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Medicare asked to review ban on gender reassignment surgery

Anti-trans policy established in 1981

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transgender, caduceus, medicare, gay news, Washington Blade, health
transgender, caduceus, medicare, gay news, Washington Blade, health

LGBT groups are askng Medicare to lift its ban on gender reassignment surgery. (Image public domain)

Medicare is being asked to review a policy that prohibits transgender people from receiving coverage for gender reassignment surgery.

Last week, a quartet of LGBT rights groups ā€” the National Center for Lesbian Rights, the American Civil Liberties Union, Gay & Lesbian Advocates & Defenders and civil rights attorney Mary Lou Boelcke ā€” filed an administrative challenge to eliminate Medicare’s ban on coverage for the procedure.

Joshua Block, a staff attorney with the ACLU’s LGBT Project, said the challenge was filed because a policy change is “overdue.”

“It is completely out of line with any scientific or medical evidence or standards of practice,” Block said. “There are people out there who are in desperate need of the surgery. Their doctors have told them they need the surgery. And they’re being told it’s not covered because it was allegedly experimental 30 years ago.”

The challenge, sent on March 26, was filed on behalf of Denee Mallon, a transgender woman in Albuquerque, New Mexico. A Medicare recipient who’s age 73,Ā Mallon wasĀ recommended to have gender reassignment surgery by doctors to treat her gender dysphoria.

A veteran of the U.S Army, Mallon joined the the service when she was 17 and worked as a forensics investigator for a city police department. She was later diagnosed with gender identity disorder.

Mara Keisling, executive director of the National Center for Transgender Equality, said she’s “very excited” about the challenge.

“Americans, in general, are really tired of health care decisions being made by legislators and bureaucrats and insurance companies,” Keisling said. “Most of us believe that health care decisions should be made by patients and doctors, and the medical community is pretty unified. This is a legitimately necessary surgery.”

Keisling said NCTE isn’t directly involved in the challenge because it involves lawyers representing clients, and the organization doesn’t provide those legal services.

The ban, which is codified as National Coverage Determination 140.3, was put in place in 1981 during the Reagan administration. Keisling said the ban was put in place as a result of the stigma on transgender people at the time and lobbying from insurance groups.

The National Coverage Determination from 1981 spells out why transgender people are unable to receive this coverage under Medicare.

“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 this policy, theĀ American Medical Association and the American Psychological Society support gender reassignment surgery for transgender people.

Block said the challenge has been filed at this time ā€” more than 30 years after the ban was put in place ā€” because “each year that goes by, it becomes ever more clear how unfounded the categorical sweeping ban is.”

“Each year that goes by, there’s more and more evidence that just reaffirms the widely accepted view that these surgeries are safe, medically necessary and effective to treat a serious medical condition,” Block said.

Now that the challenge has been filed, the Department Appeals Board of the Department of Health & Human Services is set to review the ban, determine if it’s reasonable under current standards of care and make a decision on whether to reverse it. It’s estimated the process could take months to resolve.

It’s unclear how many transgender people the change would affect. A recent study from the Williams Institute found that one-third of one percent of Americans identify as transgender. Given that an estimated 48 million people receive coverage under Medicare, about 144,000 transgender people are believed to receive coverage under Medicare.

In an apparently separate development last week, the Centers for Medicare & Medicaid Services included a statement on its website asking for public comment because it would reconsider the ban. But the notice was removed on Friday from the agency’s website after conservative media, such as Drudge Report, took note of it.

Brian Cook, a CMS spokesperson, told the Blade solicitation for public comment was removed as a result of the legal challenge from LGBT groups coming to light.

ā€œAn administrative challenge to our 1981 Medicare national coverage determination concerning sex reassignment surgery was just filed,” Cook said. “This administrative challenge is being considered and working its way through the proper administrative channels. In light of the challenge, we are no longer re-opening the national coverage determination for reconsideration.ā€

Although the challenge was filed last week, LGBT groups didn’t notify the press about it until Monday. Block said the notice that went up on the Medicare website ā€” and its subsequent removal ā€” prompted the news statement.

“I think there were a lot of questions ā€” particularly by members of the transgender community ā€” about the status of NCD and what this administrative challenge was, and so we thought it was important to give affirmative clarification about what this challenge is and how it’s separate from the CMS process,” Block said.

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National

House Republicans propose steep cuts in federal AIDS budget

Advocacy groups say move would eliminate ā€˜Ending HIV Epidemicā€™ initiative

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The Ending the HIV Epidemic initiative was launched during the administration of President Donald Trump.

The Republican-controlled U.S. House Subcommittee on Labor, Health, and Human Services, Education, and Related Agencies approved a spending bill on June 26 that calls for cutting at least $419 million from federal AIDS programs that AIDS activists say would have a devastating impact on efforts to greatly reduce the number of new HIV infections by 2030.

The subcommitteeā€™s proposed bill, which includes billions of dollars in cuts in a wide range of other federal health, education, and human services related programs, is scheduled to be considered by the full House Appropriations Committee on July 10. Officials with AIDS advocacy groups say they are hopeful that the full committee, like last year, will refuse to approve the proposed cuts in the AIDS budget.

The proposed GOP cuts would eliminate $214 million from the U.S. Centers for Disease Control and Preventionā€™s HIV prevention programs, $190 million from the Ryan White HIV/AIDS Program, and $15 million from the Department of Health and Human Services Secretaryā€™s Minority HIV/AIDS Program.

Activists say the impact of those cuts would kill the federal governmentā€™s Ending the HIV Epidemic initiative, which among other things, calls for reducing the number of new HIV infections in the U.S. by 75 percent by 2025 and by 90 percent by 2030. The activists point out that ironically the Ending the HIV Epidemic initiative was launched during the administration of President Donald Trump.

 ā€œInstead of providing new investments in ending HIV by increasing funding for testing, prevention programs, such as PrEP, and life-saving care and treatment, House Republicans are again choosing to go through a worthless exercise of cutting programs that the American people depend on and will never pass,ā€ said Carl Schmid, executive director of the HIV + Hepatitis Policy Institute.

ā€œWhile we vigorously fight these cuts, we look forward to working with the entire Congress in a bipartisan fashion on spending bills that can actually become law,ā€ Schmid said in a statement.

 Schmid noted that the bill also includes provisions known as ā€œpolicy ridersā€ that would take away rights and protections from women, such as access to birth control and abortion, and for minorities, including LGBTQ people.

According to a statement released by the office of Rep. Rosa DeLauro (D-Conn.), who is the ranking minority member of the House Appropriations Committee, one of the policy riders would ā€œblock the Biden administrationā€™s policies to ensure nondiscrimination on the basis of gender identity and sexual orientation.ā€™  The statement says another policy rider would ā€œprevent policies or programs intended to promote diversity, equality, or inclusion.ā€

Most political observers believe the Democratic-controlled U.S. Senate would also kill the GOP proposed policy riders and cuts in the AIDS budget if the full Republican-controlled House were to approve the budget bill passed by the appropriations subcommittee.

Rep, Tom Cole (R-Okla.), who serves as chair of the full House Appropriations Committee, released a statement on June 27 defending the  subcommitteeā€™s bill and its proposed spending cuts. ā€œThe bill provides appropriate and fiscally responsible funding to ensure these departments can continue to perform their core missions while also acknowledging the fiscal realities facing our nation,ā€ he said.

ā€œImportantly, the bill pushes back on the Biden administrationā€™s out-of-touch progressive policy agenda, preventing this White House from finalizing or implementing controversial rules or executive orders,ā€ Cole said in his statement. ā€œIt also preserves long standing bipartisan policy provisions protecting the right to life.ā€

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Concern over marriage equality in US grows two decades after first Mass. same-sex weddings

Gay and lesbian couples began to marry in Bay State in 2004

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(Bigstock photo)

Two decades after Massachusetts became the first state to legalize same-sex marriage, a new study reveals both significant progress and ongoing challenges for married LGBTQ couples in the U.S., with a growing sense of insecurity about the future of their rights.

The Williams Institute at UCLA School of Law surveyed 484 married same-sex couples from all 50 states and D.C. The study, released Monday, marks the 20th anniversary of legal same-sex marriage in the U.S.

Researchers found that 93 percent of respondents cited love as a primary reason for marrying, with 75 percent also mentioning legal protections. Over 83 percent reported positive changes in their sense of security, and 74.6 percent noted improved life satisfaction since marrying.

However, the study also highlighted persistent discrimination and growing concerns about the future. About 11 percent of couples who had a wedding reported facing prejudice during the planning process.

Alarmingly, nearly 80 percent of respondents expressed concern about the potential overturning of the 2015 Obergefell v. Hodges decision, which legalized same-sex marriage nationwide. This anxiety has been exacerbated by initiatives like Project 2025, a conservative policy blueprint that some fear could roll back LGBTQ rights if implemented.

The possibility of a former President Donald Trump victory in the upcoming election has further intensified these concerns. Many respondents cited Trump’s previous U.S. Supreme Court appointments and his statements on LGBTQ issues as reasons for their apprehension. One participant stated, “The thought of another Trump presidency keeps me up at night. We’ve come so far, but it feels like our rights could be stripped away at any moment.”

The current political climate has 29 percent of respondents considering moving to another state, with 52.9 percent citing socio-political concerns as a primary reason. This reflects a growing sense of insecurity among LGBTQ couples about their rights and freedoms.

Brad Sears, founding executive director of the Williams Institute, noted, “The data clearly show that marriage equality has had a profound positive impact on same-sex couples and their families. However, it also reveals ongoing challenges and serious concerns about the future of these rights in light of current political trends and the upcoming election.”

Christy Mallory, legal director at the Williams Institute and lead author of the study, added, “This research provides crucial insights into the lived experiences of same-sex couples two decades after marriage equality began in the U.S. The high level of concern about potential loss of rights underscores the continued importance of legal protections and public support for LGBTQ+ equality.”

The study found that 30 percent of surveyed couples have children, with 58.1 percent of those parents reporting that marriage provided more stability for their families. However, many of these families now worry about the security of their legal status in the face of potential policy changes and shifting political landscapes.

As the nation reflects on two decades of marriage equality, the study underscores both the transformative power of legal recognition and the ongoing need for vigilance in protecting LGBTQ+ rights. The findings highlight the complex reality faced by same-sex couples in America today: Celebrating hard-won progress while grappling with uncertainty about the future, particularly in light of upcoming political events and potential shifts in leadership.

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State Department

State Department hosts meeting on LGBTQ rights and foreign policy

Event took place before Pride Month reception

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Secretary of State Antony Blinken speaks at the State Department Pride Month event on June 27, 2024. (Screen capture via Forbes Breaking News YouTube)

Secretary of State Antony Blinken on Thursday hosted a group of LGBTQ activists and politicians from around the world at the State Department.

The event ā€” described as a “Convening on U.S. Foreign Policy: National Security, Inclusive Development, and the Human Rights of LGBTQI+ Persons” ā€” took place before the State Department’s annual Pride Month reception. Participants included:

ā€¢ Jessica Stern, the special U.S. envoy for the promotion of LGBTQ and intersex rights

ā€¢ U.S. Ambassador to the U.N. Linda Thomas-Greenfield

ā€¢ U.S. Trade Representative Katherine Tai

ā€¢ U.S. Ambassador to India Eric Garcetti

ā€¢ Suzanne Goldberg, senior advisor to the Under Secretary of State for Civil Security, Democracy, and Human Rights

ā€¢ Under Secretary of State for Civilian Security, Democracy, and Human Rights Uzra Zeya

ā€¢ U.S. Agency for International Development Senior LGBTQI+ Coordinator Jay Gilliam

ā€¢ USAID Counselor Clinton D. White

ā€¢ National Security Council Senior Director for Democracy and Human Rights Kelly Razzouk

ā€¢ Assistant U.S. Secretary of Health Adm. Rachel Levine

ā€¢ National Security Council Human Rights Director Jess Huber

ā€¢ U.N. Assistant Secretary General for Human Rights Ilze Brandt Kehris

ā€¢ Icelandic Ambassador to the U.S. BergdĆ­s EllertsdĆ³ttir

ā€¢ Council for Global Equality Co-Executive Director Mark Bromley

ā€¢ Outright International Senior Advisor for Global Intersex Rights Kimberly Zieselman

ā€¢ Essy Adhiambo, executive director of the Institute for Equality and Non Discrimination in Kenya

ā€¢ Pau GonzĆ”lez, co-chair of Hombres Trans PanamĆ” and PFLAG-PanamĆ”

“Forty-five years ago, thousands gathered in D.C. in what became the first national march for LGBTQI+, demanding their voices be heard,” said Thomas-Greenfield in a post to her X account that showed her speaking at the event. “We must continue to carry forward the spirit of these pioneers and fight for equal rights and dignity for all.”

President Joe Biden in 2021 signed a memo that committed the U.S. to promoting LGBTQ and intersex rights abroad as part of his administrationā€™s overall foreign policy.

“LGBTQI+ rights are human rights,” said Blinken. “Our government has a responsibility to defend them, to promote them ā€” here and everywhere.”

Blinken noted consensual same-sex sexual relations remain criminalized in 64 countries, with the death penalty in 11 of them.

He specifically highlighted Uganda’s Anti-Homosexuality Act and Hungarian Prime Minister Viktor OrbĆ”n’s government’s “smearing scapegoating, stigmatizing LGBTQI+ persons ā€” vilifying them with degrading labels, denying them equal rights, normalizing violence against them.” (Gay U.S. Ambassador to Hungary David Pressman this month marched in the annual Budapest Pride parade.)

Blinken noted Iraqi MPs earlier this year “passed legislation that punishes same-sex relations with up to 15 years in prison.” He also pointed out that Indonesian lawmakers approved a new criminal code banning extramarital sex.

“In a nation where same-sex couples cannot marry, these laws effectively make all same-sex conduct illegal and they undermine privacy for all Indonesians,” said Blinken.

“Weā€™re defending and promoting LGBTQI+ rights around the world,” he said.

Blinken noted seven countries ā€” Barbados, St. Kitts and Nevis, Antigua and Barbuda, Dominica, Namibia, Singapore, the Cook Islands ā€” have decriminalized consensual same-sex sexual relations over the last two years. He also highlighted Greece, Liechtenstein, and Thailand this year extended marriage rights to same-sex couples, and other countries are banning so-called “conversion therapy.”

“These achievements are possible because of incredibly courageous human rights defenders and government partners on the ground, but I believe Americaā€™s support is indispensable,” said Blinken. “When we engage ā€” sometimes publicly, sometimes privately, sometimes both ā€” when we share our own knowledge and experience, we can and we do achieve change.”

Blinken also announced the U.S. now considers sexual orientation and gender identity are part of the International Covenant on Civil and Political Rights that took effect in 1976.

“This is one of the key treaties committing nations to upholding universal rights,” he said. 

“In our regular reporting to the council on human rights, we will continue to include incidents of discrimination or abuse committed against LGBTQI+ persons, now with the clear framework of this well-supported interpretation,” added Blinken.Ā “That will further empower our efforts.”

Blinken reiterated this point and the Biden-Harris administration’s commitment to the promotion of LGBTQ and intersex rights abroad when he spoke at the State Department’s Pride Month event.

“Defending, promoting LGBTQI+ rights globally is the right thing to do, but beyond that, itā€™s the smart and necessary thing to do for our country, for our national security, for our well-being,” he said.

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