Because it is important
The Department of Veterans Affairs offers most medical procedures known as gender-affirming care, including hormone therapy, prosthetics, and hair removal. But veterans must seek surgeries outside of VA hospitals, where they have to rely on private health insurance coverage or pay costs out of pocket.
Josie Caballero, the association's interim president, said the cost could force veterans to settle for lower-quality care or delay care, adding to their distress.
The National Center for Transgender Equality estimates there are more than 134,000 transgender veterans. In a VA survey of transgender and gender nonconforming veterans conducted in 2022 and 2023, 78 percent of 6,600 respondents said they wanted gender-affirming surgeries. More than half said they had delayed or not received treatment, with most citing cost as a reason.
VA doctors already perform procedures that would be considered gender-affirming surgeries. For example, a mastectomy would be covered to treat or prevent breast cancer, but the same procedure is not covered for a veteran experiencing gender dysphoria. An exception is made when reviewing or treating complications from surgeries performed outside the VA system.
“That is a deep frustration that many veterans feel,” Caballero said. “The surgeons are there. “They just need permission to do it.”
Background
Shortly after President Biden took office in 2021, McDonough announced that the administration would offer the surgeries. At the time, it was estimated that changing health care benefits for transgender veterans could take years.
The advocacy group took the delay to court in January. McDonough responded with a letter denying the proposed policy change and saying the department was not ready “at this time.”
At a news conference days later, McDonough suggested that the availability of gender-affirming surgeries would be delayed until Dr. Shereef Elnahal, the department's assistant secretary of health, completed a review of the PACT Act of 2022, a law that expanded the veterans benefits.
“We've given him several months to do it,” McDonough said in February. He added, “VA remains committed to providing care to transgender veterinarians, but at this time we are not ready to initiate rulemaking that addresses the specific regulatory changes proposed in the petition.”
What happens next?
Lindsey Cormack, an associate professor at Stevens Institute of Technology who studies policies for veterans, said the administration was likely in the middle of the bureaucratic rulemaking process, trying to clear a legal path to ensure that expanded care provisions medical to include gender -Affirmative surgeries are allowed under the PACT Act.
Ms. Cormack noted that there were other health care treatments that the Department of Veterans Affairs did not offer, such as ketamine therapy or psychedelic drugs.
It's unclear how soon policy can be changed to make gender-affirming surgeries available at VA hospitals. Recently, the department has expanded other medical treatments to all veterans, such as offering in vitro fertilization to single veterans and those in same-sex marriages.
The American Transgender Veterans Association is represented in this lawsuit by the Yale Law School Veterans Legal Services Clinic, which successfully sued the department to make such fertility treatments more widely available.
“The Veterans Administration itself is moving slowly,” Ms. Cormack said. “It's not something fast, convenient and changeable.”
