- The Washington Times - Tuesday, March 8, 2016

A woman from Pennsylvania who now identifies as a transgender man wants to have his uterus surgically removed, and he says Obamacare requires the state to pay for it.

Attorneys for the plaintiff, who is identified only as 30-year-old schoolteacher “John Doe” in court documents, filed a federal complaint Feb. 18 challenging a Pennsylvania law that prohibits Medicaid funds from being used in sex-reassignment surgeries.

“Under Obamacare, it’s got to be provided,” said Julie Chovanes, a transgender woman who represents the plaintiff and is executive director of the Trans Resource Foundation. “It can’t be discriminatorily not provided when medically necessary and prescribed by a doctor.”

The lawsuit is among the first to cite the civil rights provision of the Affordable Care Act, for which the U.S. Department of Health and Human Service’s Office of Civil Rights issued a proposed rule reinterpretation in September.

Section 1557 of the Affordable Care Act prohibits federally subsidized entities in the health care marketplace from discriminating on the basis of race, color, national origin, sex, age or disability.

But the proposed rule change would also bar discrimination on the basis of gender identity, which the HHS says is covered by the provision on sex discrimination, despite the radical distinction between “sex” and “gender” on which transgender advocates insist in every other context.

“What the Obama administration is trying to do is reinterpret the ban on sex discrimination to include sex stereotyping and gender identity,” said Roger Severino, director of the DeVos Center for Religion and Civil Society at The Heritage Foundation. “And they’re trying to do this through these proposed regulations. No one would expect on the natural reading of the word ‘sex’ that that would include subjective concepts like gender identity, when it’s not specifically mentioned.”

The reinterpretation could strike down laws in states that ban Medicaid funds from being used in sex-reassignment procedures.

“I think it’s another striking example of federal overreach and intrusion, not only into the operations of the states, but into the operations of individual hospitals, physicians, and insurers, who should have the ability to make their own decisions when it comes to controversial treatments,” Mr. Severino said.

Underlying the debate on who should pay for the surgeries is whether such procedures even work to treat transgender people.

Dr. Paul McHugh, a professor of psychiatry at the Johns Hopkins University School of Medicine, said gender dysphoria is a psychosocial ailment — similar to anorexia and other body-dysmorphic maladies — and therefore should be treated through psychotherapy and counseling.

He said there is scant evidence to suggest that sex change surgeries work and argues that proponents of the procedures are taking a “great shot in the dark for an ideological reason.”

“Nobody would give this kind of treatment, with this kind of evidence, for anything other than ideological reasons,” said Dr. McHugh, who ended such procedures at Johns Hopkins in his capacity as chairman of the Department of Psychiatry in 1979.

But Sarah Warbelow, legal director of the Human Rights Campaign, said Dr. McHugh’s understanding flies in the face of standard medical practice, citing the American Psychiatric Association and American Medical Association, which recommend a physical rather than mental remedy.

“Mental health services are important for a wide variety of people for a wide variety of needs,” Ms. Warbelow said. “And certainly transgender people do seek relationships with mental health care providers, but the appropriate treatment as deemed by the American Medical Association and every major physical and mental health-care organization out there is to affirm people in their gender identity.”

The price of the procedures has also caused critics to question whether such funds would not be better spent elsewhere.

Dr. McHugh said the treatment plan can vary drastically from patient to patient — some of whom opt only for hormone or testosterone injections while others seek an assortment of procedures from electrolysis for facial and body hair to penectomy, vaginoplasty and facial reconstruction.

In total, he said, the surgeries can run in the tens of thousands of dollars. “And then, of course, people have to have medical care afterward for all kinds of hormone treatments. It’s an expensive business.”

But Ms. Chovanes said the costs of sex-reassignment surgeries would be a drop in the pond of the multibillion-dollar Medicaid budget.

“There are 2.2 million Pennsylvania people on Medicaid, and since the entire program is something like $26 billion, this specific care should be pretty minor when considered within the greater context of the program,” Ms. Chovanes said.

“I would say the exact cost estimate really isn’t important,” Ms. Warbelow said. “That we provide health care and health benefits to ensure people are healthy and are able to engage in a full life, you certainly don’t question what it costs to provide treatments for any number of health care needs.”

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