The Obama administration on Friday ended a 33-year ban on Medicare coverage for gender reassignment surgery — a major victory for transgender rights and a decision that is likely to put pressure on more insurers to provide coverage for such services.
The ruling by a Department of Health and Human Services board was in response to a lawsuit filed last year on behalf of Denee Mallon, 74, a transgender woman and army veteran from Albuquerque.
The blanket Medicare ban was put in place in 1981 when such surgeries were considered experimental. But now most medical groups, including the American Medical Association and the American Psychological Association, consider it a safe option for those suffering from gender dysphoria, a condition that is characterized by intense discomfort — or “incongruence,” according to the official definition — with one’s birth sex.
On Friday, the independent board, whose decisions are binding on HHS, said that medical studies published over the past three decades showed that the grounds for exclusion of coverage are “not reasonable” anymore and lifted the ban.
“This is long overdue,” said Judith Bradford, co-chair of the Fenway Institute, a Boston-based research center that focuses on LGBT health. “It brings government policy in line with the science around transpeople’s health-care needs.”
Although Medicare coverage is only for people 65 and older, and the transgender population makes up only about 0.3 percent of the U.S. adult population, private insurance plans often take their cues from Medicare on what should be considered a medically necessary covered treatment. As a result, the ruling is likely to open up more options for transgender individuals.
But in some ways, the ruling was more important from a symbolic standpoint than a practical one. Medical professionals say very few people opt for surgical interventions. And the cost to insurers that offer coverage — which can be anywhere from $10,000 to $50,000 per surgery — is often negligible in relation to their entire patient pools, according to several studies.
Administration officials originally sought to overturn the ban in 2013, but the attempt prompted a backlash among social conservatives and religious groups who oppose taxpayer funding for such procedures.
SOURCE: Ariana Eunjung Cha
The Washington Post