Reduced funding for gender-affirming care for low-income youth comes with real costs
The House Energy and Commerce Committee released their reconciliation bill recently, which proposed to cut $715 billion out of Medicaid. Medicaid cuts will cause millions of people to lose coverage, access to services and their health status. One of the provisions of the bill would prohibit federal funding of “gender-transition procedures” for those under 18 years of age enrolled in Medicaid or CHIP. This prohibition would prevent young people from receiving medically-necessary inpatient and outpatient medical interventions, medications, and procedures used to treat gender dysphoria (also known as gender affirming care). The bill would also prohibit gender-affirming services as essential health benefits, which could limit adult access to these services under Medicaid and Marketplace plans. The CBO estimate of $700 million savings over ten year is inflated. The CBO estimate is significantly inflated. See Supp. Decl. David Williams P Flack V. Wis. Dep’t Health No. 3:18-cv-00309-wmc (Oct. 16, 2018, W.D. Wis.) . Flack v. Wis. Dept’ Health, 395 F. Supp. Flack v. Wis. Dept’ Health, 395 F. Supp. 3d 1001, 1008 (W.D. Wis. 2019).
The CBO’s figure is also inconsistent other estimates of the costs of care for youth who use gender-affirming treatment such as hormone treatment and puberty-suppressing medications, which are relatively low cost, ranging from a few hundred to $4,000 per annum. A study found that the lifetime cost of gender-affirming treatment ranged between $25,000 and $75,000 for an individual. It also noted that this cost pales in comparison to other procedures or drugs that are routinely paid for by Medicaid. In studies of employer-sponsored health insurance, gender-affirming coverage has consistently been found to be so inexpensive that it is “negligible”. For example, San Francisco initially covered gender-affirming services for its employees by adding a small surcharge. However, after five years, the cost for the care was a fraction of what the surcharge collected. San Francisco then phased out the charge. Colorado has also added gender affirming care and other services to the EHB benchmark plan, which is a model that outlines benefits that all individual and small group market plans in the State must cover. To incorporate gender-affirming care into the EHB benchmark plan, actuaries in Colorado had to certify that the added costs of covering these services was minimal, even while assuming that between 80% and 100% of all transgender individuals would use the newly available benefits.
Moreover, the CBO estimate fails to account for the costs associated with withholding care from youth who need it. The research shows that paying for medically-necessary gender-affirming services is cost-effective. This is partly because people with gender dysphoria, who cannot access treatment, are more likely than others to develop other health conditions, such as depression, HIV and substance abuse disorders. Research shows that denying medically necessary care to young people with gender dysphoria can have a significant impact on their mental and physical health. The research shows that people with gender dysphoria, who cannot access medically-necessary care early in life, are more likely to require more expensive and invasive interventions in later years. The attempt by Congress to use the budgetary system to deny low-income Medicaid recipients access to medically necessary care is morally repugnant. The bill’s claim that excluding care will save money for the federal budget is just a thinly-veiled guise to hide its true intention – the continued bullying and harassment of Transgenders, especially Transgender Children. Those who want to deny medically necessary gender affirming services are willing to pay millions in legal fees just to defend their cruel policy. NHeLP continues its affirmation that gender-affirming health care is good for everyone. We urge Congress to remove from its budget proposal provisions that would curtail federal funds for gender-affirming health care.
