National
Medicare asked to review ban on gender reassignment surgery
Anti-trans policy established in 1981
LGBT groups are askng Medicare to lift its ban on gender reassignment surgery. (Image public domain)
Medicare is being asked to review a policy that prohibits transgender people from receiving coverage for gender reassignment surgery.
Last week, a quartet of LGBT rights groups — the National Center for Lesbian Rights, the American Civil Liberties Union, Gay & Lesbian Advocates & Defenders and civil rights attorney Mary Lou Boelcke — filed an administrative challenge to eliminate Medicare’s ban on coverage for the procedure.
Joshua Block, a staff attorney with the ACLU’s LGBT Project, said the challenge was filed because a policy change is “overdue.”
“It is completely out of line with any scientific or medical evidence or standards of practice,” Block said. “There are people out there who are in desperate need of the surgery. Their doctors have told them they need the surgery. And they’re being told it’s not covered because it was allegedly experimental 30 years ago.”
The challenge, sent on March 26, was filed on behalf of Denee Mallon, a transgender woman in Albuquerque, New Mexico. A Medicare recipient who’s age 73, Mallon was recommended to have gender reassignment surgery by doctors to treat her gender dysphoria.
A veteran of the U.S Army, Mallon joined the the service when she was 17 and worked as a forensics investigator for a city police department. She was later diagnosed with gender identity disorder.
Mara Keisling, executive director of the National Center for Transgender Equality, said she’s “very excited” about the challenge.
“Americans, in general, are really tired of health care decisions being made by legislators and bureaucrats and insurance companies,” Keisling said. “Most of us believe that health care decisions should be made by patients and doctors, and the medical community is pretty unified. This is a legitimately necessary surgery.”
Keisling said NCTE isn’t directly involved in the challenge because it involves lawyers representing clients, and the organization doesn’t provide those legal services.
The ban, which is codified as National Coverage Determination 140.3, was put in place in 1981 during the Reagan administration. Keisling said the ban was put in place as a result of the stigma on transgender people at the time and lobbying from insurance groups.
The National Coverage Determination from 1981 spells out why transgender people are unable to receive this coverage under Medicare.
“Transsexual surgery for sex reassignment of transsexuals is controversial,” the regulation states. “Because of the lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental. Moreover, there is a high rate of serious complications for these surgical procedures. For these reasons, transsexual surgery is not covered.”
Despite this policy, the American Medical Association and the American Psychological Society support gender reassignment surgery for transgender people.
Block said the challenge has been filed at this time — more than 30 years after the ban was put in place — because “each year that goes by, it becomes ever more clear how unfounded the categorical sweeping ban is.”
“Each year that goes by, there’s more and more evidence that just reaffirms the widely accepted view that these surgeries are safe, medically necessary and effective to treat a serious medical condition,” Block said.
Now that the challenge has been filed, the Department Appeals Board of the Department of Health & Human Services is set to review the ban, determine if it’s reasonable under current standards of care and make a decision on whether to reverse it. It’s estimated the process could take months to resolve.
It’s unclear how many transgender people the change would affect. A recent study from the Williams Institute found that one-third of one percent of Americans identify as transgender. Given that an estimated 48 million people receive coverage under Medicare, about 144,000 transgender people are believed to receive coverage under Medicare.
In an apparently separate development last week, the Centers for Medicare & Medicaid Services included a statement on its website asking for public comment because it would reconsider the ban. But the notice was removed on Friday from the agency’s website after conservative media, such as Drudge Report, took note of it.
Brian Cook, a CMS spokesperson, told the Blade solicitation for public comment was removed as a result of the legal challenge from LGBT groups coming to light.
“An administrative challenge to our 1981 Medicare national coverage determination concerning sex reassignment surgery was just filed,” Cook said. “This administrative challenge is being considered and working its way through the proper administrative channels. In light of the challenge, we are no longer re-opening the national coverage determination for reconsideration.”
Although the challenge was filed last week, LGBT groups didn’t notify the press about it until Monday. Block said the notice that went up on the Medicare website — and its subsequent removal — prompted the news statement.
“I think there were a lot of questions — particularly by members of the transgender community — about the status of NCD and what this administrative challenge was, and so we thought it was important to give affirmative clarification about what this challenge is and how it’s separate from the CMS process,” Block said.
U.S. Federal Courts
Federal judge scraps trans-inclusive workplace discrimination protections
Ruling appears to contradict US Supreme Court precedent
Judge Matthew Kacsmaryk of the U.S. District Court for the Northern District of Texas has struck down guidelines by the U.S. Equal Employment Opportunity Commission designed to protect against workplace harassment based on gender identity and sexual orientation.
The EEOC in April 2024 updated its guidelines to comply with the U.S. Supreme Court’s ruling in Bostock v. Clayton County (2020), which determined that discrimination against transgender people constituted sex-based discrimination as proscribed under Title VII of the Civil Rights Act of 1964.
To ensure compliance with the law, the agency recommended that employers honor their employees’ preferred pronouns while granting them access to bathrooms and allowing them to wear dress code-compliant clothing that aligns with their gender identities.
While the the guidelines are not legally binding, Kacsmaryk ruled that their issuance created “mandatory standards” exceeding the EEOC’s statutory authority that were “inconsistent with the text, history, and tradition of Title VII and recent Supreme Court precedent.”
“Title VII does not require employers or courts to blind themselves to the biological differences between men and women,” he wrote in the opinion.
The case, which was brought by the conservative think tank behind Project 2025, the Heritage Foundation, presents the greatest setback for LGBTQ inclusive workplace protections since President Donald Trump’s issuance of an executive order on the first day of his second term directing U.S. federal agencies to recognize only two genders as determined by birth sex.
Last month, top Democrats from both chambers of Congress reintroduced the Equality Act, which would codify LGBTQ-inclusive protections against discrimination into federal law, covering employment as well as areas like housing and jury service.
The White House
Trump travels to Middle East countries with death penalty for homosexuality
President traveled to Saudi Arabia, Qatar, and United Arab Emirates
Homosexuality remains punishable by death in two of the three Middle East countries that President Donald Trump visited last week.
Saudi Arabia and Qatar are among the handful of countries in which anyone found guilty of engaging in consensual same-sex sexual relations could face the death penalty.
Trump was in Saudi Arabia from May 13-14. He traveled to Qatar on May 14.
“The law prohibited consensual same-sex sexual conduct between men but did not explicitly prohibit same-sex sexual relations between women,” notes the State Department’s 2023 human rights report, referring specifically to Qatar’s criminalization law. “The law was not systematically enforced. A man convicted of having consensual same-sex sexual relations could receive a sentence of seven years in prison. Under sharia, homosexuality was punishable by death; there were no reports of executions for this reason.”
Trump on May 15 arrived in Abu Dhabi, the capital of the United Arab Emirates.
The State Department’s 2023 human rights report notes the “penalty for individuals who engaged in ‘consensual sodomy with a man'” in the country “was a minimum prison sentence of six months if the individual’s partner or guardian filed a complaint.”
“There were no known reports of arrests or prosecutions for consensual same-sex sexual conduct. LGBTQI+ identity, real or perceived, could be deemed an act against ‘decency or public morality,’ but there were no reports during the year of persons prosecuted under these provisions,” reads the report.
The report notes Emirati law also criminalizes “men who dressed as women or entered a place designated for women while ‘disguised’ as a woman.” Anyone found guilty could face up to a year in prison and a fine of up to 10,000 dirhams ($2,722.60.)
Trump returned to the U.S. on May 16.
The White House notes Trump during the trip secured more than $2 trillion “in investment agreements with Middle Eastern nations ($200 billion with the United Arab Emirates, $600 billion with Saudi Arabia, and $1.2 trillion with Qatar) for a more safe and prosperous future.”
Former President Joe Biden traveled to Saudi Arabia in 2022.
Saudi Arabia is scheduled to host the 2034 World Cup. The 2022 World Cup took place in Qatar.
State Department
Rubio mum on Hungary’s Pride ban
Lawmakers on April 30 urged secretary of state to condemn anti-LGBTQ bill, constitutional amendment
More than 20 members of Congress have urged Secretary of State Marco Rubio to publicly condemn a Hungarian law that bans Pride events.
California Congressman Mark Takano, a Democrat who co-chairs the Congressional Equality Caucus, and U.S. Rep. Bill Keating (D-Mass.), who is the ranking member on the House Foreign Affairs Committee’s Europe Subcommittee, spearheaded the letter that lawmakers sent to Rubio on April 30.
Hungarian lawmakers in March passed a bill that bans Pride events and allow authorities to use facial recognition technology to identify those who participate in them. MPs last month amended the Hungarian constitution to ban public LGBTQ events.
“As a NATO ally which hosts U.S. service members, we expect the Hungarian government to abide by certain values which underpin the historic U.S.-Hungary bilateral relationship,” reads the letter. “Unfortunately, this new legislation and constitutional amendment disproportionately and arbitrarily target sexual and gender minorities.”
Prime Minister Viktor Orbán’s government over the last decade has moved to curtail LGBTQ and intersex rights in Hungary.
A law that bans legal recognition of transgender and intersex people took effect in 2020. Hungarian MPs that year also effectively banned same-sex couples from adopting children and defined marriage in the constitution as between a man and a woman.
An anti-LGBTQ propaganda law took effect in 2021. The European Commission sued Hungary, which is a member of the European Union, over it.
MPs in 2023 approved the “snitch on your gay neighbor” bill that would have allowed Hungarians to anonymously report same-sex couples who are raising children. The Budapest Metropolitan Government Office in 2023 fined Lira Konyv, the country’s second-largest bookstore chain, 12 million forints ($33,733.67), for selling copies of British author Alice Oseman’s “Heartstopper.”
Former U.S. Ambassador to Hungary David Pressman, who is gay, participated in the Budapest Pride march in 2024 and 2023. Pressman was also a vocal critic of Hungary’s anti-LGBTQ crackdown.
“Along with years of democratic backsliding in Hungary, it flies in the face of those values and the passage of this legislation deserves quick and decisive criticism and action in response by the Department of State,” reads the letter, referring to the Pride ban and constitutional amendment against public LGBTQ events. “Therefore, we strongly urge you to publicly condemn this legislation and constitutional change which targets the LGBTQ community and undermines the rights of Hungarians to freedom of expression and peaceful assembly.”
U.S. Reps. Pramila Jayapal (D-Wash.), Sarah McBride (D-Del.), Jim Costa (D-Calif.), James McGovern (D-Mass.), Gerry Connolly (D-Va.), Summer Lee (D-Pa.), Joaquin Castro (D-Texas), Julie Johnson (D-Texas), Ami Bera (D-Calif.), Mark Pocan (D-Wis.), Lloyd Doggett (D-Texas), Becca Balint (D-Vt.), Gabe Amo (D-R.I.), Ted Lieu (D-Calif.), Robert Garcia (D-Calif.), Dina Titus (D-Nev.), Raja Krishnamoorthi (D-Ill.), Jan Schakowsky (D-Ill.) and Mike Quigley (D-Ill.) and Del. Eleanor Holmes Norton (D-D.C.) signed the letter alongside Takano and Keating.
A State Department spokesperson on Wednesday declined to comment.
Marjorie Taylor Greene’s bill to criminalize gender affirming care advances
Delaware considers enshrining same-sex marriage into state Constitution
Returning to Alcatraz: Memory through a queer lens
PHOTOS: Equality Prince William Pride
Chilean lawmakers back report that calls for suspension of program for trans children
Ashley Biden to speak at Blade’s Summer Kickoff Party in Rehoboth Beach
Pete Buttigieg, eyeing a presidential run, holds Iowa town hall
Global LGBTQ rights crackdown overshadows this year’s IDAHOBiT
Calendar: May 16-22
