Denee Mallon, Photocredit: Craig Fritz—AP
Lisa Leff of the Associated Press writes Medicare Ban on Sex Reassignment Surgery Lifted, by a HHS appeals board that ruled that based on new research over the last 32 years, Medicare "can no longer automatically deny coverage requests for sex reassignment surgeries.
Ruling in favor of a 74-year-old transgender Army veteran whose request to have Medicare pay for her genital reconstruction was denied two years ago, the agency's Departmental Appeals Board said there was no justification for a three-decade-old HHS rule excluding such surgeries from procedures covered by the national health program for the elderly and disabled.
"Sometimes I am asked aren't I too old to have surgery. My answer is how old is too old?" the veteran, Denee Mallon, of Albuquerque, New Mexico, said in an email interview before the board issued its decision. "When people ask if I am too old, it feels like they are implying that it's a 'waste of money' to operate at my age. But I could have an active life ahead of me for another 20 years. And I want to spend those years in congruence and not distress."
While the ruling doesn't mean Medicare will automatically grant approval for such payments, they cannot automatically deny them, either, but must examine each case on its merits, after the applicant submits documentation from doctors and health professionals along with their application.
Gary Gates a demographer at The Williams Institute estimates that "people who self-identify as transgender make up 0.3 percent of the U.S. adult population. Others estimate this number is closer to 0.5 percent.
Overall, the research now supports the efficacy of surgical interventions to "reduce distress" in cases of gender dysphoria.
"We have no difficulty concluding that the new evidence, which includes medical studies published in the more than 32 years since issuance of the 1981 report underlying the NCD, outweighs the NCD record and demonstrates that transsexual surgery is safe and effective and not experimental. Thus, as we discuss below, the grounds for the ...exclusion of coverage are not reasonable," the civilian panel said.
Advocates for transgender health services hope private insurance and state Medicaid programs will follow suit.
Transgender actress Laverne Cox, of Orange is the New Black, was highlighted on the cover of Time Magazine.
Katy Steinmetz of Time Magazine write Board Rules That Medicare Can Cover Gender Reassignment Surgery
The decision by the Department of Health and Human Services overturns a longstanding rule preventing the government health insurance program from covering such procedures and opens the doors for other Medicare enrollees to make similar requests. It comes at a time when states are beginning to prohibit insurance companies from including specific exclusions for treatments related to gender transitions. ...
Though numbers are far from concrete, studies estimate that that 0.5% of the U.S. population is transgender, meaning that they identify with a gender other than the sex they were assigned at birth. Not all of the country’s estimated 1.5 million transgender citizens desire reassignment surgery, a serious procedure that alters a person’s sexual characteristics. That decision may depend on the desire to have children or physical preference, fear of surgery or having other health conditions that would make such surgery risky, as well as the cost of surgery.
Transgender people who desire surgery will likely be diagnosed with severe gender dysphoria, a diagnosis recognized by the American Psychiatric Association. Jamison Green, president of the World Professional Association of Transgender Health, describes gender dysphoria as discomfort with the gender in which one is living or expected to live in. ... “We’re very excited about it,” Green tells TIME of the ruling. “Now there is considerable evidence that shows that this is a valid condition, that the treatment is effective … it can be disabling if it’s not treated.”
One question I have about this passage is what does Steinmetz mean when she says the decision to have the operations depends many factors such as the "desire to have children," as this operation does not allow one to have children? Perhaps, she means some psychological aspect of being a mother?
Acceptance of gender variety is improving as evidenced by Time Magazine putting transgender actress, Laverne Cox, of Orange is the New Black, on its cover after admitting it was an error to leave her off of its 100 Most Influencial People list.
Laverne Cox recounts an interview Carmen Carrera and herself, on Katie Couric's syndicated show Katie in January of 2014. Couric:
In January of 2014, Cox joined trans woman Carmen Carrera on Katie Couric's syndicated show, Katie. Couric referred to transgender people as "transgenders," and after being rebuffed by Carerra on the subject of her surgeries, specifically what genital augmentation she had done, turned the same question to Cox. Cox responded:
I do feel there is a preoccupation with that. The preoccupation with transition and surgery objectifies trans people. And then we don’t get to really deal with the real lived experiences. The reality of trans people’s lives is that so often we are targets of violence. We experience discrimination disproportionately to the rest of the community. Our unemployment rate is twice the national average; if you are a trans person of color, that rate is four times the national average. The homicide rate is highest among trans women. If we focus on transition, we don’t actually get to talk about those things.[17]
Laverne Cox makes in excellent point about peoples' preoccupation with "the surgery." One wouldn't normally ask someone they've just met about their private parts. In this case, this decision by HHS, that Medicare will no longer routinely exclude covering this basic medical care approved of by the medical community represents a major step forward for TGs and TSs in terms of support and acceptance, which seems worth reporting.
So we see more welcome progress in society becoming more accepting, and supportive of our diverse American people. I've had two close friends choose the gender reassignment surgery after long 5 year plus transitions, and they are both much happier now. I also know many M to F TGs who live full as women who are also happy.
Not everyone who transitions seek the SRS surgery, it is a decision each person must make with their doctors, based on a number of factors, including other health issues, risks of any surgery, complications, and cost. It is good news to know those on Medicare will not be prevented from taking this step, if desired, by an automatic ban insurance coverage.
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Footnote: Robyn and I posted on this same topic yesterday. She was first, so I took this one down as soon as I noticed. We did cover different articles and from different angles so I'm giving this a second chance this evening. - HD
Robyn's post looks at the history and different points of view about SRS, which I recommend, in HHS eliminates medicare ban on sex-reassignment surgery.