At conference, Medicare policy change underscores trans-health complexities, hopes

An appeals board recently lifted Medicare’s longstanding policy against covering sex-reassignment surgery, even when recommended by a doctor.

Trans-health advocates convening in Philadelphia this week for a major health conference are applauding the change, but say it has limitations.

“First and foremost, it means that seniors and people with disabilities who are on Medicare and need transition-related medical care will have decisions made about their coverage on the basis of their medical needs and medical science rather than a political decision that was made 30 years ago,” said Harper Jean Tobin, with the National Center for Transgender Equality.

Not getting recommended treatments can have serious consequences for those in transition, said 36-year-old Sharron Cooks, a local advocate.

“It’s like you don’t want to leave your house. You can’t focus on anything. People have committed suicide, people have gone to the black market trying to get things off the street which will endanger their health,”   said Cooks, adding that the out-of-pocket cost for such medical treatments can be tens of thousands of dollars. “They want to feel corrected, like their body and their mind are one. They want to feel normal.”

Cooks views the Medicare change as an important step, but worries many are left out, including those who are uninsured. Some private insurers also have exclusion policies for the procedures.

According to Mazzoni Center staff attorney Barrett Marshall, state-affiliated health programs in Pennsylvania don’t cover anything related to transition care.

“At this point, what the state has done is draw a line around the transgender community and said this particular kind of care can never be administered,” Marshall said.

Marshall hopes the Medicare ruling spurs “a domino effect,” leading to changes in state and private insurance policies in the future.

Michael Munson, with the Wisconsin-based trans anti-violence group Forge, agrees.

“I think it’s going to set the precedent for everything underneath that, so it’s only a matter of time,” he said, while distributing information outside the conference.

For Munson, the implication of the decision extends beyond coverage for just transition treatments. In his work, he says, he often observes instances where individuals are wrongly denied general medical coverage due to their gender status.