Over the weekend, the Obama administration ended a 33 year old ban on Medicare coverage for gender reassignment, announcing that tax dollars will now cover transsexual surgeries for elderly or disabled Americans.
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 who wanted genital reconstruction.
Mallon was born a man but has been diagnosed with "gender dysphoria," a state of distress about one's biological gender. Medicare denied Mallon's request for surgery two years ago, but today the appeals board overturned that decision.
"Sometimes I am asked aren't I too old to have surgery," Mallon said before the board's decision. "My answer is how old is too old? 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."
In explaining its decision, the appeals board said the old ban on sex reassignment surgery was based on medical evidence compiled in 1981 and said new research showed the ban was "no longer reasonable." Calling gender reassignment surgeries "safe" and an "effective treatment option," the board said the Centers for Medicare & Medicaid Service did not try to challenge its decision, which is final unless appealed in federal court.
Jennifer Levi, a lawyer who directs the Transgender Rights Project of Gay & Lesbian Advocates and Defenders in Boston, says the decision does not mean that sex-reassignment surgeries will automatically be paid by the government, but simply that the ban has been lifted. Patients will still need to have documentation from a doctor and mental health professionals stating that the gender reassignment surgery is a medical necessity.
However, Leanna Baumer, a senior legislative assistant with the Family Research Council, said that the ruling "ignores the complexity of issues" surrounding gender identity issues.
"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," she told the Washington Post.
No statistics have yet been released on how many people might be affected by the decision. Gary Gates, a demographer with The Williams Institute, a think tank on LGBT issues based at the University of California, Los Angeles, has estimated that people who self-identify as transgender make up 0.3 percent of the U.S. adult population. Over 49 million Americans are enrolled in Medicare.