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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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Mississippi

Art used to spotlight people of color lost to AIDS in the South

National AIDS Memorial, Southern AIDS Coalition created Change the Pattern exhibit

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The National AIDS Memorial and Southern AIDS Coalition have announced a new initiative to raise awareness about the impact of HIV/AIDS among communities of color in the South. (Photo courtesy of the National AIDS Memorial)

The National AIDS Memorial has joined forces with the Southern AIDS Coalition to stage a series of art exhibitions and educational forums to honor Black and Brown people in the South who have been lost to HIV/AIDS.

The initiative, titled Change the Pattern, began in Jackson, Miss., on Wednesday with curated quilt exhibitions, displays, educational forums, advocacy, storytelling and quilt-making, according to a press release from the National AIDS Memorial. A $2.4 million grant from the biopharmaceutical company Gilead Sciences, Inc., funded Change the Pattern.

More than 500 hand-stitched quilt panels from the area were featured in what the National AIDS Memorial says is “the largest display of the AIDS Memorial Quilt ever” in Mississippi.

“By creating an empowering message and safe spaces for conversation, we can uplift, inspire and make progress toward ending the HIV epidemic, challenge cultural stigmas and continue the legacy of advocacy that the quilt represents,” said National AIDS Memorial CEO John Cunningham in the release. 

Change the Pattern was announced in honor of Southern HIV/AIDS Awareness Day during the Southern AIDS Coalition’s annual Saving Ourselves Symposium that took place in August. 

The conference, which was heavily attended by LGBTQ activists from the South, featured 100 quilt panels, and attendees participated in quilt-making workshops to make new quilt panels representing their loved ones.

Interested LGBTQ advocacy organizations in the South were invited to apply for funding to support local quilt-making workshops in their communities so as to ensure that the legacies of Black and Brown people are captured through newly-sewn panels on the quilt through the Memorial’s Call My Name program, according to the National AIDS Memorial press release. 

The application process opened on Sept. 15 with up to 35 eligible organizations receiving as much as $5,000 to support hosting local workshops. 

The first major Change the Pattern Quilt was founded 35 years ago as a visual representation of the need to end stigma and provide equitable resources to communities most impacted by HIV/AIDS, according to Southern AIDS Coalition Executive Director Dafina Ward.

“Change the Pattern is a call to action and change in the South,” said Ward. “Quilt-making has such a deep cultural connection in the Black community and in the South. The sharing and telling of these powerful stories through the quilt, coupled with advocacy and open dialogue, can help end HIV-related stigma and bring the stories of those we’ve lost to light.”

As the Change the Pattern initiative occurs, conversations about how to handle health epidemics within LGBTQ communities of color have become national topics, especially with the prevalence of monkeypox cases amongst Black gay men.

Despite earlier panic about the disease, the Centers for Diseases Control and Prevention in a report released on Wednesday said that individuals who were vaccinated against the disease were less likely to be affected over the summer compared to those who weren’t. 

The effectiveness and duration of immunity after a single dose, however, is not known, and few individuals in the current outbreak have completed the recommended two-dose series, according to the report. 

The most recent CDC data reports that 25,509 monkeypox cases have thus far been confirmed in the U.S. Only one death has been reported.

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U.S. Federal Courts

Doctor, transgender spouse indicted for passing information to Russia

Jamie Lee Henry first active-duty Army officer to come out as trans

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Jamie Lee Henry and their spouse Anna Gabrielian (Photos from social media)

A federal grand jury on Wednesday handed down an indictment of a Johns Hopkins anesthesiologist and her spouse, a doctor and major in the U.S. Army, with conspiracy and for the disclosure of individually identifiable health information related to their efforts to assist Russia in connection with the conflict in Ukraine.

The office of the U.S. Attorney for the District of Maryland in a press release stated Anna Gabrielian, 36, and her spouse, Jamie Lee Henry, 39, both of Rockville, Md., both of whom had secret clearances, were attempting to provide medical information about members of the military to the Russian government.

Gabrielian and Henry met with an individual they believed to be associated with the Russian government, but who was, in fact, an Federal Bureau of Investigation Undercover Agent.

Court documents indicate Gabrielian told the FBI agent posing as a Russian operative that she had previously reached out to the Russian Embassy by email and phone, offering Russia her and her spouses’ assistance.

According to the U.S. Attorney’s office, Gabrielian told the FBI agent that, although Henry knew of Gabrielian’s interaction with the Russian Embassy, she never mentioned Henry’s name to the Russian Embassy.

In the narrative released by the U.S. Attorney’s office, on Aug. 17, 2022, Gabrielian met with the FBI at a hotel in Baltimore. During that meeting, Gabrielian told the FBI she was motivated by patriotism toward Russia to provide any assistance she could to Russia, even if it meant being fired or going to jail. 

She proposed potential cover stories for her meeting with the “Russians” and stressed the need for “plausible deniability” in the event she was confronted by American authorities. Gabrielian also told the FBI that, as a military officer, Henry was currently a more important source for Russia than she was, because they had more helpful information, including how the U.S. military establishes an army hospital in war conditions and information about previous training provided by the U.S. military to Ukrainian military personnel. 

Henry identifies as a “transgender military physician” on their Twitter account.

Henry received public attention in 2015 after becoming the first known active-duty Army officer to come out as trans.

Henry was at one point a member of SPARTA, the nation’s largest nonprofit representing actively-serving trans U.S. servicemembers. A spokesperson for SPARTA, in an emailed statement commenting on the announcement of the arrest and indictment of Henry and their spouse told the Washington Blade:

“Transgender people are as diverse as the societies to which they belong. One’s gender identity neither increases nor decreases a propensity towards alleged criminal activity.”

As stated in the indictment, Gabrielian is an anesthesiologist and worked at Medical Institution 1 in Baltimore.  

Henry, a major in the U.S. Army who held a secret-level security clearance, is Gabrielian’s spouse and a doctor. During the time of the alleged conspiracy, Henry worked as a staff internist stationed at Fort Bragg, the home of the Army’s XVIII Airborne Corps, headquarters of the U.S. Army Special Operations Command and the Womack Army Medical Center.

Gabrielian was scheduled to have initial appearance at 11:30 a.m. on Thursday in U.S. District Court in Baltimore before U.S. Magistrate Judge Brendan A. Hurson. Henry is also expected to have an initial appearance today, although a time has not yet been set.

Full statement from SPARTA:

“SPARTA, a non-profit advocacy organization representing transgender Service members in the United States, is saddened to learn of the arrest and indictment of Jamie Lee Henry, an officer in the U.S. Army and a medical doctor.

SPARTA has long advocated for the inclusion and total equity for transgender persons throughout the United States uniformed services. Today, thousands are serving honorably and authentically at home stations worldwide.

The actions alleged in the indictment do not reflect Henry’s identity as transgender. Their alleged actions are those of an individual and should not be taken as a representation of transgender people broadly or transgender members of the military specifically.

All people in the United States are entitled to the same rights, including due process and the presumption of innocence in this case. SPARTA does not condone any actions alleged in the indictment and expects the process to play out fairly and equitably as it would for anyone accused of a crime.”

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The unvaccinated are 14 times more likely to contract monkeypox: health officials

Guidance updated to allow shots in places other than forearm

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U.S. health officials are celebrating data finding the monkeypox contraction is lower among people who are vaccinated.

U.S. health officials are celebrating preliminary data on the vaccine used in the monkeypox outbreak, which has led them to conclude eligible persons who didn’t get a shot were 14 times more likely to become infected than those who are vaccinated.

The new data, as described by health officials on the White House monkeypox task force during a call with reporters on Wednesday, comes as the overall number of new cases of monkeypox is in sharp decline, although considerable racial disparities persist in the remaining cases as Black and Latino people are overrepresented in the numbers.

Rochelle Walensky, director of the Centers for Disease Control & Prevention, said during the conference call the preliminary data — collected from 32 states between July 2022 and September 2022 — provides an early shapshot of the effectiveness of the vaccine and cause for optimism on the path forward.

“These new data provide us with a level of cautious optimism that the vaccine is working as intended,” Walkensky said. “These early findings and similar results from studies and other countries suggest even one dose of the monkeypox vaccine offers at least some initial protection against infection.”

Walensky during the conference call admitted the data is incomplete in numerous ways. For example, the data is based on information on individuals who have obtained only the first shot as opposed to both shots in the two-shot vaccination process. (The data showing positive results from individuals who have only one shot contradicts previous warnings from the same U.S. health officials that one shot of the monkeypox vaccine was insufficient.)

The data also makes no distinction between individuals who have obtained a shot through subcutaneous injection, a more traditional approach to vaccine administration, as opposed to intradermal injection, which is a newer approach adopted in the U.S. guidance amid the early vaccine shortage. Skeptics of the new approach have said data is limited to support the idea the intradermal injection is effective, particularly among immunocompromised people with HIV who have been at higher risk of contracting monkeypox.

Not enumerated as part of the data were underlying numbers leading health officials to conclude the unvaccinated were 14 times more likely to contract monkeypox as opposed to those with a shot, as well as any limiting principle on the definition of eligible persons. Also unclear from the data is whether individual practices in sexual behavior had any role in the results.

Despite the positive data on the monkeypox vaccine based on one shot, U.S. health officials warned during the conference call the two-shot approach to vaccine administration is consistent with their guidance and more effective.

Demetre Daskalakis, the Biden administration’s face of LGBTQ outreach for monkeypox and deputy coordinator for the White House monkeypox task force, made the case that for individuals at risk obtaining a second dose is “really important.”

“So we see some response after the first [shot] in the laboratory, but the really high responses that we want to really get — that you know, level 10 forcefield as opposed to the level five forcefield — doesn’t happen until the second dose,” Daskalakis said. “So the important message is this just tells us to keep on trucking forward because we need that second dose at arms that people haven’t gotten the first should start their series of two vaccines.”

Also during the call, health officials said they would be expanding opportunities for vaccines as pre exposure prophylaxis, as opposed to practices in certain regions granting vaccines in their limited supply to individuals who meet certain criteria or have had risk of exposure.

The Centers of Disease Control & Prevention, officials said, is also updating its guidance to allow injection of the vaccines in places other than a patient’s arm.

Daskalakis said fear of stigma about getting a noticeable shot in the forearm after obtaining a monkeypox vaccine was a key part of the decision to issue the new guidance on implementation.

“Many jurisdictions and advocates have told us that some people declined vaccine to monkeypox because of the stigma associated with the visible but temporary mark often left on their forearm,” Daskalakis said. “New guidance from CDC allows people who don’t want to risk a visible mark on their forearm to offer a vaccine on their skin by their shoulder or their upper back. Those are areas more frequently covered by clothes.”

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