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Medicare to examine ban on gender reassignment surgery

Rationale for policy ‘not complete and adequate’

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

HHS is set to reconsider the ban on Medicare-provided gender reassignment surgery. (Image public domain)

The Obama administration is set to re-examine the ban that prohibits Medicare from covering gender reassignment surgery, according to a memorandum obtained Tuesday by the Washington Blade.

The document from the Department of Health & Human Services, dated Dec. 2, finds that the reasoning for the ban is “not complete and adequate” to support denying Medicare coverage for transgender people seeking the procedure.

The HHS Department Appeals Board states the ban — which is codified as National Coverage Determination 140.3 — “fails to account for development in the care and treatment” for transgender people over the course of the last 30 years.

The next step, the memo states, is proceeding into a “discovery” phase for the taking of evidence to determine whether the ban can be justified.

Mara Keisling, executive director of the National Center for Transgender Equality, said “there really isn’t that much to say” at this point in the process.

“This is really a preliminary step,” Keisling said. “It’s a good sign, but we have more to go on this.”

Masen Davis, executive director of the Transgender Law Center, was optimistic the ban would be lifted following the discovery process.

“Current Medicare standards are based on science from the 1960s, so it’s about time for a review,” Davis said. “Because the current scientific evidence overwhelmingly shows that sex-reassignment surgeries are effective and medically necessary treatments for some transgender individuals, we are hopeful the board will find the exclusion is not supported.”

The DAB initiated the review of the ban on Medicare-provided gender reassignment surgery in response to a request filed in March by a quartet of LGBT advocates: the National Center for Lesbian Rights, the American Civil Liberties Union, Gay & Lesbian Advocates & Defenders and civil rights attorney Mary Lou Boelcke.

The challenge was filed on behalf of Denee Mallon, a 73-year-old transgender woman in Albuquerque, N.M. A Medicare recipient, Mallon was recommended to have gender reassignment surgery by doctors to treat her gender dysphoria

In a joint statement provided to the Washington Blade in response to the HHS memorandum, the ACLU, NCLR and GLAD expressed optimism that DAB would come to the conclusion after discovery that the ban on Medicare-provided gender reassignment surgery should be lifted.

“Because the current evidence overwhelmingly shows that sex-reassignment surgeries are effective and medically necessary treatments for some individuals with gender dysphoria, we are hopeful the Board will find the exclusion is not supported,” the statement says.

According to the memorandum, the ban was put in place in 1989 as a result of a 1981 report from the National Center for Health Care Technology, an arm of HHS. The report concluded “transsexual surgery not be covered by Medicare at this time” because of the high rate of complications and questions about whether it was effective in treating gender identity disorder.

“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 the institution of this policy, the American Medical Association and the American Psychological Association support gender reassignment surgery for transgender people as a means to treat gender identity disorder.

Notably, the Centers for Medicare & Medicaid didn’t put up a fight in response to the request from LGBT advocates to lift the ban. According to the memo, CMS notified the board in June that it wouldn’t submit a response to their request to lift the ban.

Neither HHS nor CMS responded to the Blade’s request for comment on the determination or why it declined to defend the ban.

It’s unclear when the discovery period for reevaluating the ban on Medicare-provided gender reassignment surgery will come to an end. Shawn Jain, a spokesperson f0r the ACLU, said his organization doesn’t know when the process will be complete.

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Congress

Advocates say MTG bill threatens trans youth, families, and doctors

The “Protect Children’s Innocence” Act passed in the House

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U.S. Rep. Marjorie Taylor Greene (R-Ga.) speaks at a press conference on Sept. 20 for her anti-trans legislation. (Washington Blade photo by Michael Key)

Georgia Congresswoman Marjorie Taylor Greene has a long history of targeting the transgender community as part of her political agenda. Now, after announcing her resignation from the U.S. House of Representatives, attempting to take away trans rights may be the last thing she does in her official capacity.

The proposed legislation, dubbed “Protect Children’s Innocence Act” is among the most extreme anti-trans measures to move through Congress. It would put doctors in jail for up to 10 years if they provide gender-affirming care to minors — including prescribing hormone replacement therapy to adolescents or puberty blockers to younger children. The bill also aims to halt gender-affirming surgeries for minors, though those procedures are rare.

Greene herself described the bill on X, saying if passed, “it would make it a Class C felony to trans a child under 18.”

According to KFF, a nonpartisan source for health policy research, polling, and journalism, 27 states have enacted policies limiting youth access to gender-affirming care. Roughly half of all trans youth ages 13–17 live in a state with such restrictions, and 24 states impose professional or legal penalties on health care practitioners who provide that care.

Greene has repeatedly introduced the bill since 2021, the year she entered Congress, but it failed to advance. Now, in exchange for her support for the National Defense Authorization Act, the legislation reached the House floor for the first time.

According to the 19th, U.S. Rep. Sarah McBride (D-Del.), the first trans member of Congress, rebuked Republicans on the Capitol steps Wednesday for advancing anti-trans legislation while allowing Affordable Care Act tax credits to expire — a move expected to raise health care costs for millions of Americans.

“They would rather have us focus in and debate a misunderstood and vulnerable one percent of the population, instead of focusing in on the fact that they are raiding everyone’s health care,” McBride said. “They are obsessed with trans people … they are consumed with this.”

Polling suggests the public largely opposes criminalizing gender-affirming care.

A recent survey by the Human Rights Campaign and Global Strategy Group found that 73 percent of voters in U.S. House battleground districts oppose laws that would jail doctors or parents for providing transition-related care. Additionally, 77 percent oppose forcing trans people off medically recommended medication. Nearly seven in 10 Americans said politicians are not informed enough to make decisions about medical care for trans youth.

The bill passed the House and now heads to the U.S. Senate for further consideration.

According to reporting by Erin Reed of Erin In The Morning, three Democrats — U.S. Reps. Henry Cuellar and Vicente Gonzalez of Texas and Don Davis of North Carolina — crossed party lines to vote in favor of the felony ban, joining 213 Republicans. A total of 207 Democrats voted against the bill, while three lawmakers from both parties abstained.

Advocates and lawmakers warned the bill is dangerous and unprecedented during a multi-organizational press call Tuesday. Leaders from the Human Rights Campaign and the Trevor Project joined U.S. Rep. Becca Balint (D-Vt.), Dr. Kenneth Haller, and parents of trans youth to discuss the potential impact of restrictive policies like Greene’s — particularly in contrast to President Donald Trump’s leniency toward certain criminals, with more than 1,500 pardons issued this year.

“Our MAGA GOP government has pardoned drug traffickers. They’ve pardoned people who tried to overthrow the government on January 6, but now they want to put pediatricians and parents into a jail cell for caring for their kids,” said Human Rights Campaign President Kelley Robinson. “No one asked for Marjorie Taylor Greene or Dan Crenshaw or any politician to be in their doctor’s office, and they should mind their own business.”

Balint, co-chair of the Congressional Equality Caucus, questioned why medical decisions are being made by lawmakers with no clinical expertise.

“Parents and doctors already have to worry about state laws banning care for their kids, and this bill would introduce the risk of federal criminal prosecution,” Balint said. “We’re talking about jail time. We’re talking about locking people up for basic medical care, care that is evidence-based, age-appropriate and life-saving.”

“These are decisions that should be made by doctors and parents and those kids that need this gender-affirming care, not certainly by Marjorie Taylor Greene.”

Haller, an emeritus professor of pediatrics at St. Louis University School of Medicine, described the legislation as rooted in ideology rather than medicine.

“It is not science, it is just blind ideology,” Haller said.

“The doctor tells you that as parents, as well as the doctor themselves, could be convicted of a felony and be sentenced up to 10 years in prison just for pursuing a course of action that will give your child their only chance for a happy and healthy future,” he added. “It is not in the state’s best interests, and certainly not in the interests of us, the citizens of this country, to interfere with medical decisions that people make about their own bodies and their own lives.”

Haller’s sentiment is echoed by doctors across the country.

The American Medical Association, the nation’s largest organization that represents doctors across the country in various parts of medicine has a longstanding support for gender-affirming care.

“The AMA supports public and private health insurance coverage for treatment of gender dysphoria and opposes the denial of health insurance based on sexual orientation or gender identity,” their website reads.

Rodrigo Heng-Lehtinen, senior vice president of public engagement campaigns at the Trevor Project, agreed.

“In Marjorie Taylor Greene’s bill [it] even goes so far as to criminalize and throw a parent in jail for this,” Heng-Lehtinen said. “Medical decisions should be between patients, families, and their doctors.”

Rachel Gonzalez, a parent of a transgender teen and LGBTQ advocate, said the bill would harm families trying to act in their children’s best interests.

“No politician should be in any doctor’s office or in our living room making private health care decisions — especially not Marjorie Taylor Greene,” Gonzalez said. “My daughter and no trans youth should ever be used as a political pawn.”

Other LGBTQ rights activists also condemned the legislation.

Tyler Hack, executive director of the Christopher Street Project, called the bill “an abominable attack on the transgender community.”

“Marjorie Taylor Greene’s last-ditch effort to bring her 3-times failed bill to a vote is an abominable attack on the transgender community and further cements a Congressional career defined by hate and bigotry,” they said. “We are counting down the days until she’s off Capitol Hill — but as the bill goes to the floor this week, our leaders must stand up one last time to her BS and protect the safety of queer kids and medical providers. Full stop.”

Hack added that “healthcare is a right, not a privilege” in the U.S., and this attack on trans healthcare is an attack on queer rights altogether. 

“Marjorie Taylor Greene has no place in deciding what care is necessary,” Hack added. “This is another attempt to legislate trans and queer people out of existence while peddling an agenda rooted in pseudoscience and extremism.”

U.S. Rep. Mark Takano (D-Calif.), chair of the Congressional Equality Caucus, also denounced the legislation.

“This bill is the most extreme anti-transgender legislation to ever pass through the House of Representatives and a direct attack on the rights of parents to work with their children and their doctors to provide them with the medical care they need,” Takano said. “This bill is beyond cruel and its passage will forever be a stain on the institution of the United States Congress.”

The bill is unlikely to advance in the Senate, where it would need 60 votes to pass.

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The White House

EXCLUSIVE: Democracy Forward files FOIA lawsuit after HHS deadnames Rachel Levine

Trans former assistant health secretary’s name changed on official portrait

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Adm. Rachel Levine (Washington Blade photo by Michael Key)

Democracy Forward, a national legal organization that works to advance democracy and social progress through litigation, policy and public education, and regulatory engagement, filed a lawsuit Friday in federal court seeking to compel the U.S. Department of Health and Human Services to release information related to the alteration of former Assistant Secretary for Health Adm. Rachel Levine’s official portrait caption.

The lawsuit comes in response to the slow pace of HHS’s handling of multiple Freedom of Information Act requests — requests that federal law requires agencies to respond to within 20 working days. While responses can take longer due to backlogs, high request volumes, or the need for extensive searches or consultations, Democracy Forward says HHS has failed to provide any substantive response.

Democracy Forward’s four unanswered FOIA requests, and the subsequent lawsuit against HHS, come days after someone in the Trump-Vance administration changed Levine’s official portrait in the Hubert H. Humphrey Building to display her deadname — the name she used before transitioning and has not used since 2011.

According to Democracy Forward, HHS “refused to release any records related to its morally wrong and offensive effort to alter former Assistant Secretary for Health Admiral Rachel Levine’s official portrait caption.” Levine was the highest-ranking openly transgender government official in U.S. history and served as assistant secretary for health and as an admiral in the U.S. Public Health Service Commissioned Corps from 2021 to 2025.

Democracy Forward President Skye Perryman spoke about the need to hold the Trump-Vance administration accountable for every official action, especially those that harm some of the most targeted Americans, including trans people.

“The question every American should be asking remains: what is the Trump-Vance administration hiding? For an administration that touts its anti-transgender animus and behavior so publicly, its stonewalling and silence when it comes to the people’s right to see public records about who was behind this decision is deafening,” Perryman said.

“The government’s obligation of transparency doesn’t disappear because the information sought relates to a trailblazing former federal official who is transgender. It’s not complicated — the public is entitled to know who is making decisions — especially decisions that seek to alter facts and reality, erase the identity of a person, and affect the nation’s commitment to civil rights and human dignity.”

“HHS’s refusal to respond to these lawful requests raises more serious concerns about transparency and accountability,” Perryman added. “The public has every right to demand answers — to know who is behind this hateful act — and we are going to court to get them.”

The lawsuit also raises questions about whether the alteration violated federal accuracy and privacy requirements governing Levine’s name, and whether the agency improperly classified the change as an “excepted activity” during a lapse in appropriations. By failing to make any determination or produce any records, Democracy Forward argues, HHS has violated its obligations under federal law.

The case, Democracy Forward Foundation v. U.S. Department of Health and Human Services, was filed in the U.S. District Court for the District of Columbia. The legal team includes Anisha Hindocha, Daniel McGrath, and Robin Thurston.

The Washington Blade reached out to HHS, but has not received any comment.

The lawsuit and four FOIA requests are below:

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The White House

Empty seats, canceled shows plague Kennedy Center ahead of Trump renaming

It would take an act of Congress to officially rename the historic music venue, despite the Trump-appointed board’s decision.

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Protesters march in defiance of the changes to the Kennedy Center following Trump's takeover in March. (Washington Blade Photo by Michael Key)

The board of the Kennedy Center in Washington, D.C., voted to rename it the Trump-Kennedy Center, according to the White House Press Office.

White House Press Secretary Karoline Leavitt announced the decision in a post on X Thursday, thanking the president for his work on the cultural center “not only from the standpoint of its reconstruction, but also financially, and its reputation.”

Speaking to reporters later that day at the White House, Trump said he was “surprised” and “honored” by the board’s vote.

“This was brought up by one of the very distinguished board members, and they voted on it, and there’s a lot of board members, and they voted unanimously. So I was very honored,” he said.

Earlier this year, GOP Rep. Mike Simpson of Idaho introduced an amendment that would have renamed the building after first lady Melania Trump, later saying she had not been aware of his efforts prior to the amendment’s public introduction.

Despite the board’s vote (made up of Trump-appointed loyalists), the original laws guiding the creation of the Kennedy Center during the Eisenhower, Kennedy, and Johnson administrations explicitly prohibit renaming the building. Any change to its name would require an act of Congress.

Trump has exerted increasing control over the center in recent months. In February, he abruptly fired members of the Kennedy Center’s board and installed himself as chair, writing in a Truth Social post at the time, “At my direction, we are going to make the Kennedy Center in Washington D.C., GREAT AGAIN.”

In that post, Trump specifically cited his disapproval of the center’s decision to host drag shows.

He later secured more than $250 million from the Republican-controlled Congress for renovations to the building.

Since Trump’s takeover, sales of subscription packages are said to have declined, and several touring productions — including “Hamilton” — have canceled planned runs at the venue. Rows of empty seats have also been visible in the Concert Hall during performances by the National Symphony Orchestra.

“The Kennedy Center Board has no authority to actually rename the Kennedy Center in the absence of legislative action,” House Minority Leader Hakeem Jeffries told reporters.

For decades, the Kennedy Center has hosted performances by LGBTQ artists and companies, including openly queer musicians, choreographers, and playwrights whose work helped push LGBTQ stories into the cultural mainstream. Those artists include the Gay Men’s Chorus of Washington, Harvey Fierstein, and Tennessee Williams.

In more recent years, the center has increasingly served as a space for LGBTQ visibility and acceptance, particularly through Pride-adjacent programming and partnerships.

That legacy was on display at this year’s opening production of Les Misérables, when four drag performers — Tara Hoot, Vagenesis, Mari Con Carne, and King Ricky Rosé — attended in representation of Qommittee, a volunteer network uniting drag artists to support and defend one another amid growing conservative attacks.

“We walked in together so we would have an opportunity to get a response,” said Tara Hoot, who has performed at the Kennedy Center in full drag before. “It was all applause, cheers, and whistles, and remarkably it was half empty. I think that was season ticket holders kind of making their message in a different way.”

The creation of the Kennedy Center is outlined in U.S. Code, which formally designates the institution as the John F. Kennedy Center for the Performing Arts.

As a result, it appears unlikely that Congress will come together to pass legislation allowing the historic venue to be renamed.

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