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It was just a bit premature for this to be news when I started writing this diary.  There is a panel review still underway and we all know that politics could still happen.  

But the Department of Health and Human Services is not airtight when it comes to keeping secrets and sources therein are saying that Medicare's blanket ban on gender-confirmation surgery will be lifted.

Later Friday the HHS Appeals Board ended the blanket ban.

Some interpret that to mean that insurance company decisions will also be affected.  Others of us know that some of the larger investors in insurance companies are conservative organization totally opposed to anything which benefits transgender people.

Medicare has for decades considered sex-reassignment surgery “experimental,” despite opposition from many major medical professional associations and LGBT advocates, who say the ban denies necessary care to transgender people.  The private insurance industry has also been slow to adopt coverage options for sex-reassignment surgery and related care, something advocates say stems from the Medicare ban.

--Evan McMorris-Santoro, BuzzFeed Politics staff

A challenge to the Medicare ban was filed last year by the ACLU, Gay and Lesbian Advocates and Defenders (GLAD) and the National Center for Lesbian Rights (NCLR).  Lifting the ban would not mean surgeries would be immediately covered, but it does mean they would be considered under due process.

The challenge was filed on behalf of Denee Mallon, 73 at the time, a Medicare recipient from Albuquerque, NM.  Melton is a veteran of the US Army who worked as a forensic investigator for the Albuquerque city police department.  She was diagnosed with gender identity disorder after she retired.

Americans, in general, are really tired of health care decisions being made by legislators and bureaucrats and insurance companies.  Most of us believe that health care decisions should be made by patients and doctors, and the medical community is pretty unified.  This is a legitimately necessary surgery.

--Mara Keisling, National Center for Transgender Equality

The ban is codified as National Coverage Determination 140.3, which was put in place in 1981 by the Reagan administration...at the behest of the insurance industry in an era rife with the stigmatization of transgender people.
Transsexual surgery for sex reassignment of transsexuals is controversial.  Because of the lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental.  Moreover, there is a high rate of serious complications for these surgical procedures.  For these reasons, transsexual surgery is not covered.

--National Coverage Determination 140.3

Both the American Medical Association and the American Psychological Society support gender confirmation surgery for transgender people who desire it.
Each year that goes by, there’s more and more evidence that just reaffirms the widely accepted view that these surgeries are safe, medically necessary and effective to treat a serious medical condition.

--Joshua Block, ACLU

An interim ruling on February 25 determined that the board "determined that new evidence submitted by the aggrieved party 'has potential to significantly affect' the Board's evaluation" of the ban.  That initiated a 90-day window before the Appeals Board would have to issue a final ruling...or announce an extension of the review period.
AMA supports public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient’s physician.

--AMA bylaws

The American Psychiatric Association advocates for removal of barriers to care and supports both public and private health insurance coverage for gender transition treatment.

--American Psychiatric Association Position Statement on Access to Care for Transgender and Gender Variant individuals

Critics have tried to shut down a re-examination of the ban before.  A parallel track administration proposal to review the ban was scrapped last year by HHS leadership after controversy erupted among critics who questioned the need for Medicare funds to cover what was once called “sex change” surgery.
Let's face it.  Some folks would like to use the fact that they just don't like us to deny us medical care.  And that dislike is not restricted to conservative forces.  Just last evening someone posted in one of my diaries that
Nobody mentions how frequently...

...these surgeries fail, and the high complication rate. I would discourage any patient from attempting them.

It's not a magic bullet, and no amount of disfigurement can make you what you're not.

That was posted in a diary about the cultural progress society was making to improve the condition of gender-variant people.
It’s helping people be who they really are.  It’s a body that does not match how you identify.  We as a society should be helping people do that.  I find that medically necessary.

--Stephen Forssell, director of the Graduate Program in LGBT Health Policy and Practice at George Washington University

Current understanding of the Affordable Care Act is that the insurance reforms do not require companies to cover gender reassignment.

Oppressive forces felt the need to express their disagreement.

Real compassion for those struggling with a gender identity disorder is to offer mental health treatments that help men and women become comfortable with their actual biological sex — not to advocate for costly and controversial surgeries subsidized by taxpayers.

--Leanna Baumer, Family Research Council

Ms. Baumer ignores the years of research that shows such "mental health treatments" are ineffective.

NOM's Frank Schubert felt the need to weigh in, even though this had nothing to do with marriage:

he also objects to the decision for moral reasons and that it does not encourage children “to respect who they are, how they were born.”
Jamison Green, president of the World Professional Association for Transgender Health (WPATH), calls the ruling a positive step in ending medical discrimination, but cautions there is more work to be done:
He explained, for example, that some transgender men have had trouble getting coverage for mammograms or hysterectomies when they developed fibroids or even cancer.  Green said that in some cases, the issues can be resolved by having the person change his or her official gender on paper with an insurer.  But he said for some, such a requirement could be psychologically damaging, especially if the person is already struggling with sexual identity.
The net effect is highly prejudicial.  It is about people using the opportunity to punish transgender individuals for being different.  These are the things we need to resolve.

--Jamison Green

I am relieved to know that my doctor and I can now address my medical needs, just as other patients and doctors do.

--Denee Mallon

Originally posted to TransAction on Sat May 31, 2014 at 10:59 AM PDT.

Also republished by Good News.

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Comment Preferences

  •  That comment that was posted in your diary (8+ / 0-)

    last night which you quoted above, seemed really off the wall to me. I strongly doubt that the person is really a physician performing such surgery.

        •  The use of the term disfigurement (12+ / 0-)

          Cements that diagnosis.

          •  Is it still up. I'm familiar with a certain school (2+ / 0-)
            Recommended by:
            Richard Lyon, Aunt Pat

            of health care "professionals" that we've been sort of batting with  for several decades. One wrote a book "The Transsexual Empire," which was hurtful and highly ideological. Is this post still up? I'd like to take a look at it.

            Oh goodness robyn, I started writing this up on Friday, and then thought this is something you would probably like to cover. After I show you post on a different topic yesterday, I just spent a couple hours adding to it and just posted a take from a different angle, but I'll gladly take it down, if you think it distracts from your post here.

            Could you take a uick glance and tell me what you think?  I could also take it down and post it some later time. Maybe that's he best idea. As long as you are here, though, maybe you can take a look at it first as I'd was thinking I'd like to get your view of it before I posted it. Let me know after you've read it and then I'll take it down.

            Cheers. (Well that's a new problem, eh, too many TG-TS  posts all at once. LOL)

            Humor Alert! No statement from this UID is intended to be true, including this one. Comments and Posts intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited.

            by HoundDog on Sat May 31, 2014 at 12:40:06 PM PDT

            [ Parent ]

            •  I don't see it. (2+ / 0-)
              Recommended by:
              HoundDog, Aunt Pat

              I was busy fixing lunch.

              •  I took it down. I didn't want it to detract from (4+ / 0-)
                Recommended by:
                ypochris, rserven, Aunt Pat, gooderservice

                your excellent post here. Maybe later sometime I'll put it back up. I would be interested in you opinion of it.

                Two of my best friends have had this surgery years ago and they are still very happy with it.

                So I helped research physicians, have read hundreds of articles on it.

                With regard to your critic  

                Two camps of critics are still occasionally problematic. The first has pretty much been completely refuted in the academic and medical community, the second is a small group an still controversial.  

                A third possibility, might be poor communication for one minority school, but still prominent group  

                Radical feminist Janice Raymond wrote the The Transsexual Empire: The Making of the She-Male is a 1979 book by the A

                The_Transsexual_Empire Janice Raymond wrote The Transsexual Empire

                 
                Raymond maintains that transsexualism is based on the "patriarchal myths" of "male mothering," and "making of woman according to man's image." She claims this is done in order "to colonize feminist identification, culture, politics and sexuality," adding: "All transsexuals rape women's bodies by reducing the real female form to an artifact, appropriating this body for themselves .... Transsexuals merely cut off the most obvious means of invading women, so that they seem non-invasive."[1]

                These views on transsexuality have been criticized by many in the LGBT and feminist communities as extremely transphobic, and indeed constituting hate-speech against transsexual men and women.[2][3][4][5]

                She's been refuted but her contorted logic of GID being a pathology lives on in a few minority forms. One tenured gay faculties of a sexual studies department (I forget which university as it was nearly 10 years ago, I last looked this up,) has been battling saying the M to F TG and TS people are really effeminate gay males who have been "brainwashed," by TG propaganda.

                He is confusing sexual orientation with gender identity which as you know are two entirely different dimensions.

                The majority of the health professionals I'm aware of with the most experience strongly reject both of these views and see themselves as trying to serve individual people and support them in the view and self-perceptions they choose for themselves.

                There is another group of "old school" psychologists who have resisted reclassifying Gender Identity "Disphoria" so it is not listed as a pathology but one of a variety of situations, much the same way homosexuality was dropped as a psychopathology from DSM III to DSM IV.
                So now you can get treatment for "social adjustment" stress if you are tormented for being gay, you are not considered pathological.

                Some in this school accept that SRS can "relieve distress" in those with GID, and extreme cases, where suicide, chronic depression, substance abuse may be the consequence, they see it as a "last resort" only after all else has failed. Partially, because it is expensive, and like all surgeries there are risks.

                John Hopkins shut down its program back in the 70s or 80s based on some these theories, and complications. But there were doing an old form of the operation which cut the nerves and left people without sensation.

                The most modern variation pioneers and espoused by a doctor in the midwest, whose name escapes me for the moment, a TS herself, uses a variation of the "penile inversion" technique which leaves all of the nerves intact, and after doing thousands of operations has reduced complications to very low rate.

                As you can imagine, satisfaction with this newer style operation is much higher. The John Hopkins group had found that after their rather primitive operation one third was happier (even without sexual sensation), one third was about the same, and one third felt less happy. Which was the same stats as the groups who wanted to, but did not have the operation either for medical reasons or costs. (In those days 50 was about the maximum age, and weight limits were stricter because of surgical complicatons.)

                In addition to JH closing their SRS program, Medicare and a lot of insurance companies, who were looking for excuses anyway, used that same logic and research to deny coverage.

                Adding a whole lot of extra significance to the decision by the HHS, who after reviewing the last 30 years of new data decided that previous ruling was obsolete and invalid.

                But, we still have people going around, unnecessarily hurting a lot of people's feelings, and sometimes spreading misinformation. If the person who commented in your post  was from that generation, speaking from purely a "benefit/cost" logic they may have been trying to say, if you can live with who your are, (and your current anatomy,) it better not to take any medical risk.

                What they do not understand is that for some people, "that anatomy is not who they are" and the SRS may be appropriate for them if they meet the Benjamin standards.

                Which bring up another complication. In the Boston areas I have many connections to several TG-TS communities and sadly not all are completely friendly with each other.

                There are a number of older TGs who took a lot of grief from some snotty individuals, in this area, who just happened to also be TSs. In various support groups a few of these folks established themselves as the "queen bees" who defined a CD-TG-TS spectrum with everyone who had not yet had SRS, could pass, and had about $50,000 of FFS (Feminizing Surgery from Hofsteadter out in San Fransisco) as "not able to be or comprehend what it is like to be  a"real woman.")

                Needless to say this hurt a lot of peoples feelings and made others angry, since the number of TGs who do not get the surgery exceed the number that do by at least 25 to 1 if not more. Rather than allow TG to be defined as "failed TSs"  or even wanna be TSs, there is a movement by many therapists who serve this comunit(ies) to encourage everyone to be "comfortable who they really are."

                The book Brain Sex, which is getting old, there must newer more up to date discourses, proposes that any typology making fewer than six dimensions of distinction when it comes to gender, and sex issues, risks oversimplification.

                They proposed genotype, phenotype, sexual orientation, gender identity, gender  affectation, and sexual expression can all vary independently providing over a 100 basic combinations with lots of "spectrums" in between.

                So when it comes to how people view themselves I've heard people describe themselves as transgender, transsexual, I a woman, or man, intersex, androgynous, both, neither, asexual, pan-sexual, multi-sexual, she-males, bi-gendered (distinct from bisexual - I'm just talking about identify not orientation), and gender mind-fucked.

                The person who says the later always scopes out her/his/its audience and chooses the description that will upset the most number of people and is angry about having people try to "stuff" others into their "mindless and stupid" overly simplistic stereotypes.  

                My personal feeling is we do best to respect however people wish to identify, (or not) and call people what they prefer to be called.

                And, I completely agree with you robyn that this HHS decision is great, and represents progress toward greater acceptance and support of diversity and the way people choose to view themselves and be who they feel they really are.  

                BTW None of this in my post. I'm just responding to what you said about that on comment.

                Humor Alert! No statement from this UID is intended to be true, including this one. Comments and Posts intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited.

                by HoundDog on Sat May 31, 2014 at 02:31:47 PM PDT

                [ Parent ]

                •  The transsexual surgeon you referred to... (3+ / 0-)
                  Recommended by:
                  HoundDog, Aunt Pat, gooderservice

                  ...is Marci Bowers in Trinidad, CO.

                  •  Yes, that's the one. I remembered her first name. (2+ / 0-)
                    Recommended by:
                    rserven, Aunt Pat

                    She seems great to me. Who was the really famous doctor she studied under that did about 5,000 operations. I know a few people who liked him a lot.

                    One of my friends used that famous person in Montreal.

                    Dang, I can't believe I can't remember all of this. It was about 10  to 15 years ago when I last helped them research this.

                    Humor Alert! No statement from this UID is intended to be true, including this one. Comments and Posts intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited.

                    by HoundDog on Sat May 31, 2014 at 03:37:03 PM PDT

                    [ Parent ]

                    •  Stanley Biber. (2+ / 0-)
                      Recommended by:
                      HoundDog, Aunt Pat

                      Personally, I went to Eugene Schrang in Neenah, WI.

                      •  I've heard good things about him as well. (2+ / 0-)
                        Recommended by:
                        rserven, Aunt Pat

                        Humor Alert! No statement from this UID is intended to be true, including this one. Comments and Posts intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited.

                        by HoundDog on Sat May 31, 2014 at 03:56:57 PM PDT

                        [ Parent ]

                    •  IIRC Northwestern (2+ / 0-)
                      Recommended by:
                      rserven, HoundDog
                      One tenured gay faculties of a sexual studies department (I forget which university as it was nearly 10 years ago, I last looked this up,) has been battling saying the M to F TG and TS people are really effeminate gay males who have been "brainwashed," by TG propaganda.
                      He is confusing sexual orientation with gender identity which as you know are two entirely different dimensions.

                      Warning - some snark may be above‽ (-9.50; -7.03)‽ eState4Column5©2013 "If we appear to seek the unattainable, then let it be known that we do so to avoid the unimaginable." (@eState4Column5)

                      by annieli on Sat May 31, 2014 at 03:44:40 PM PDT

                      [ Parent ]

                        •  This is so embarrassing. I feel like we are (1+ / 0-)
                          Recommended by:
                          jessical

                          playing some game show in a nursing home and I'm the contestant of the week.

                          You all have heard of these folks though right? I just didn't want you to feel badly if you ran across one of those folks. I'm not suggesting you read any of their crap. My point is that there are some obscure people like this out of the fringe of the community you might occasionally run into.

                          The last I heard of the fellow I was talking about, and I just do not remember his name, but he was being sued, and heavily criticized by the parents of one child born male, but wanted to play with dolls, dress in dresses right from the beginning, which only became "a problem" when going to kindergarten.

                          This unlucky family happened to get this guys as their psychologist and he insisted they make the poor kid get "his" hair cut, dress male, and have nothing to do with "feminine" behavior. This went on for some while the child transitioned as a late teenager but had "issues" about this person's advice which he still insisted was correct.  

                          So my only message is there are some odd people out there and some of them become doctors.

                          Humor Alert! No statement from this UID is intended to be true, including this one. Comments and Posts intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited.

                          by HoundDog on Sat May 31, 2014 at 04:06:28 PM PDT

                          [ Parent ]

              •  I'll send it to you later. (2+ / 0-)
                Recommended by:
                rserven, jessical

                Humor Alert! No statement from this UID is intended to be true, including this one. Comments and Posts intended for recreational purposes only. Unauthorized interpretations may lead to unexpected results. This waiver void where prohibited.

                by HoundDog on Sat May 31, 2014 at 02:35:03 PM PDT

                [ Parent ]

    •  Unfortunately, DK can be vulnerable to people who (3+ / 0-)
      Recommended by:
      rserven, HoundDog, annieli

      say they are something when they are not....and it isn't always easy to readily detect such misconduct.

      Diarists posing as physicians and spreading disinformation is an example of such DK user misconduct.

  •  raises the interesting question of which (4+ / 0-)
    Recommended by:
    jayden, rserven, VeggiElaine, HoundDog

    insurance companies or rather their staffs will now deny covering such procedures as "elective" since the denial or abuse of care happens at such micro-levels

    Warning - some snark may be above‽ (-9.50; -7.03)‽ eState4Column5©2013 "If we appear to seek the unattainable, then let it be known that we do so to avoid the unimaginable." (@eState4Column5)

    by annieli on Sat May 31, 2014 at 11:21:32 AM PDT

  •  One step closer to the day in this country (8+ / 0-)

    where simply existing as a human being gives you the same right to medical care as anyone else.

  •  can I get retroactive top surgery coverage? (4+ / 0-)
    Recommended by:
    rserven, HoundDog, jessical, annieli

    Will I have to pay out of pocket for my T Mon?

    Can I get lower surgery?

  •  This is rich... (4+ / 0-)
    Recommended by:
    rserven, VeggiElaine, HoundDog, jessical
    he also objects to the decision for moral reasons and that it does not encourage children “to respect who they are, how they were born.”
    What does a guy like that know about respecting who someone is, how they were born?

    One good thing about music, when it hits you feel no pain -Bob Marley

    by Darwinian Detritus on Sat May 31, 2014 at 12:19:54 PM PDT

  •  Republished to Good News - (3+ / 0-)
    Recommended by:
    rserven, HoundDog, jessical

    I wonder if this improves the odds for Chelsea Manning to get what she needs?



    Is it true? Is it kind? Is it necessary? . . . and respect the dignity of every human being.

    by Wee Mama on Sat May 31, 2014 at 01:54:58 PM PDT

  •  If they must treat us... (2+ / 0-)
    Recommended by:
    rserven, annieli

    ...must they also treat us well?

    There seems a fair chance we're about to become part of the national conversation for a bit.  Wouldn't it be great to already have basic medical coverage and civil rights and not be part of anyone's national conversation?   :)  I don't want to talk about this with people because they heard it on the news.  I will find out things about them I do not want to know and would need to ignore, should further interaction be required.

    It is definitely worth noting that Canada, UK, NL, and other countries provide trans care without going bankrupt or collapsing (and as you note, the US used to do some of the same, varying by state I think).

    If it does stand, I don't know if you're right about the insurance companies.  If transition rate corresponds to Europe and Canada, we might be a nice forward-thinking bennie to put in at relatively low cost overall, sort of like insurance policy cupholders. (See, trying for the optimistic thing...)  I think a lot may depend on how this particular event plays out in the media.

    ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

    by jessical on Sat May 31, 2014 at 04:04:55 PM PDT

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