Progress on Transgender Rights and Health

From The New York Times:

June 9, 2014

Progress on civil rights typically comes in incremental steps that discard old policies for new approaches advancing fair treatment. The Obama administration recently took such a step by reversing a 1981 policy that excluded gender reassignment surgery from coverage under Medicare.

A Health and Human Services Department’s appeals board concluded in May that the exclusion was “no longer reasonable” because the surgery is safe and effective for individuals diagnosed with gender dysphoria — the medical term applied to those whose identities differ from their gender at birth — and can no longer be considered experimental. Since very few people choose to have the surgery, and even fewer after age 65, the budget consequences will be negligible. But the change will help relieve the anguish of individuals who need and want the procedure and otherwise could not afford it.

As The Times’s Roni Caryn Rabin has reported, a small but growing number of large companies and university health plans have started to cover gender transition services. The move by the health and human services board is expected to accelerate that trend because many health plans look to Medicare in setting coverage guidelines. The ruling is all the more gratifying because it coincides with other positive developments, including Defense Secretary Chuck Hagel’s stated willingness to review the military’s senseless ban on transgender service, the enactment of Maryland’s new law extending civil rights protections to transgender people, and the demise, for insufficient signatures, of a conservative drive to put repeal of Maryland’s new law on the ballot in November.

New York State provided further good news last week when it changed a state policy that required transgender people born in New York to provide proof of gender reassignment surgery in order to change the gender designation on their birth certificate. Going forward, a medical provider’s affidavit of “appropriate clinical treatment” will be sufficient. Birth certificates that do not conform with the holder’s gender identity and expression can result in harassment and humiliation and threaten eligibility for jobs. Regrettably, the change does not apply to New York City, which has its own system for issuing birth certificates, and which should quickly adopt the state’s enlightened reform.

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