AMA, American Psychiatric Association, California, Colorado, Connecticut, District of Columbia, Fortune 500 companies, FTM, gender confirming surgery, health insurance, HHS, Massachusetts, Medicaid, Medicare, MTF, Oregon, private insurance, San Francisco, Sex reassignment surgery, Social Security Administration, transsexuals, Vermont
About two months ago, the Social Security Administration announced a policy change that Medicare will now cover the costs of gender confirming surgery as part of the treatment of transsexuals. Previously, Medicare would not cover such costs on the grounds that such surgery was considered ineffective in treating the condition, and amounted to little more than elective cosmetic surgery. Growing evidence to the contrary as recognized by the recognized medical community was cited as the main reason for the reversal of the previous policy that had been in place for 33 years.
While a number of transsexuals at or near the age of Medicare eligibility will benefit from this new policy, it can be expected that the number of those using Medicare to pay for the surgery will dwindle over time. As social stigma towards transsexuals wanes and transition occurs more frequently at younger ages, it will not be long (perhaps 10-20 years) that most transsexuals will have the surgery, if they elect to have it, long before they reach Medicare age.
In fact, the new policy will help to make that a reality. It is likely that the longer reaching effect will be outside of Medicare. With the endorsement of a Federal agency that this surgery is a necessary part of the treatment of transsexuals, backed by the opinion of the AMA, APA and many other respected medical organizations, it will be very difficult for private insurance companies to successfully deny coverage for the surgery unless they specifically redline the procedure. Most policies are written to cover any treatments that are deemed medically necessary. We have reached the point where that is now the accepted expert opinion.
I waited awhile to post this news on my blog because I wanted to see what the fallout of the decision would be. As I expected, there has been very little. There are a few reasons for this. First of all, despite hand-wringing in some quarters that the growing acceptance of transsexuals means that the barbarians are at the gate and civilization as we know it is doomed, there simply are not that many transsexuals in the United States to make much impact on the overall society. (The estimate is 0.3% of the adult population.) That also means that the number of us who will be taking advantage of this new benefit will be small, even in the peak years.
A few years ago, the City of San Francisco included coverage of this surgery as a medical benefit for their employees. Their insurance carrier did a survey to find out the number of transsexuals employed by the city. They then raised their premiums accordingly. They made a substantial profit as a result. They made the assumption that every transsexual on the payroll would jump to have the surgery. But it wasn’t so. First of all, not every transsexual wants the surgery. Some elect to remain non-op for various reasons: some expect to remain that way for a lifetime while others may choose it for an indefinite period. A great many FTM transsexuals decline the surgery simply because it does not produce a very realistic or functional result. While the surgery produces far better physical results for MTF’s, there are still a significant number who wait or refrain from the surgery. Accommodating the needs and desires of a spouse or partner is one reason. Personal sexual preference is another. Recent trends of younger transgender persons toward gender fluidity and away from a gender binary would be the rationale for others. General health issues or concerns about undergoing surgery are still more reasons.
We also will not see much impact from this decision unless a case becomes public where a transsexual challenges the decision of her insurance carrier to deny coverage for the procedure. There were some stories about these challenges being successful prior to Medicare’s decision to change the policy. If insurance companies are falling in line on this issue and not denying coverage, that will not be newsworthy.
Finally, we have yet to see whether Medicaid will make the same change in policy. Especially in those states where expanded Medicaid is in place, that could be a far more significant change. Medicaid covers a broader and generally healthier age range than Medicare. Even so, the tiny percentage of transsexuals in the population will mean very little financial impact by this decision on the system.
There are already five states (California, Colorado, Connecticut, Oregon and Vermont) plus the District of Columbia that also affirm that gender confirming surgery can be a necessary part of treatment. Initiatives have been sponsored by the Governor of Massachusetts to join the list. There is also a growing trend for private corporations to cover the surgery. A recent survey of Fortune 500 companies showed that 28% now cover it. None did in 2002.
So far Medicaid in only three states will pay for the surgery: California, Massachusetts and Vermont. At the moment, Medicaid coverage is occurring on a state by state basis.
Does this mean that a person on Medicare can simply find a surgeon who specializes in these procedures and arrange for surgery and Medicare will foot the bill? Absolutely not. Each patient will still need to go through the appropriate procedures of diagnosis and receive a recommendation by qualified members of the medical community before such surgery can be considered medically necessary.
Here are links to two stories written immediately after the decision was announced, covering different angles on the topic.
Submit yourselves to every ordinance of man for the Lord’s sake: whether it be to the king, as supreme; Or unto governors, as unto them that are sent by him for the punishment of evildoers, and for the praise of them that do well. For so is the will of God, that with well doing ye may put to silence the ignorance of foolish men: As free, and not using your liberty for a cloke of maliciousness, but as the servants of God. Honour all men. Love the brotherhood. Fear God. Honour the king. – 1st Peter 2:13-17