Trans Vets Deserve Surgery Benefits

It's time the VA paid for gender-confirmation surgery for trans servicemembers who need it, Rep. Mike Quigley of Illinois argues.

By Rep. Mike Quigley

 

September 29 2016 

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Dee Fulcher served our country in the U.S. Marine Corps for nearly a dozen years. Giuliano Silva is a recent veteran of the U.S. Army. Outside of the obvious similarities, Ms. Fulcher and Mr. Silva have one particular trait in common — they both identify as transgender. And on May 9 of this year, they bravely submitted a petition to the U.S. Department of Veterans Affairs asking the department to rewrite the discriminatory rule that prohibits providing transition-related surgeries for transgender veterans.

Currently, the VA provides many services for transgender veterans, including hormone therapy, mental health care, preoperative evaluation, and long-term care following gender-confirmation surgery, but gender-confirmation surgery itself is noticeably missing from the list.

The VA is now exploring a regulatory change that would allow it to perform gender-confirmation surgery, a change that would align the VA with the latest research on treatment options for transgender people, which has evolved greatly since the VA’s ban was instituted in the 1990s. To help further this cause, I was proud to lead a letter with some of my Congressional Transgender Equality Task Force colleagues, which urged the VA to move swiftly on this issue and bring the VA’s policy in line with most other federal government agencies.

Medicare made the change in 2014, after its ban on gender-confirmation surgery had been in place for 33 years. The change came in response to a lawsuit filed by a transgender woman, who also happens to be a veteran. And although the procedure was considered outside the mainstream in years past, major health organizations, including the American Medical Association, have determined that gender-confirmation surgery is effective and, perhaps more importantly, medically necessary for many transgender people. That’s not to say that every transgender person needs or even wants surgery, but those procedures can be lifesaving for those who do want them.

And for a veteran like Silva, who is currently living on unemployment benefits, paying out of pocket for gender-confirmation surgery is out of the realm of possibility. The surgeries can cost upward of $50,000, crippling an individual’s finances. However, several studies and the experience of some states and employers have found that providing gender-confirmation surgery based on individual medical necessity has extremely little to no net cost for large insurers. Even better, it potentially provides long-term savings to governments by preventing future medical and mental health care costs, such as treatment of suicide attempts or substance abuse.

Fulcher and Silva are not the only American veterans who desperately desire to represent themselves as they truly feel. And as our country continues to become a more open and inclusive place, this rule change could impact countless lives in a positive way. In 2013 the VA treated more than 2,500 veterans for gender dysphoria, with the exception of providing surgical care, of course. And a study by the University of California, Los Angeles’s Williams Institute estimates that 150,000 transgender Americans have served or are currently serving in the military. 

This past year has proved historic for transgender equality and visibility. At no other time in our nation’s history has the transgender community better or more publically advocated for full inclusion throughout all parts of society and equal protection under the law. We’ve made significant gains, yet more work remains to be done.

Our veterans earned the benefits provided to them through dedicated service to the protection of our country. And it is our collective responsibility to ensure that all of our veterans are able to access the health care they have dutifully earned. 

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MIKE QUIGLEY is a Democratic U.S. congressman representing Illinois's 5th congressional district, which includes part of Chicago and its suburbs.

 
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