Wednesday, June 18, 2008

AMA Opposes Transgender Health Care Exclusions

RESOLVED, That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder (GID) ; and be it further

RESOLVED, That our AMA oppose categorical exclusions of coverage for treatment of GID when prescribed by a physician.

So states a May 5 resolution of the AMA's House of Delegates, entitled "Removing Financial Barriers to Care for Transgender Patients." The AMA has supported transition therapies and opposed anti-trans discrimination in the past, but now it is on record squarely against the exclusion of transition-related counseling, hormone therapy and reassignment surgery from private or public insurance plans.

The impact of this statement remains to be seen, but it could prove significant in a number of legal arenas. While exclusions in private insurance are nearly impossible to challenge, litigants could draw support from the AMA's position in a number of other areas:

Medicaid coverage. States make their own rules for Medicaid coverage -- within reason. Challenges to the exclusion of transition therapies have been a mixed bag to date, and no doubt there will be more in the future.

Prisoner health care. In 2005, Wisconsin passed a law (the "Inmate Sex Change Prevention Act") that bars prison doctors from providing any kind of transition-related treatment to inmates, no matter how medically necessary. The law is currently being challenged (under the Eighth Amendment, which forbids denials of medically necessary care to prisoners) in a case called Sundstrom v. Frank. The federal district court temporarily enjoined the law, and the case went to trial last fall. If the law is upheld, similar measures will no doubt be considered elsewhere.

Tax deductions. The U.S. Tax Court is expected soon to release a decision (In re Rhiannon O'Donnabhain) on whether sex reassignment surgery is a medically necessary, and therefore tax-deductible, expense.

In all these areas, the legal question boils down to whether transition therapies are appropriate, necessary medical care.

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