First on CNN: Biden administration moves to make gender confirmation surgery available through Veteran Affairs health care system
McDonough announced the move, whose plans were first reported on by CNN, on Saturday at a Pride event at the Orlando Vet Center in Florida.
“We are taking the first necessary steps to expand VA care to include gender verification surgery – enabling transgender vets to go through the full gender verification process with VA by their side,” McDonough said at the event.
The change marks a major shift in care for eligible transgender veterans. The National Center for Transgender Equality estimates that there are approximately 134,000 transgender veterans.
While the VA Health Benefits package includes coverage for mental health services and hormone therapy, it has excluded coverage or funding for a sex confirmation surgery, which is considered a “medically necessary intervention” by people with gender dysphoria to “use distress over.” Describing the incongruence between gender and anatomy, “according to an opinion article in the AMA Journal of Ethics.
McDonough said the decision to make this change was based on the “recommendation of our clinicians, so this is a healthcare decision that has very real physical health implications as well as significant mental health implications.”
Gender confirmation, or surgery, is a procedure, or a series of procedures, often to reconstruct genital organs so that a person’s anatomy matches the gender with which they identify. Gender-affirming surgery was initially viewed as a cosmetic or elective procedure, but research shows that surgery is an effective treatment for people with gender dysphoria.
Sex confirmation surgery has “been shown to be effective in alleviating serious health conditions such as suicidality, substance abuse and dysphoria,” said a VA spokesman.
“Partly due to minority stress, LGBTQ + veterans are far more likely to experience mental illness and suicidal ideation than those outside their community, but they are far less likely to seek routine care, largely because they fear discrimination,” McDonough said.
Because of this, “it perpetuates a cycle in which LGBTQ vets and individuals have less access to preventive health services, less use of health services, and more negative health care experiences,” said McDonough. He called this “unacceptable”.
McDonough acknowledged that “for far too long and for far too many” respect and care “has not been the norm for our LGBTQ + community and our veterans,” but said the VA “is determined to continue down this path. The path of the Progress. “
McDonough said the move to include gender confirmation surgery in VA health care was ultimately Biden’s decision.
“It is the President’s decision, and we just announced today that we are going to implement that decision. That decision is being made for many, many months now, but ultimately it is the responsibility of the President, “said McDonough. “He made it clear that the time had come and that is exactly what we are going to do.”
Leading medical associations such as the American Medical Association, the American Psychological Association, and the American Psychiatric Association have issued statements supporting gender-affirming coverage that includes medical and surgical treatments for gender dysphoria. Major insurance companies, including Blue Cross Blue Shield in many states and Kaiser Permanente, have also recognized gender-based surgery as a medically necessary health benefit, not just cosmetic surgery, according to an opinion piece in the AMA Journal of Ethics.
McDonough’s announcement is just the beginning of the process. In order for a sex confirmation surgery to be covered by VA health care and included in coverage offered at VA hospitals, policy changes will need to be made. The process of creating a new federal regulation can take years. The VA plans to begin the state rulemaking process this summer to make that change, a VA spokesman said.
“There are several steps to be taken and it will take time,” said McDonough. “But we are moving methodically because we want this important change in policy to be implemented in a way that has been carefully considered to ensure that the services provided to veterans meet VA’s rigorous standards for quality healthcare correspond.”
McDonough said he has already contacted members of Congress to make sure they are aware of the move. He said the process would be “transparent” and “in full coordination with Congress”.
McDonough also ordered an ongoing review of all departmental policies in late February to “ensure transgender veterans and employees are not being discriminated against on the basis of gender and expression.”
Changing the VA’s health policy is a positive move to making real progress, Jennifer Dane, executive director of the Modern Military Association of America, an advocacy group that supports LGBTQ + veterans and military personnel, told CNN.
“It takes more than words to make real progress, and we are delighted with Secretary McDonough’s announcement that the VA is adding gender-based confirmatory surgery to care and updating health services to be more inclusive,” Dane told CNN in a statement. “These are clear examples of how words can be turned into action. This is the only way we can move forward.”
The President and CEO of the national LGBTQ + media organization GLAAD, Sarah Kate Ellis, also praised the move.
“Transgender veterans deserve equal access to medically necessary and life-saving health care, including sex confirmation surgery,” Ellis said in a statement to CNN. “This news is not just an overdue victory for transgender veterans, but the latest move by Sec. McDonough and the VA to validate LGBTQ veterans.”
This story has been updated with McDonough’s remarks.