What should and shouldn’t be covered under government-sponsored healthcare has long been a subject of debate in many parts of the United States. Many states simply set their own limits (or don’t set any at all), changing their laws as they discover a need, while others carved out clear policies concerning what was and wasn’t covered by state healthcare.
One state the set its own clear regulations is the state of Wisconsin. One of the limits that the state set on Medicaid distributed through the state is that it should not cover elective surgeries and treatments. Now, two transgender Wisconsin residents have filed a federal lawsuit, claiming that the state’s refusal to pay for their gender reassignment surgeries is discrimination.
They’re hoping to force Wisconsin’s Medicaid program, it’s taxpayers, to pay for their reassignment surgeries and “damages.”
The pair, angry that the state will not pay for their transitional procedures, is challenging a 1997 Wisconsin regulation that holds “transsexual surgery” medically unnecessary, and therefore not a procedure eligible for Medicaid coverage.
Flack and Makenzie claim that they suffer from “gender dysphoria,” a mental health illness classified in the DSM-5, which basically makes the sufferer feel like they don’t belong in their body and would rather be the opposite sex.
Furthermore, the pair claim that there is no scientific basis for Wisconsin’s decision to deny gender reassignment, or the choice to classify it as an elective surgery, which is completely false.
They say that there is a “strong medical consensus” that the best treatment for the mental health condition known as ‘gender dysphoria’ is sex reassignment surgery and hormone treatments.
The attorneys acting on behalf of the pair claim that Medicaid operates with federal funds, but is operated by the state government.
They say denying the pair services ‘that they desire’ amounts to discrimination based on gender identity.
Flack claims that he has been extremely depressed and under emotional distress because he cannot ‘fully’ transition.
Makenzie, likewise, claims that she was suicidal, as well as engaging in “self-harming behaviors, including cutting her genital area” according to her attorneys.
Both claim that they have been ‘harmed’ by the ‘discrimination’ they face in the state’s Medicaid program. However, her attorneys face an uphill battle in this lawsuit for a wide variety of reasons.
Firstly, the ‘science’ behind transgender treatments is not settled. Even with treatment, many individuals who suffer from gender dysphoria don’t get better. Suicide rates for transgender individuals, post-gender reassignment surgery, are FAR higher than they are for the average person, so calling it a ‘solution’ or a ‘treatment’ is a stretch.
Moreover, the ‘discrimination based on identity,’ using the ACA’s wording as a basis for overturning Wisconsin’s regulation, which is really the crux of the argument, is on weak footing.
Wisconsin’s Medicaid program is not barring transgender individuals alone from receiving questionably-useful hormone treatments, breast implants, and ‘gender reassignment’ surgeries. It bars all those treatments for its citizens, save in a handful of specific cases.
Searching through the state’s Medicaid website, there is no information on breast implants whatsoever, even for those who undergo treatments such as a mastectomy.
If the procedure is not available to people who need it as a medical necessity, it’s difficult to claim that refusing to provide the procedure on a purely elective basis is somehow discriminatory.
Medicaid is not meant to cover people simply wanting the government to shoulder the burden of their elective procedures.
Medicaid generally covers people who live below a certain income level, so long as they meet one of a number of other conditions.
Generally, Medicaid will cover the extremely impoverished who are single mothers, people under 21 or over 65, and those who are blind or disabled.
Wisconsin is not the only state in the country that denies ‘transgender treatments’ in their Medicaid program, either.
All told, 10 states, including Wisconsin, bar such treatments under the program.
Eighteen states and Washington D.C. cover such treatments explicitly, deeming them to be necessary. However, from a legal standpoint, just because one state chooses to cover a treatment or operation, it doesn’t necessarily strengthen the claim that other states should cover the same treatment or operation.
It’s a complex legal question, and it is likely to go beyond the federal court that first hears it.
Makenzie, a Baraboo resident who has lived as a woman since 2012, and Flack, a Green Bay resident who began transitioning in 2006, are not only demanding that the state cover their ‘reassignment procedures,’ though.
They’re also demanding that the state pay their attorney fees, as well as compensatory damages for ’emotional distress.’