The US Department of Health and Human Services has ruled that that transgender people are entitled to sex-change surgery provided under Medicare Advantage insurers. An Air Force veteran, Charlene Lauderdale, sought coverage for her transitioning surgery in November 2014 but it was denied because it was not the proper treatment for her, as she had been hospitalised four times for psychiatric problems.
“This decision reaffirms that Medicare beneficiaries deserve care based on real medicine, not knee-jerk biases,” said Mara Keisling, executive director of the National Center for Transgender Equality. “We hope it sends a clear message that insurance companies need to follow the established standards of care — and that patients can fight companies who don’t.”
The background to this decision in instructive. For many years, Medicare refused to cover transgender surgery. But in May 2014 a HHS Appeals Board ruled that this exclusion was based on outdated, incomplete, and biased science and medicine.
It turns out that the board reached its decision in a rather unusual way. In 1981 Medicare described sex reassignment surgery as “controversial” and “experimental” and said that it should not be covered. When this was appealed in 2013, the Centers for Medicare & Medicaid Services (CMS) declined to defend the old determination. The only evidence presented to the appeals board was submitted by advocacy groups supporting the “aggrieved party”. The CMS presented not one sentence of evidence to defend the 1981 determination.
Our legal system is adversarial and its integrity depends on an honest encounter of two conflicting points of view.