Medical Tuesday Blog
Lifts The Ban On Sex-Reassignment Surgery
Medicare Ban on Sex-Reassignment Surgery Lifted
Decisions on Procedure Now Will be Made on Case-by-Case Basis
By Stephanie Armour, WSJ, June 1, 2014
WASHINGTON—Transgender people who receive Medicare benefits will no longer be automatically denied coverage for sex-reassignment surgery, a federal review board ruled Friday.
The decision means that Medicare, the federal health insurance program for seniors and those with disabilities, will now cover sex-reassignment surgery on a case-by-case basis rather than routinely denying the surgery under guidance adopted during the 1980s.
Although the Department of Health and Human Services appeals-board decision involved a single case—a New Mexico woman who sought gender-reassignment surgery—it could have broad ramifications because private insurance companies and Medicaid, the state-federal program for the poor, often follow Medicare’s lead on coverage.
The surgery is often the last step in a long process toward gender-reassignment. Some people call themselves transgender even if they haven’t had the operation.
“It’s pretty clear there’s no basis for the arbitrary discriminatory rule they established in the 1980s when they wouldn’t cover it,” said Mara Keisling, executive director at the National Center for Transgender Equality, an advocacy organization in Washington, D.C. “It’s not up to bureaucrats anymore. It’s up to doctors and patients. It’s very important.”
While the ruling doesn’t require Medicare to pay for the surgery, it does mean coverage decisions will be made on a case-by-case basis by doctors and other Medicare contractors, based on clinical evidence that the procedure is medically appropriate, according to the Centers for Medicare and Medicaid Services.
The case decided Friday involved Denee Mallon, a 74-year-old transgender woman from Albuquerque, N.M., who was born as a male.
Her doctors agreed she should have sex-assignment surgery, but Medicare denied the procedure two years ago.
“Medicare determined there is no medical reassurance for this exclusion,” said Ms. Mallon’s attorney, Jennifer Levi, who heads the Transgender Rights Project of Gay and Lesbian Advocates and Defenders in Boston.
“This brings Medicare policy into the 21st century,” Ms. Levi said.
America’s Health Insurance Plans, a trade association for the health-insurance industry, said coverage for sex-reassignment surgeries varies by plan.
The total cost of transgender-specific care for one person is estimated at between $25,000 and $75,000, according to the Human Rights Campaign, an advocacy group for lesbian, gay, bisexual, and transgender people. The organization also said that many providers of gender-reassignment surgery might not accept Medicare coverage, posing a challenge to those seeking the procedure.
We have one sexual dysphoria patient in our practice who was married, had three children and thought she was really a man trapped in a female body. She divorced her husband and had sex-reassignment surgery at a prestigious medical center. She is now a DAD (although a biologic mom) to her three children who also have another dad.
After the surgery, she married another female, and her clitoris, now with hormone treatment, is a small male phallus. He is able to insert his clitoris, after hormone therapy, into his wife’s vagina and achieve an orgasm. He has no ejaculation and cannot urinate through his penis since there is no urethra inside the shaft of his clitoris, now his penis. His urethra is still beneath the clitoral phallus, and does not go through it. Hence, he empties his bladder as she (he) did when he was still a woman. He had a scrotum built behind the clitoris which is now his phallus, and the urethra is behind his two aluminum testicles resting in his newly built scrotum. Since a female urinates straight down, the urinary stream does miss his aluminum testicles. He enjoyed showing the nurses on his last hospitalization where they had to insert the catheter by elevating his scrotum with the aluminum testicles, which are always in the male tight ejaculating position, even though he (she) does not ejaculate during his clitoral orgasm.
Of course, he had the rest of the transforming surgery. His breasts were amputated, his vagina was removed. He had a hysterectomy and a bilateral oophorectomy. And voila, he thought he was now in a male body. After hormone therapy, he was able to grow a beard, mustache, pubic hair, and his clitoris began to enlarge. It is now about 4 cm long. Which he states is long enough to stimulate his new wife’s clitoris and give her an orgasm.
He went through a psychiatric crisis. He was treated as a schizophrenic for a few years and on his last visit, his female wife states he is no longer schizophrenic, but was given a new diagnosis.
Was she really a male trapped in a female body? Or was she primarily homoerotic and liked girls better than boys? In our current open society, could she not have achieved her current status in a lesbian relationship without such mutilating surgery? Or is he now really a genetic female trapped in a female body modified to look like a male but still with the x-x chromosome which ultimately defines him as a genetic female. And she (he) is married to a genetic female with all the secondary female sex characteristics. Doesn’t this define the lesbian relationship, genetic female having sex with a true genetic female? Couldn’t she have this relationship without the operations and years of psychotherapy which more likely than not cost taxpayers more than $100,000.
Are sex-reassignment operations for sexual dysphoria ever indicated in our present society?
And now Medicare pays for these sex change operations?
How does a sex change operation in a 74-year-old transgender person bring us into the 21stcentury?
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Government is not the solution to our problems, government is the problem.
– Ronald Reagan
It may also make the problem worse!