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HHS may be poised to end long-standing Medicare ban on gender-confirmation surgeries for trans people

An independent review process that started back in December is now winding down, and change may be on its way

Katie McDonough
May 8, 2014 7:53PM (UTC)

The Department of Health and Human Services may be poised to end its long-standing ban on federally subsidized gender-confirmation surgeries for transgender people, according to a report from BuzzFeed. An independent review process that started with an appeal of the exclusion back in December is now winding down, and sources close to the review panel say that HHS is on the verge of repealing the Medicare and Medicaid blanket bans on transition-related surgeries.

HHS has banned Medicare and Medicaid coverage for these surgeries since 1989, calling them "experimental." But in recent years, the American Medical Association, American Psychiatric Association and American Psychological Association have come out in support of gender-confirmation surgeries as necessary healthcare for trans people.


As Evan McMorris-Santoro at BuzzFeed notes, the American Psychiatric Association released a statement in May 2012 urging the "removal of barriers to care" and supporting "both public and private health insurance coverage for gender transition treatment.”

But the language of the blanket Medicare ban -- now almost three decades old -- doesn't reflect the medical consensus. “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,” according to the current language. “Moreover, there is a high rate of serious complications for these surgical procedures. For these reasons, transsexual surgery is not covered.”

The end of the Medicare ban would expand access to gender-confirmation surgeries for low-income individuals, and may also have a ripple effect in the private insurance market, as McMorris-Santoro points out:


Because Medicare guides many insurance industry decisions, eliminating the blanket ban on the procedure could have significant consequences in the private health insurance market for the transgender community, transgender rights advocates say.

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.

In a December appeals ruling on the ban, HHS declared that the outdated medical literature used in the exclusion "is not complete and adequate to support the validity" of banning coverage of gender-confirmation surgeries, and noted how much has changed in the 30 years since the ban was introduced. The exclusion is not "supportable by the current state of medical science," according to the decision.

"Dozens of new studies have been conducted that … confirm that sex reassignment surgery is a safe and extremely effective treatment for individuals with severe gender dysphoria," the decision continues. "Advancements in surgical techniques have dramatically reduced the risk of complications from sex reassignment surgery" and "a robust medical consensus has developed among mainstream medical organizations which endorse the treatment standards established by the World Professional Association for Transgender Health."

h/t Feministing / the Advocate


Katie McDonough

Katie McDonough is Salon's politics writer, focusing on gender, sexuality and reproductive justice. Follow her on Twitter @kmcdonovgh or email her at kmcdonough@salon.com.

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