the tax,” Paulsen says. “That’s a big deal to our economy.”

Bob Paulson is CEO of NxThera, a small firm in Minnesota that makes devices involved in the treatment of urological conditions. His company had only been paying the device tax since November, he says, when NxThera started selling products in the United States. The tax made it harder to find financing, he says, because investors balked at putting their money into an industry that’s been singled out to pay a tax. Thanks to the tax hiatus, he says, he now plans to enlarge his staff of 43 researchers and sales people.

“It absolutely means additional money that we can invest in both of those areas,” he says.

Still, some industry analysts question whether suspending the tax will significantly boost the number of jobs created.

The Congressional Research Service concluded the tax was having fairly minor effects on employment, changing payrolls by no more than two-tenths of 1 percent. The same report called the tax difficult to justify, and noted that such excise taxes are typically put in place to discourage a particular behavior, such as smoking.

Jason McGorman, a senior analyst with Bloomberg Intelligence, says the suspension won’t really change what big companies are doing, but will help their bottom lines. Big, publicly traded firms also might return the money to shareholders by buying up their own shares, he says.

“Smaller companies felt a bigger tax bite than the giants, so they are more likely to put the tax savings back into the business,” McGorman says.

Industry analyst Brooks West, of Piper Jaffray, says device makers would be smart to reinvest the windfall.

“Politically, they better spend this money on R and D,” West says, “or the government can look at this and say, you know, ‘Look, if you just pass this on to the shareholders, we’re going to reimpose the tax.’ “

But Rep. Paulsen says he doubts the tax will return. He’s optimistic the two-year tax suspension will become a permanent repeal.

This story is part of NPR’s reporting partnership with Minnesota Public Radio and Kaiser Health News.

The U.S. Supreme Court next month is scheduled to hear its biggest abortion case in at least a decade, and the reach of that decision will likely be impacted by the absence of Justice Antonin Scalia, who died over the weekend.

A Texas law requires that doctors have local admitting privileges, and that clinics make costly building upgrades to operate like out-patient surgical centers. Numerous other states have passed similar laws, and Scalia was widely expected to provide a fifth vote to uphold such restrictions.

Without him, it may not change much for Texas. A 4-4 split in the court would leave in place the 5th Circuit Court of Appeals ruling that upheld these provisions. Ilyse Hogue of NARAL Pro-Choice America says that would shut down a number of clinics that perform abortion. And she says that would come in addition to other Texas restrictions that have already closed about half the state’s clinics, leaving some women to travel hundreds of miles to obtain an abortion.

“We would be looking at an even greater health care crisis in Texas than we’re already facing,” Hogue says.

But a split decision in the Supreme Court would have no national precedent. That means other appeals court rulings striking down similar laws would also stand. And Hogue says there are more cases to come.

“I think this vacancy is far, far greater in terms of its implication than this one case in Texas,” she says. “There are so many laws looking to restrict not only abortion access and abortion rights, but a broader set of reproductive rights in front of the court right now.”

One of them also comes up next month, when the court hears a challenge to the Affordable Care Act’s mandate on covering birth control for female employees.

There’s also been a wave of abortion restrictions passed since Republicans took control of numerous statehouses in 2011, and many of those cases are winding their way through the appeals courts. Abortion opponents had been hoping to have them affirmed by the Supreme Court, with the help of a great ally in Justice Scalia.

“He was one of the two justices on the court who has publicly opposed Roe v. Wade in prior cases and prior votes,” says Clarke Forsythe, senior counsel with Americans United for Life. “And he was probably the most vocal and longstanding, having been there since 1986.”

Scalia had said that since the U.S. Constitution does not recognize a right to abortion, neither should the Supreme Court. The issue, he wrote, should be left to the states.

Now, if the court flips to a liberal majority, Forsythe foresees a large scale rolling back of decades of abortion restrictions. He can imagine justices overturning the ban on public funding for the procedure. That ban is known as the Hyde Amendment, something presidential candidates Hillary Clinton and Bernie Sanders have both vowed to overturn.

Forsythe also thinks a liberal Supreme Court “will probably throw out all parental notice and parental consent laws in the country, will throw out all informed consent laws in the country, and virtually any regulation, and create an absolute right to abortion for any reason at any time that we haven’t seen in 42 years.”

Abortion rights groups say all that is speculation at best. But with so much at stake, both sides of this contentious issue say they’re throwing themselves into the fierce battle over choosing Scalia’s replacement.