October 14, 2016 at 5:25 pm EDT | by Chris Johnson
GOP lawmakers express ‘concerns’ over trans health care
From left, Rep. Joe Pitts (R-Penn.), Rep. Steve King (R-Iowa) and Rep. Vickie Hartzler (R-Mo.) (Photo of Pitts public domain; Washington Blade photos of King and Hartzler by Michael Key)

From left, Rep. Joe Pitts (R-Penn.), Rep. Steve King (R-Iowa) and Rep. Vickie Hartzler (R-Mo.) (Photo of Pitts public domain; Washington Blade photos of King and Hartzler by Michael Key)

In the aftermath of the Obama administration interpreting the Affordable Care Act to ensure transgender people have access to transition-related health care, a group of 45 House Republicans led by Rep. Joe Pitts (R-Pa.) is raising “significant concerns” about the development.

In a letter dated Oct. 6 and made public on Wednesday, Pitts and other Republicans assert — incorrectly — the rule made final by the Department of Health & Human Services requires doctors to perform gender reassignment surgery even if they believe the procedure is not in the patient’s best interest.

“Doctors who follow their oath to act in the best interest of the patients by refusing to perform these procedures massive financial penalties and even job loss,” the letter says. “Never before has the federal government forced doctors to choose between caring for their patients based on their best medical judgment, and complying with federal law.”

In July, HHS made final a rule interpreting Section 1557 of the Affordable Care Act, which bars discrimination in health care on the basis of gender, to prohibit discrimination on the basis of gender identity and gender non-conformity. The rule ensures transgender people have access to all areas of transition-related care, including gender reassignment surgery.

Contrary to the fear mongering in the letter, neither the law nor the rule supersedes providers’ professional, clinical judgment about the appropriate treatment for each patient, as well as when to provide referrals.

Stoking fears about children who would be subject to unnecessary procedures under the rule, lawmakers cite a statistic that 94 percent of children who suffer from dysphoria outgrow the condition and the mandate “strips doctors of their ability to counsel and advise the best course of medical care in their professional judgment if they believe gender transition procedures to be harmful.”

(Past studies didn’t differentiate between non-transgender children who have non-stereotypical interests and children who consistently express a transgender identity. More recent research shows that the latter group is distinct and children are healthier when they can express their gender identity, typically without medical treatments.)

Claiming Medicare and Medicaid don’t require providers to cover the procedure, lawmakers take issue with mandating “virtually every private physician, health care provider and health insurance plan in the country to do otherwise.” (The rule also applies to Medicare and Medicaid. Before the rule was instituted, Medicare lifted its ban on coverage for transition-related care, including surgery, but didn’t require contractors to provide it. Medicaid provided these treatments in a number of states.)

The letter also objects to the absence of a religious exemption in the rule; says the estimated number of more than 900,000 health care providers required to comply “is breathtaking”; and expresses concern about whether the rule requires health care professionals to perform abortions despite their religious objections.

“HHS received numerous requests to provide clarification as to whether prohibitions on sex discrimination could be construed to require insurance plans to cover abortion or require health care professionals to provide one contrary to their religious or moral beliefs,” the lawmakers wrote. “Despite these requests, the final rule offers no such assurances that these individuals and organizations will not be penalized for providing quality care or insurance coverage that excludes abortions.”

Although lawmakers don’t outright call for a reversal of the rule, they seek clarification from HHS on 12 stated points by Nov. 14. Among them is whether a doctor is required to prescribe children puberty-blocking medications even if that’s against their medical judgment; why no religious exemption was included in the rule; what kind of speech, including intended use of a gender pronoun different from a person’s gender identity “could rise to the level of creating a hostile environment;” and why Medicare and private entities are subject to different standards for transition-related care.

Among the 45 lawmakers who signed the letter in addition to Pitts are Republicans who have a history of hostility toward LGBT rights, including Reps. Steve King (R-Iowa), Vicky Hartzler (R-Mo.), Tim Huelskamp (R-Kansas) and Martha Blackburn (R-Tenn.).

An HHS spokesperson declined to comment on the letter on the basis the department has a practice of keeping correspondence with lawmakers confidential unless lawmakers seek to make public that information. A spokesperson for Pitts says the lawmaker has yet to receive a response to the letter.

The letter comes on the heels of litigation filed by Texas Attorney General Ken Paxton and the Becket Fund for Religious Liberty seeking to overturn the regulation on the basis it violates religious freedom.

Mara Keisling, executive director of the National Center for Transgender Equality, said the letter is “nothing more than a misleading rehash of the malicious suit filed by Texas.”

“They mischaracterize various studies and the government policies they are attacking, and they ignore decades of medical research about transgender people,” Keisling said. “Hopefully, HHS will respond with the facts and the members of Congress will understand they are wrong. But they seem to be making political rather than policy or medical arguments. Shame on them.”


Chris Johnson is Chief Political & White House Reporter for the Washington Blade. Johnson is a member of the White House Correspondents' Association. Follow Chris

  • I fail to see how morality has anything at all to do with the condition of ones birth. Transgender people are born transgender. There has never been any choice as to whether or not a transgender person is really who they claim they are. Even Jesus recognized the lack of choice to be a given fact in his remarks in the book of Matthew to his disciples during a discussion on the topic of marriage.

    In Jesus’ time the term transgender did not yet exist. The much less accurate term eunuch was the most frequently used term when referring to a transgender person. From my perspective, it would seem that denying the life condition of anyone that has been recognized as having been ‘born that way’ by such an important figure as the Messiah himself would run dangerously close to denying a biblical truth.

    Matthew 19:12 (NIV)

    12 For there are eunuchs who were born that way, and there are eunuchs who have been made eunuchs by others–and there are those who choose to live like eunuchs for the sake of the kingdom of heaven. The one who can accept this should accept it.”

    I was raised Southern Baptist. And, I was taught that a good Christian kept their religion out of the work place and did as instructed in the book of Matthew, chapter six.

    Matthew 6: 5-6 5 “When you pray, you are not to be like the hypocrites; for they love to stand and pray in the synagogues and on the street corners so that they may be seen by men. Truly I say to you, they have their reward in full. 6 “But you, when you pray, go into your inner room, close your door and pray to your Father who is in secret, and your Father who sees what is done in secret will reward you.

    • Dee O'Malley's Oral Expletives

      Wow Leslie! Outstanding! I am reminded of “render to Caesar what is Caesar’s” which effectively separated personal faith from public government.

      • Thanks. I really like to use their bible against them. Like the way the bible condemns anyone that knowingly tells a lie, even they think they are acting in the name of their God.

        Liars in the bible…

        Ephesians 4:29 Let no corrupt communication proceed out of your mouth, but that which is good to the use of edifying, that it may minister grace to the hearers.

        Proverbs 6:16-19 16 There are six things the Lord hates,seven that are detestable to him: 17 haughty eyes, a lying tongue, hands that shed innocent blood, 18 a heart that devises wicked schemes, feet that are quick to rush into evil, 19 a false witness who pours out lies and a person who stirs up conflict in the community.

        There is no such thing as a white lie.

        John 8:44 You belong to your father, the devil, and you want to carry out your father’s desires. He was a murderer from the beginning, not holding to the truth, for there is no truth in him. When he lies, he speaks his native language, for he is a liar and the father of lies.

        If it isn’t in the bible then God and company did not say it and therefore it is a lie.

        Ezekiel 22:28 Her prophets whitewash these deeds for them by false visions and lying divinations. They say, ‘This is what the Sovereign Lord says’—when the Lord has not spoken.

        • Dee O'Malley's Oral Expletives

          While they take the Bible “as Bible” , I will continue to see it as a story of a people, a promise of a better world, a message of salvation and love wrapped in literature format.

          • I am aware that many people view the Bible as the literal word of God. And unlike many of the followers of Christianity, I respect that. But, as someone that does not share those beliefs, I see the Bible as a compilation of myths from many Middle Eastern cultures that give a fascinating glimpse into the mystical practices, political intrigues and feuds of the bronze age.

          • Dee O'Malley's Oral Expletives

            Indeed its a compilation… A mix of content with varying paradyms…. I don’t take much of it literally and that sadly it has been and continues to be used as a weapon is beyond argument. For me, my faith has mostly to do with personal experience…

          • Faith should be intensely personal.

          • Dee O'Malley's Oral Expletives

            Completely agree. Like sexuality. How people can try to compel others to believe the same as they is beyond me….love and belief are neither if compelled.

          • Three words, self appointed entitlement.

  • Dee O'Malley's Oral Expletives

    As a transgender Caucasian Christ-following Latina, with a military enlistment completed, I am thoroughly disgusted by anti-LGBT conduct expressed by Republicans. It’s not their disagreement or even disapproval…we all can’t agree nor should we about everything but for being intimate bed mates with religious meddlers they sure know how to wage war using the devil’s most potent tool: deceit. In fact deceit, we read, was the violation that birthed the curse of man such that perfection became a potential, illness always near, and death a guarantee.

    Shame on Republicans for stepping into the wrong side of history and soiling their pants in the process. History once more will record their malevolence against citizens who are already maligned and discarded. I should know… just ask my last employer almost 7 years ago who tossed me right out…because of, you know, “safety” concerns. I feel utterly and completely betrayed…feels like my military sacrifice was for naught…it truly does.

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