Medicare Ends Coverage Ban for Sex Changes

Tuesday, June 03, 2014

The Medicare patch is a bramble of thorny political issues. (Shutterstock)

Medicare can no longer ban coverage for sex reassignment surgery, according to a Health and Human Services board decision last week. Amy Whelan, senior staff attorney for the National Center for Lesbian Rights, one of the groups which worked on this case, talks about what the decision means for trans rights, private insurance, and views of gender dysphoria.


Amy Whelan

Comments [23]

Gwen from Long Island

I am also the mother of a transgendered person. I missed the original segment and am so glad that Maisie got through. I knew nothing at all about the issue before our child came out to us at age 16. It has been a transition for us as well as for our child, one day at a time. I know now that our child had no choice, really, but to transition. She had been absolute turmoil from the age of three and as she transitioned the turmoil seeped out of her. What she is up against in this word terrifies me. She is not safe in the world to say the least. Still, I am convinced that transitioning was her only option. Thank you Brian for airing this segment.

Jun. 03 2014 07:54 PM
(fe)male from NYC

some of the comments on this board are shameful and derive from sheer ignorance and the arrogance to presume to know all about the broad spectrum of sexual identities.

Being gay isn't an invention of the 21st century.
Being born into one sex and feeling yourself to identify with another sex isn't an invention of the 21 century.

Perhaps the media has done a very poor job introducing the public at large to topics beyond gay/straight.
There is a broad spectrum of everything that falls in between.
Too bad it's met with so much ignorance and arrogance, not to mention mockery.

Jun. 03 2014 01:26 PM
CooganNYC from Nyc

Food for thought on this hot topic:

Gender dysphoria is a recent western society that is basically a made up definition based on it being a pathology, something wrong that needs to therefor needs to be cured. Historically speaking in the rest of the world and in Native American Indian culture being a 'third sex' (loosely defined) is/was an unusual, yet normal reality and sometimes revered not reviled. A Native American friend said they were considered mystic sages who were consulted before going into battle, gave blessings over newborns, were marriage councilors, etc.

We forget there is an upside and exceptional gift in being this way, which offers an usual life with of course the standard hardships many must deal with in life- like being born blind, deaf, with a deeply disfiguring physical deformity, etc. Given the option many actually say they'd choose to keep their 'disability' because altering yourself externally does not necessarily assure a happy life or that it's equal to a magic pill that makes one suddenly feel right in their own skin. Imagine if there was skin tone/pigment reassignment surgery for races who feel their skin color is wrong? Millions feel uncomfortable if not suicidal and would certainly qualify for surgery reassignment under the current definition. Bad enough they already do skin bleaching, extreme tanning, eyelid surgery, etc..

Lastly I offer this gender dysphoria definition: "Gender identity disorder is a conflict between a person's physical gender and the gender he or she identifies as. For example, a person identified as a boy may actually feel and act like a girl. The person is very uncomfortable with the gender they were born."

What does "feel like a boy" and "act like a girl" mean to them? They act like there's a standard, rules how one sex can or should act! Haven't we mostly destroyed these tired, controlling, archaic definitions? This horrible American 1959's Barbie & ken artificial image of what sex is or should be? When it comes down to it, this is the very genesis of the argument. How can one say if they are the right sex? Based on what- not liking your genitals/eyes/chin/breasts, etc? Who in society loves what they have? It's a sliding scale.

From the outset, this is what most disturbs me, the idea sexuality is defined by what you see in the mirror- that clothes play a large part in this idolizations, or warping the mind. When a child says they don't like their body, it's normal-children have always gone through this stage! Professionals now quickly diagnose them as trans and shockingly encourage parents to consider surgery! It robs the child the autonomy to grow to adulthood then make the decision for themselves. When an adult says they feel wrong-what definition are they using to define what normal is then? How does having a certain body part stop you or from living a certain way, in this era where the lines are so blurred and becoming more so?

Jun. 03 2014 12:44 PM
KY from Princeton, NJ

Maisie in New Haven, thank you so much for your moving and inspiring call. I believe that, if we had more mothers (and parents and people) like you, there'd be a lot less suffering and cruelty in the world.

Maisie, would you be at all willing to answer a private question by email, in whatever privacy-protected way might work for you? I ask this on behalf of a friend who is newly facing a similar situation, one that includes a child who has endured much hardship because of trans-gender issues. Of course, I understand if this is not possible.

Thank You, Maisie.


Jun. 03 2014 11:51 AM
larry from new york

There is not enough discussion about the range of sexual identity. Too much focus on Male and Female as the only options. penis+breasts? cool! beards on women? cool! hairy men in high heals? way cool! Let's mix it all up. I'm pretty butch myself, but never identified as a man. I neither identify as a woman. I'm bisexual. Why do I have to choose? If society stopped restricting the sexual possibilities to male vs. female, i bet nobody would even feel the need to get a sex change.

Jun. 03 2014 11:39 AM
Pauline Park from Queens

NCLR is a good organization doing important work to support the transgender community; however, it is important to recognize that gender dysphoria is a false diagnosis with no scientific basis; it is simply a new version of the original 'gender identity disorder' (GID) diagnosis in the Diagnostic & Statistical Manual of Mental Disorders (DSM) with softened language. Every diagnosis in the DSM is for a mental illness, and no amount of softening can obscure the fact that transgendered people are still labeled as mentally ill simply by virtue of the presence of such a diagnosis in the DSM. Transgender identity is neither abnormal nor is it a medical condition per se, even if some transgendered people (though by no means all) seek medical interventions such as HRT and/or SRS. There are much better ways to provide access to such procedures without having to resort to the use of such pathologizing diagnoses, and one such way would be to amend federal law to prohibit discrimination in health care based on gender identity or expression. This is the speech I gave at Harvard a few years ago on this topic:

Jun. 03 2014 11:32 AM

The person who called in who said that in DSM-5 gender dysphoria only requires that one feels he or she was born in the wrong sex doesn't know what she is talking about.
As with virtually all diagnoses in the DSM-5, the symptoms of the disorder must cause the person to have significant impairment in the ability to function. I'm sorry Brian let this person rave on without challenging her on this.
It is unfortunate that when most non-mental professionals talk about the DSM they overlook that the symptoms of disorders are insufficient to make the diagnoses. They also need to impair significantly impair functioning. This is why people who claim every war veteran suffers from PTSD are similarly ignorant.

Jun. 03 2014 11:28 AM
Mandee from NYC

Go Pauline! I agree completely that we have to fight against pathologizing transgendered people and keep working to support an inclusive culture that accepts difference!

Jun. 03 2014 11:22 AM
The Truth from Becky

TOTAL confusion!

Jun. 03 2014 11:20 AM
Mr. Bad from NYC

I have an honest question: How does this work? I mean if a person "feels" or "thinks" they are the opposite gender but they are not (presumably because they have the right chromosomes/sex organs)why is that "feeling" not treated? Because that is the way every other mental illness is treated. I cannot think of any other mental illness that is treated with surgical treatment below the neck, can you? Finally how does becoming a mutilated man or woman(because only the external appearance of sex organs can be modified)"treat" the transgender person. It would seem to only change their body to suit their mental illness. If that is the case why can't someone who believes they are a fish or bird demand nonfunctional gills or wings be surgically constructed to suit their particular illness?

Jun. 03 2014 11:20 AM
Michelle from East Village, NYC

I am transsexual, and the importance of the surgery to me is not wanting to cry every time I saw my body. The relief I've felt from medical intervention is profound. I am also immersed in an unrelated issue that Medicare will not cover, care for my ill mother....

Jun. 03 2014 11:19 AM
Phased from nyc

wow that caller mother rocks!!!!!!!!!!!!!!
no body really wants to go through such invasive surgery unless they felt their it was matter of life/death for them.

Jun. 03 2014 11:18 AM
John A

An additional cost to society.
A new class of special needs.
A declaration that a person needs surgery physically to be complete mentally.
A removal of working body parts to replace with nonworking ones.
Somewhat shocking.

Jun. 03 2014 11:17 AM
francyne pelchar from pelham bay park

this should not be paid for. it's the individual's responsibility, just like cosmetic surgery. if someone is ugly or has a big nose, he/she should pay for the surgery. i agree with the person who said that doctors will say it's a disorder, of course, they will if they get paid for the surgeries.

Jun. 03 2014 11:16 AM
Steve from NYC

Love to hear the guest talk about trans-racial people as well. So much talk about transgender and their rights, but I identify with the minority black community since a young age. I feel as if I was born the wrong race. And I was denied scholarships to college even though I identify as black. Solely because others look at me as Caucasian. Please, help all trans communities. I deserve the minority scholarships. I studied hard. I need the scholarship or I can't go to school. But they discriminate against me. They won't allow me to be black, but I am!!

Jun. 03 2014 11:16 AM
Leo_A from NJ

No tax payer money should be going to these surgeries. I am not against people choosing to have this surgery, but at the end of the day it's a choice to have it. to the caller that said that it's like missing a lung or whatever the analogy was, you don't die from choosing to change your sex

Jun. 03 2014 11:15 AM
jgarbuz from Queens

Discrimination against old people is rampant, and against fat people, and against all kinds of people who do not look like TV or movie stars in their youth. Okay, so there is some discrimination against homosexuals in some areas too. I believe that the best person suited for any job should get the job regardless of anything else. But we will never get rid of all biases. Communism tried and failed. People are born unequal but should get equal rights under the law, and in education and such, but it is absurd to believe that we will ever do away with subrosa discrimination.

Jun. 03 2014 11:14 AM

Yes - hearing aids, dentures, eye glasses, joint replacement... before sex change.

And yes, doctors who will profit from sex change operations will agree that the proceedure is necessary.

Jun. 03 2014 11:07 AM
BK from Hoboken

I am very much pro-gay rights, support my lgbt friends, but am somewhat skeptical of this purely from a cost/insurance stance. Medicare doesn't even cover hearing aids for otherwise healthy seniors whose lives are severely affected by hearing loss. But we are going to cover what some will argue is an elective surgery?
As a 38 year old, i sincerely doubt that I will EVER get to use my Medicare benefits as it will be bankrupt by the time I am old enough. It's time for some tough decisions to be made.

Jun. 03 2014 11:03 AM
Miscellaneous from NYC

As a taxpayer, I am not interested in paying for anyone's "gender reassignment" surgeries or other medical costs involved in this procedure/treatment.

Jun. 03 2014 11:02 AM
jgarbuz from Queens

How about medicare paying for cosmetic surgery for the aged who want to look and feel better about themselves? How about rights for everybody and not just for homosexuals? And what stops heterosexuals from calling themselves gay or lesbian and demanding these rights? Is there an objective test for sexuality?

Jun. 03 2014 11:01 AM
Mr. Bad from NYC

Brave New World coming soon to a College near you...

Jun. 03 2014 11:01 AM
jgarbuz from Queens

How about medicare paying for cosmetic surgery for the aged who want to look and feel better about themselves? How about rights for everybody and not just for homosexuals? And what stops heterosexuals from calling themselves gay or lesbian and demanding these rights? Is there an objective test for sexuality?

Jun. 03 2014 11:00 AM

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