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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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Rehoboth Beach

Women’s FEST returns to Rehoboth Beach next week

Golf tournament, mini-concerts, meetups planned for silver anniversary festival

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(Washington Blade file photo by Daniel Truitt)

Women’s+ FEST 2026 will begin on Thursday, April 9 at CAMP Rehoboth Community Center.

The festival will celebrate a remarkable milestone in 2026: its silver anniversary. For 25 years, Women’s+ FEST has brought fun and entertainment for all those on the spectrum of the feminine spirit. There will be a variety of events including a golf tournament, mini-concerts and happy hour meetups.

For more information, visit Camp Rehoboth’s website.

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Belarus

Belarusian lawmakers approve bill to crackdown on LGBTQ rights

Country’s president known as ‘Europe’s last dictator’

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(Photo by eugenef/Bigstock)

Lawmakers in Belarus on Thursday approved a bill that would allow the government to crack down on LGBTQ advocacy.

The Associated Press notes the bill would punish anyone found guilty of “propaganda of homosexual relations, gender change, refusal to have children, and pedophilia” with fines, community labor, and 15 days in jail.

The House of Representatives, the lower house of the Belarusian National Assembly, last month approved the bill. The Council of the Republic, which is the parliament’s upper chamber, passed it on Thursday.

President Alexander Lukashenko is expected to sign it.

Belarus borders Poland, Ukraine, Russia, Latvia, and Lithuania. Lukashenko — known as “Europe’s last dictator” is a close ally of Russian President Vladimir Putin.

Kazakhstan is among the countries that have enacted Russian-style anti-LGBTQ propaganda laws in recent years.

Vika Biran, a Belarusian LGBTQ activist, is among those arrested during anti-Lukashenko protests that took place in 2020 after he declared victory in the country’s presidential election.

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District of Columbia

How new barriers to health care coverage are hitting D.C.

Federally qualified health centers bracing for influx of newly uninsured patients

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Erin Loubier, vice president for access and strategic initiatives at Whitman-Walker Health. (Courtesy photo)

Washington, D.C. has the second-lowest rate of people who lack health insurance in the country, but many residents are facing new barriers to health care due to provisions of the sweeping federal law passed in July, which threatens access for thousands. 

Changes to insurance eligibility and the rising cost of premiums, which kicked in for some in October and others more recently, are expected to leave many more patients uninsured or unable to afford medical care. Federally qualified health centers, including D.C.’s Whitman-Walker Health, where 10 to 12 percent of patients are uninsured, are bracing for an influx of newly uninsured patients while facing their own financial challenges. 

Even in D.C., where uninsured rates have been among the lowest in the country, changes brought on by the passage of the Republican mega bill (known as the “Big Beautiful Bill”) will have major effects. 

The changes from the bill affect Medicaid, which is free to low-income patients, and subsidies for insurance that people buy on the health insurance exchanges that were started under the Affordable Care Act, which were allowed to expire on Dec. 31. 

Erin Loubier, vice president for access and strategic initiatives at Whitman-Walker Health, says some Whitman-Walker Health patients have received notices about premium increases, including several who say the increases are up to 1,000 percent more than they were paying. 

“That is like paying rent,” she says. “We live in an expensive city, so any increases are going to be really, really hard on people.”

Whitman-Walker Health and other healthcare providers are expecting the changes to have multiple effects — some patients may not be able to afford coverage or may avoid going to the doctor and allow health conditions to worsen because they can’t afford care, and many more will be seeking care who don’t have insurance. 

“I’m worried that we’re going to not just have people who can’t get care, but that they delay care until they’re really sick, and then the care is not as effective because they might have waited too long, and then we may have a less healthy population,” Loubier says.

Loubier says delaying care, and serving more people without insurance has major implications for Whitman-Walker Health and other health centers serving the community.

“There’s going to be a lot of pressure on us to try to find and raise more money, and that’s going to be harder, because I think all organizations who provide health care are going to be facing this,” she says. 

The U.S. health care system is the most expensive in the world, and has much higher out-of-pocket costs for individuals. But in other countries like the United Kingdom, Australia, Canada, and many others, health care is much less expensive — or even free.

Even though the U.S. has a high-priced healthcare system, critics say there are still ways to bring down costs by forcing insurance and pharmaceutical companies to absorb more of the costs, rather than transferring the costs to patients.

“In the U.S., they end up trying to cut costs at the person’s level, not at the level of the different corporations or structures that are making a lot of money in healthcare,” said Loubier. “Our system is so complicated and there is probably waste in it, but I don’t think that that cost and waste is at the ‘people’ level. I think it’s higher up at the system level, but that is much, much harder to get people to try to make cuts at that end.”

Ultimately at Whitman-Walker Health, healthcare providers and insurance navigators are planning to help with everyday necessities when it comes to healthcare coverage and striving to provide healthcare in partnership with patients, said Loubier.

“The key here is we’re going to have a lot of people who may lose insurance, and they’re going to rely on places like Whitman-Walker Health and other community health centers, so we have to figure out how we keep providing that care,” she said. 

(This article was written by a student in the journalism program at Bard High School Early College DC. This work is part of a partnership between the Washington Blade Foundation and Youthcast Media Group, funded through the FY26 Community Development Grant from the Office of D.C. Mayor Muriel Bowser.)

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