December 29, 2006
Volume 34
Issue 52
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Monday, Jan 20, 2020



State to deny gender reassignment surgery to clients of state-funded health plans
State to deny gender reassignment surgery to clients of state-funded health plans
"Political unpopularity and stigma must not form the basis of medical coverage decisions," said ERW Advocacy Director Josh Friedes.

by Robert Raketty - SGN Staff Writer

A rule change by the Health and Recovery Services Administration of the Department of Social and Health Services could leave Transgender patients without access to gender reassignment surgeries. The procedure is the only proven course of treatment for some who live with gender identity disorder (GID), claim Transgender rights advocates.

Washington was one of only a few states to cover gender reassignment surgeries for those on state-funded health plans, such as low-income state residents. Under the rule change, however, hormone treatment and psychotherapy will become the only options for Transgender patients receiving state-funded healthcare.

Despite being recognized by the leading psychiatric associations and professional groups as a treatment for GID, few government or private healthcare programs will cover gender reassignment surgery.

"In justifying its proposed rule change, DSHS relied on the Hayes Report, an anonymously-authored report (commissioned by the state) that has been widely criticized by Transgender health experts," said Equal Rights Washington Advocacy Director Josh Friedes. "For example, the World Professional Association for Transgender Health -- an international organization with hundreds of members -- has determined that surgeries for Transgender people are effective and appropriate treatment, not 'experimental.' DSHS claims that medical research does not support coverage of surgeries, but it is making a political decision to ignore the numerous studies concluding otherwise."

By adopting the rule, Friedes believes the state is perpetuating institutionalized prejudice that has resulted in the lack of comprehensive medical research of conditions that affect the Transgender population. "Rather than making use of the best evidence available, DSHS seems to be demanding near perfect research," he said. "This would be a hard standard to meet for any group, but given how marginalized Transgender people have been in our society, Transgender people will not be able to meet this standard, or perhaps even lesser standards, until the government, the medical community, and institutions put appropriate resources into Transgender health studies."

Citizens, organizations and experts had the opportunity to provide testimony at the last of two hearings on Wednesday or by submitting written testimony. ERW was one of an "impressive array of people and organizations," according to Friedes, which provided testimony against the rule change. Recently, fifty Washington State health care providers also submitted a letter to DSHS opposing the proposed rule.

Earlier this month, the Associated Students of the University of Washington, which represents the undergraduate student body, voted to add Transgender healthcare issues to its 2007 legislative priorities for its lobbyist in Olympia. According to ASUW Student Senator Bryce McKibben, students were concerned about efforts to exclude gender services and procedures from state health plans or university plans.

"In terms of direct impact, there are a number of Transgender individuals on campus -- students, faculty, and staff. In terms of the indirect, we are students who are both being educated and educating others about the values of our generation," said McKibben. "This speaks a lot to our credibility as a socially conscious and progressive student body -- taking into account the realities of modern scientific and social learning (much through medicine, some of which occurs on our campus). Lobbying in Olympia on issues like this reminds legislators that we value all people -- regardless of gender or sexual orientation -- and the healthcare for all."

Recent controversy over state-funded gender reassignment surgeries took root after the Washington State Auditor's Office questioned the practice. Republican lawmakers in Olympia quickly condemned DSHS for covering the surgery. Senator Charles Grassley, an Iowa Republican, even sent a letter to Governor Christine Gregoire informing her that he would seek to have federal inspectors look into the matter.

However, gender-reassignment surgeries have been covered only six times in the last fifteen years. In August, the state reported it had paid for two procedures totaling approximately $113,000 since 2000 and that another two procedures would be performed before the new rule takes affect.

In July, a state appeals board ruled that the state should pay for two people to receive the surgery. The state estimated that the procedures would likely cost around $50,000 to $60,000 dollars each. In each case, medical professionals testified that the surgery was best for their clients.

"Transgender health experts all over the world recognize that, for many Transgender people, surgeries are a form of medically necessary care that is essential for health and well-being," added Friedes. "The consequences for Transgender people of being denied adequate treatment are severe and, in extreme cases, can even include suicide.

"Political unpopularity and stigma must not form the basis of medical coverage decisions."

The new rule takes affect January 1, 2007. Friedes said ERW will work with the appropriate healthcare professionals and Transgender rights advocates to ensure that the issue is revisited. ERW is also circulating an online petition, which will be sent to DSHS officials and the Gov. Gregoire. To sign, visit:

SGN Contributing Writer Devin Glaser contributed to this report.

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