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Medicare asked to review ban on gender reassignment surgery

Anti-trans policy established in 1981

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transgender, caduceus, medicare, gay news, Washington Blade, health
transgender, caduceus, medicare, gay news, Washington Blade, health

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.

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The White House

WNBA players back petition for White House to ‘prioritize’ Brittney Griner’s release

Phoenix Mercury center detained in Russia in February

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Russian state TV has released a photo of WNBA star Brittney Griner, who was arrested on drug charges in the country after Russian officials say cannabis oil was found in her luggage. (Screenshot)

The Women’s National Basketball Players Association has endorsed a petition that urges the Biden administration to “prioritize” WNBA star Brittney Griner’s release.

“It is imperative that the U.S. government immediately address this human rights issue and do whatever is necessary to return Brittney home quickly and safely,” reads the Change.org petition that Tamryn Spruill, a freelance journalist and author, created.

“The WNBPA and its members proudly join Tamryn Spruill, the creator of this petition, in demanding that lawmakers prioritize Griner’s return,” it continues. “White House and Biden adminsitration, we ask that you take action today—doing whatever is necessary—to bring Brittney Griner home swiftly and safely.”

More than 135,000 people have signed the petition.

Spruill on Saturday in a tweet said the WNBPA, a union that represents WNBA players, partnered with them and Change.org “in demanding that our elected officials work urgently to gain BG’s swift and safe release.”

Griner — a center for the Phoenix Mercury and a two-time Olympic gold medalist who is a lesbian and married to her wife — was taken into custody at Moscow’s Sheremetyevo Airport in February. Russian officials said customs inspectors found hashish oil in her luggage.

The State Department earlier this month determined Russia “wrongfully detained” Griner. A Russian court on Friday extended her detention for another month.

“The Russian system wrongfully detained Ms. Griner,” then-White House Press Secretary Jen Psaki told reporters on Friday during her last White House briefing. “We take our responsibility to assist U.S. citizens seriously.  And we will continue to press for fair and transparent treatment for all U.S. citizens when they are subject to legal processes overseas.”
 
“Now, because the State Department recategorized her as wrongfully detained, it means that our Special Presidential Envoy for Hostage Affairs — it’s quite a title but a well-deserved one — is going to be overseeing this case and leading the effort,” added Psaki. “Because it’s a deliberative process and we know from experience of bringing other Americans home, we’re just not going to detail what those efforts look like at this point in time.”

Griner faces up to 10 years in prison.

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Wyoming

GOP Sen. Cynthia Lummis issues ‘apology’ after transphobic comments during graduation speech

“My reference to the existence of two sexes was intended to highlight the times- times in which the metric of biological sex is under debate”

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Screenshot/University of Wyoming YouTube

During her speech delivered to the University of Wyoming’s College of Arts and Sciences and the College of Education commencement Saturday afternoon, Republican U.S. Senator Cynthia Lummis told graduates that “the existence of two sexes, male and female” was a “fundamental scientific truth.” 

The audience’s immediate reaction to her transphobic remarks were loud expressions of disapproval including jeering, boos, and demands she leave the podium.

The senator’s remarks came in the latter third of her twenty-minute address which had primarily focused on the critical need for teachers and in the fields of agriculture and other endeavors she noted were Wyoming hallmarks.

In a statement released by her office Sunday, a spokesperson noted that Lummis was apologizing to those who felt “un-welcomed or disrespected” by the comments.

“My reference to the existence of two sexes was intended to highlight the times in which we find ourselves, times in which the metric of biological sex is under debate with potential implications for the shared Wyoming value of equality,” the statement read.

“I share the fundamental belief that women and men are equal, but also acknowledge that there are biological differences and circumstances in which these differences need to be recognized. That being said, it was never my intention to make anyone feel un-welcomed or disrespected, and for that I apologize. I have appreciated hearing from members of the University of Wyoming community on this issue, and I look forward to continuing this dialogue.” 

An Assistant Professor in the University of Wyoming’s Sociology Program in the College of Arts and Sciences tweeted pointing out the graduate’s reactions along with the fact that the UW campus community had recently lost a Trans student to suicide, making the senator’s remarks more hurtful.

The university’s president also issued a statement Sunday expressing support for all members of the UW campus and community:

May 15, 2022

To the UW community:

On Saturday, the university celebrated spring 2022 commencement with a series of events that showcased the best of what makes us special: our students, our staff, our faculty and our ability to openly embrace and debate complex issues. One of our speakers made remarks regarding biological sex that many on campus take issue with. While we respect the right of all to express their views, from students to elected officials, we unequivocally state that UW is an institution that supports and celebrates its diverse communities that collectively make us the wonderful place that we are.

Thank you to the many students and families who celebrated with us this weekend. We welcome the incredible individuality and intellect of all our dynamic and diverse students and never want you to feel otherwise.

Sincerely,

Ed Seidel, President

Senator Cynthia Lummis’ remarks are at the 50:11 time mark:

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U.S. Federal Courts

Federal court blocks part of Ala. trans medical treatment law

Trump-appointed judge issued late Friday ruling

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Hugo L. Black United States Courthouse, Birmingham, Alabama (Photo Credit: US Courts/DXR)

In a 32 page ruling released Friday evening, U.S. District Judge Liles Burke preliminarily enjoined the state from enforcing the law criminalizing medical care for transgender minors in Alabama.

The law made it a felony for doctors and licensed healthcare providers to give gender-affirming puberty blockers and hormones to trans minors.

Burke, who was nominated to the bench by former President Trump to serve on the U.S. District Court for the Northern District of Alabama, wrote that the section of the Alabama Vulnerable Child Compassion and Protection Act that makes treatment of trans minor children a felony; “the court finds that there is a substantial likelihood that Section 4(a)(1)–(3) of the act is unconstitutional and, thus, enjoins defendants from enforcing that portion of the act pending trial.”

Burke however ruled that all other provisions of the act remain in effect, specifically: (1) the provision that bans sex-altering surgeries on minors; (2) the provision prohibiting school officials from keeping certain gender-identity information of children secret from their parents; and (3) the provision that prohibits school officials from encouraging or compelling children to keep certain gender-identity information secret from their parents.

The U.S. Justice Department had challenged the state’s Senate Bill 184 — a bill that would criminalize doctors for providing best-practice, gender-affirming care to trans and non-binary youth.

In the filing by the Justice Department, the complaint alleges that the new law’s felony ban on providing certain medically necessary care to transgender minors violates the Fourteenth Amendment’s Equal Protection Clause. The department is also asking the court to issue an immediate order to prevent the law from going into effect.

SB 184 makes it a felony for any person to “engage in or cause” specified types of medical care for transgender minors. SB 184 thus discriminates against trans youth by denying them access to certain forms of medically necessary care.

It further discriminates against trans youth by barring them from accessing particular procedures while allowing non-transgender minors to access the same or similar procedures. The penalties for violating the law include up to 10 years of imprisonment and a fine of up to $15,000. SB 184 would force parents of trans minors, medical professionals, and others to choose between forgoing medically necessary procedures and treatments, or facing criminal prosecution.

The Justice Department’s complaint alleges that SB 184 violates the Equal Protection Clause by discriminating on the basis of sex and trans status.

LGBTQ legal rights advocates SPLC, GLAD, NCLR and HRC, joined by co-counsel King and Spalding LLP and Lightfoot, Franklin and White LLC, had previously filed a legal challenge in federal district court against Alabama SB 184.

Shannon Minter, the legal director for the National Center for Lesbian Rights, one of the legal rights advocacy groups who had sued Alabama told the Washington Blade late Friday night:

“We are thrilled by this outcome, which will provide enormous relief to transgender children and their families. As the court recognizes, this is well established medical care that has been endorsed by 22 major medical associations. Thanks to this decision, kids in Alabama can now continue to receive this lifesaving care, and their doctors cannot be prosecuted simply for doing their jobs. This is a huge victory for compassion and common sense and a much needed antidote to the tidal wave of hostile legislation targeting these youth.”

In addition to the Justice Department, the doctors challenging SB 184 in Ladinsky v. Ivey are Dr. Morissa J. Ladinsky and Dr. Hussein D. Abdul-Latif, both providers at the Children’s Hospital of Alabama and members of the medical staff at the University of Alabama at Birmingham Hospital and the teaching staff at UAB School of Medicine. Ladinsky and Abdul-Latif have long-term expertise in caring for trans children of Alabama families. Under SB 184, they both face criminal penalties including up to 10 years in prison if they continue to provide that support to their patients.

The Alabama family plaintiffs are proceeding anonymously to protect their children. They include Robert Roe, and his 13-year-old trans daughter Mary, of Jefferson County; and Jane Doe and her 17-year-old-trans son John, of Shelby County. These families have deep ties to Alabama. If SB 184 is allowed to go into effect both families will be forced to choose between leaving the state, breaking the law, or facing devastating consequences to their children’s health.

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