Many insurance companies, and even some politicians, describe gender-affirming surgery as cosmetic, whereas most (if not all) major medical organizations say that these procedures are medically necessary.
Surgical procedures such as these, tend to be one of many treatments for gender dysphoria, which refers to the psychological distress that results from a difference between one’s assigned sex at birth and their gender identity, according to the American Psychiatric Association.
The World Professional Association for Transgender health, or WPATH, is considered the main governing body on this kind of issue, wrote in a “medical necessity statement” in 2016 that “medical procedures attendant to gender affirming/confirming surgeries are not cosmetic or elective, or for the mere convenience of a patient.”
These reconstructive procedures are not optional in any meaningful sense, but are understood to be medically necessary for the treatment of a diagnosed condition, in this case, gender dysphoria. In many cases the surgery is the only effective treatment for the condition, and for some people genital (bottom) surgery, in particular, is essential and potentially even life saving.
Dallas Ducar, CEO and co-founder of Transhealth Northampton in Massachusetts, said she was shocked by the “endless barriers that exist for patients seeking to transition.”
“For cisgender individuals, hormone replacements, puberty blockers, are easily accessible, and they’ve been used in the past to treat precocious puberty,” she said. “Hormone Replace Therapy (HRT), has been beneficial for endocrine, cardiovascular conditions, and trans people are burdened with paperwork, psychiatric assessments, and insurance pre-authorizations.”
Most people in power – clinicians, politicians, and insurance company employees – are cisgender, a term meaning that one does identify with their assigned sex at birth. These people have created systems that have actively, and continuously, reduce access to quality gender-affirming care.
No single policy governs how insurers cover gender-affirming care and procedures.
Lindsey Dawson, a director at KFF, a nonprofit organization focused on health policy, described state insurance laws as a patchwork.
Twenty-four states and Washington, D.C., prohibit transgender exclusions in health insurance coverage, according to the nonprofit think tank, Movement Advancement Project. Twenty-three states and D.C., have Medicaid policies that explicitly cover transition care for transgender people. The remaining states have mixed policies, some having no policy that explicitly covers this kind of care. 10 states have policies that explicitly exclude trans health coverage and care, where one state – Arkansas – allows all insurers in the state to refuse to cover gender-affirming care.
The Obama administration interpreted Section 1557 of the ACA, which prohibits discrimination based on sex in federally funded health care facilities, to include discrimination based on sexual orientation and gender identity, but the Trump organization had essentially erased these protections.