My Public Comment in Support of Gender-Afffirming Care
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Sorry for the second blast of the day (I try very hard not to spam you lovely people). I decided to do this as a second post for future reference. Here’s my public comment and here is my post on how make your own by 11:59pm Eastern time tonight! Please do not just copy/paste this - make it your own, or it will be considered a “form letter” and potentially discounted.
My public comment
My comment on: "Prohibition on Coverage of Sex-Trait Modification as an EHB (§ 156.115(d))".
I am a transgender woman, and this rule could have highly negative effects on me, as well as over two million other transgender Americans (https://tinyurl.com/37e7y9wp).
Gender Dysphoria is a recognized condition in the “principal authority for psychiatric diagnoses”, the DSM-5, produced by the American Psychiatric Association (https://tinyurl.com/kk7sbr6x). “Sex-trait modification” (STM), or, as it is referred to in the medical community, “gender-affirming care” (GAC – the term I will use throughout), is endorsed as the appropriate treatment for gender dysphoria by every major medical organization in the United States (https://tinyurl.com/2z5yxmub). Furthermore, satisfaction with it is found to be incredibly high – 97% or higher (https://tinyurl.com/48eczwfe, page 18). The regret rate is much lower than many other common medical treatments (https://tinyurl.com/4533f547, https://tinyurl.com/y848zvwd). This is true even for minors (https://tinyurl.com/ycxpm6v4), where there are also decades of supporting research to back gender-affirming care as being sound medicine.
No other treatment for gender dysphoria has an evidence base that shows positive results, meaning that this rule’s limits on gender-affirming care would deny effective treatment to many transgender Americans. “Conversion therapy”, broadly the umbrella of attempting to treat gender dysphoria via psychological therapy, is found to be a net negative (https://tinyurl.com/2e4dk8yn), causing increases in mental health issues and suicidal ideation and attempts. It is denounced by numerous medical organizations (see link).
This matches my own experience. I did not begin my transition until I was in my early 40’s, and it has been the best thing ever for my life. My entire life was marked by a struggle with gender dysphoria. Since transitioning, I am happier and healthier. My mental health has improved dramatically, though the stress of societal prejudice against transgender people is not insignificant, including having to worry about rules such as this one. My kids report that I am a better parent, and my wife reports that I am a better partner. My friends say that they can see how much easier life is for me now. After having had facial feminization surgery, I finally recognize myself in the mirror, and like what I see.
Put simply: transgender Americans and our medical providers are overwhelmingly in favor of evidence backed gender-affirming care (again, what this rule refers to as “sex-trait modification), and the government should be promoting it for the public good, not curtailing access to it when there is no comparable body of research to support such limits.
Economic considerations should not matter, as we do not decide what treatments should be covered based on how much they cost (this would be a form of eugenics, and Republicans stood strongly against the potential for this during the debates about the Affordable Care Act - https://tinyurl.com/nhcpcrnd). It is surprising to me to see a Republican administration now proposing to do exactly that. But if economics are the issue, a study showed that as of 2020, there were still only ~13,000 gender-affirming surgeries annually. If each cost $10,000, that would amount to only $130 million/year, or 0.003% of the total $4.1 trillion (https://tinyurl.com/8ns3radz) United States spending on health care. This amounts to less than fifty cents for each of the over 300 million people living in America. Surely this is no burden for the richest nation on earth (https://tinyurl.com/kcccxdwu). Furthermore, recall that the lack of this care leads to mental health issues, which can lead to medical treatment or losses of productivity, meaning the overall burden on taxpayers may be higher by denying this care.
Finally, in addition to the harm done to transgender Americans, there is a precedent laid here for HHS to further insert itself into decisions that should be between a patient and their relevant health care professionals. For HHS to forbid something like conversion therapy makes sense, because it is denounced by the relevant medical organizations. But for it to forbid gender-affirming care (aka “sex-trait modification”) opens pandora’s box of big government, by saying that the federal government can override those personal medical decisions, even when those decisions are in line with universally accepted best practices.
I understand that good comments are supposed to provide alternatives. Mine is this: strengthen coverage for gender-affirming care instead of weakening it. At least, simply do not make this rule, which is driven by prejudice against transgender Americans. It will likely be rightly struck down by the courts for the animus involved in its passage, the rights that it infringes on, and more.
Please retract this proposal and instead strengthen access to gender-affirming care.
And that’s it!
Good luck to all of you writing, and remember: trans rights are human rights!
Thank you for drawing my attention to the proposed rule. I have submitted a comment.