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  1. #1
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    Minnesota faces lawsuit over transgender surgery policy

    The state of Minnesota is facing a lawsuit over its healthcare policy involving gender reassignment surgery.

    63-year-old Evan Thomas and gay rights advocacy group Outfront Minnesota have filed a lawsuit against the Minnesota Department of Human Services which oversees state health insurance plans.

    The legislature passed a law back in 2005 that bans public health programs from covering the procedures.

    "I want this statute to go away. So that people can access the care they need," said Thomas.

    Thomas was born a woman but now identifies as a man, also known as gender dysphoria.

    He attempted to have his breasts removed in April but was denied coverage of the procedure because his state-run insurance doesn't allow it.

    For about 30 years, the state did cover the procedure before lawmakers changed that 10 years ago.

    "It's a six word statute, sex reassignment surgery is not covered, and we believe that's an unconstitutional act by the legislature," said Phil Duran, an attorney with OutFront Minnesota.
    http://www.kare11.com/story/news/loc...licy/77608060/

    http://kstp.com/news/stories/s3995708.shtml

    https://www.revisor.mn.gov/statutes/?id=256b.0625

    Subd. 3a.Sex reassignment surgery. Sex reassignment surgery is not covered.
    LGBT activists and a transgender man are suing the state of Minnesota. They want the public health insurance ban on gender reassignment surgeries to be overturned. Right now 10 states and the District of Columbia cover transition-related surgery in their public healthcare plans. In Minnesota only private health insurance plans cover these surgeries.

    Medical Assistance and MinnesotaCare don't.
    http://www.huffingtonpost.com/entry/...b06fa6887d31a0

    http://www.medscape.com/viewarticle/821141_6

    http://news.yahoo.com/a-third-of-for...142740785.html

    http://obamacarefacts.com/questions/...alth-coverage/

    I personally have no problem with transgender surgery and various therapies, but I draw a line at having it paid for by state tax funds. I think there are a lot of other avenues to pay for that type of elective surgery for those that desire it-- including moving to another state that covers it, or gaining employment in one of the companies that covers it under private insurance, or raising funds to pay for it personally.

    As a health care professional, I personally don't view transgender surgeries as "medically necessary" at all, but as "highly desired" elective surgeries for "emotional and psychological well-being". That is a VERY wide category, IMO (desiring elective surgery for emotional and psychological well being) that could include lots of people with emotional and psychological desires, who want everything from tummy tucks, to vaginal tightening, to face lifts, to breast enhancement, etc. I think it's a slippery slope to trying to mandate coverage for more elective cosmetic surgeries, at a time when cost containment is critical.

    The bigger issue is "medically necessary", and how that is defined, IMO. "Need" versus "want".

    Elective surgery of all sorts should be safe and available, but not paid for by tax dollars, until we cover a whole bunch of other, "more" medically necessary things FIRST, IMO.

    What do other posters think? Should people on state funded health care plans (medicaid) be provided with this kind of surgery on request?

  2. #2
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    This is beyond ridiculous. There is no way we the people need to pay for this!

  3. #3
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    Transgender advocacy programs could set up microfinancing programs for applicants to apply for funding. Just like some cosmetic surgery centers have financing plans.

    There are a lot of ways to look at funding elective procedures without tax dollars. That's my issue.

    If we're going to fund transgender surgery at tax payer cost, I can think of a lot of other things that should be covered "on request". Dentures and glasses, for starters!

    I mean, where does it end? If I claim I'm severely depressed or suicidal because I'm not as attractive as I wish to be, what elective cosmetic procedures are covered if I'm on medicaid? Body dysmorphic disorder is a "diagnosis" too, right?

    https://en.wikipedia.org/wiki/Body_dysmorphic_disorder

  4. #4
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    By the way, I don't think congenital intersex conditions should be included in the ban on"elective" transgender surgery category. I DO think medical and surgical care for those unfortunate people with severe birth defects should be covered under all types of insurance, including tax funded medicaid, and I'm happy to have my tax dollars cover their care.

  5. #5
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    Is there a high demand?

  6. #6
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    Evan Thomas, IMO, is the wrong kind of plaintiff to bring this kind of lawsuit

    According to Out Front Minnesota (in the 26 page complaint), they "represent" 1500-2000 gay and transgendered people, but don't quantify how many are transgendered. The complaint says prior to 2005 "a couple" surgeries were approved per year.

    It doesn't matter to me how many people are affected, because I'm opposed to the use of tax payer funds for what I perceive as purely elective cosmetic surgery-- whether that's a breast augmentation, or a subcutaneous mastectomy. (If Thomas had breast cancer, I'd be fine with funding mastectomy +/- reconstruction.)

    My issue is that again, transgendered people want to be in a separate category with MORE rights and MORE coverage than is offered to non-transgendered people.

    Take, for instance, a woman who is on medicaid who has infertility. Infertility is arguably a very emotional and psychologically debilitating condition for SOME women. Yet we would not consider covering all methods of assisted reproductive technology simply "on request" of the medicaid recipient, for as many times and tries as they wanted. Nor does the state cover the costs of adoption, or elective pregnancy termination, or teeth whitening, or facelifts, etc. There is a limit to what is, and should be, covered, IMO.

    When you are taking welfare medical benefits because you cannot (or will not) provide for yourself, I don't think you have a "right" to any elective services you desire. That's just my opinion. Basic care should be covered, and emergency care, but not things like cosmetic surgeries.

    Evan Thomas is receiving hormonal therapy covered by medicaid, and more importantly, IMO, he IS covered for mental health care. It is the mental health care component, IMO, that is "medically necessary," not the bilateral mastectomy.

    The complaint is an interesting read. Evan Thomas has a PhD, in Behavioral Neuroscience, who worked for a short time at Johns Hopkins early in his career. He is a very educated person, who understands psychology, and the medical system. He is not an intellectually vulnerable, undereducated, person who has been dependent on social welfare programs for his entire life. His gender dysphoria in the academic environment at Johns Hopkins prompted him to leave that type of academic work, and become a furniture refinisher. His business failed 3 years ago, and only then did he seek social welfare programs and medicaid, and it was in April of this year that he sought (at age 63) the breast surgery at taxpayer expense. I see his life choices as part of his situation where he chose to go on medicaid. Also note that in under 2 years he will be medicare eligible.

    This man, IMO, is absolutely smart enough to figure out how to pay for the elective surgery he desires, without the tax payers footing the bill-- just as lots of other people who want elective cosmetic surgery do.

    OutFront Minnesota employs 15 people, and gets grants for all sorts of things. If Out Front MN wanted to fund his bilateral mastectomy, it would be cheaper than pushing this kind of a civil lawsuit against the State of MN, IMO.

    I'm not opposed to Evan Thomas having his elective surgery, but I am opposed to my tax dollars paying for it-- especially given his life career choices. And yes, that is discrimination-- which I think is reasonable and prudent for this kind of thing. Money doesn't grow on trees. We discriminate against funding other kinds of elective cosmetic surgery all the time.

    Why should the emotional distress of transgendered people be "more important" or "more severe" than those with infertility? Or those with a big nose who want it smaller? Or those who are embarrassed because they have rotten teeth, or missing teeth, or no teeth at all? Or those that want to modify any body part to make different or more acceptable to them? There are plenty of people on medicaid who want elective surgery. And there are many more on medicaid who barely get the basics they need to stay alive. I know some will think I'm heartless, but I just don't think elective surgery for transgendered people is medically necessary on any level. It may make them "feel better" about their appearance, but the same could be said for anyone who wants any kind of cosmetic surgery.

    I don't think Evan Thomas is an effective, sympathetic plaintiff to be the one bringing this lawsuit against the State of MN. JMO.

    Here's the 26 page complaint:

    http://www.aclu-mn.org/files/8714/50..._complaint.pdf

  7. #7
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    Slippery slopes all around, I'm afraid. The standard of being 'merely' for emotional and psychological comfort' certainly could--and used to be used to--preclude facial reconstruction for children born with anomalies. We used to routinely put off such plastic surgery prior to physical maturity so as to avoid the need for progressive repairs. Turns out the emotional and psychological discomfort was actually pretty harmful.

    Further, in some states surgical alteration has been set as a minimum standard for such things as issuing ID with appropriate gender, or use of an appropriate bathroom.

    The tax dollar argument, though is one that always leaves me cold--presuming some enhanced public right to intude in others lives (don't use SNAP to buy those chips--they're unhealthy!). Frankly, I support single-payer health care, all tax financed, so at some point we're going to have to get past looking on such things as charity with all recipients beholden.

  8. #8
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    Thought I'd share this with you all.
    San Francisco Transgender Benefit: Estimating Cost and Utilization for the "Worst Case" (1997-2001) | Human Rights Campaign
    http://www.hrc.org/resources/san-fra...tion-for-the-w


    Granted, my perspective may be somewhat different. The City has paid for this surgery for quite some time. I've had the unique experience of working alongside an extremely diverse and professional healthcare workforce in my time here. Yes, a few have utilized this benefit.

    That said, it may not raise the same eyebrows as it does in other parts of the country.

    Food for thought.


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  9. #9
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    And yet, the state of MN would not help me with my pregnancy because I am 2k over the maximum amount. Excuse me for working too hard.

  10. #10
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    Quote Originally Posted by Lulu14 View Post
    And yet, the state of MN would not help me with my pregnancy because I am 2k over the maximum amount. Excuse me for working too hard.
    Is there some criteria other than, or in addition to income that should be used?


  11. #11
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    Quote Originally Posted by kimi_SFC View Post
    Thought I'd share this with you all.
    San Francisco Transgender Benefit: Estimating Cost and Utilization for the "Worst Case" (1997-2001) | Human Rights Campaign
    http://www.hrc.org/resources/san-fra...tion-for-the-w
    Granted, my perspective may be somewhat different. The City has paid for this surgery for quite some time. I've had the unique experience of working alongside an extremely diverse and professional healthcare workforce in my time here. Yes, a few have utilized this benefit.
    Sent from my iPhone using Tapatalk

    Thank you very much for providing links w facts & $ figures.

    I could not find date of study or publication but must be post-2006. 2007? 2008? Anyone?

    Any other studies about predicted and actual costs of expanded services? Thx in adv.

  12. #12
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    Quote Originally Posted by al66pine View Post
    Thank you very much for providing links w facts & $ figures.

    I could not find date of study or publication but must be post-2006. 2007? 2008? Anyone?

    Any other studies about predicted and actual costs of expanded services? Thx in adv.
    This doesn't apply to the cost in dollars, but it does apply to the cost in human lives. I found this to be a VERY interesting study with a huge amount of statistical analysis. It's really quite hurtful to people who are trangender or suffering from gender dysphoria to say that surgery is akin to an elective cosmetic procedure. The affects of their condition goes much deeper than that on a psychological level. Suicide rates confirm that. I think their is still a great deal we have to learn about gender issues on the genetic level. JMO of course.

    http://williamsinstitute.law.ucla.ed...port-Final.pdf

    Overall, the most striking finding of our analysis was
    the exceptionally high prevalence of lifetime suicide
    attempts reported by NTDS respondents across
    all demographics and experiences. Based on prior
    research and the findings of this report, we find that
    mental health factors and experiences of harassment,
    discrimination, violence and rejection may interact to
    produce a marked vulnerability to suicidal behavior in
    transgender and gender non-conforming individuals.
    More research on suicidal behavior among transgender
    and gender non-conforming people is needed.

  13. #13
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    Why are people so jealous of what others may get on welfare? You can be on it too. Just get rid of everything you own.

  14. #14
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    Quote Originally Posted by Margo/Mom View Post
    Is there some criteria other than, or in addition to income that should be used?

    Yep. The harder and longer you work, the more benefits you should get, not the other way around.

  15. #15
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    Quote Originally Posted by human View Post
    Why are people so jealous of what others may get on welfare? You can be on it too. Just get rid of everything you own.

    Yep, just quit work. Or divorce my husband. These rules really make you want to work and achieve something in life, don't they?

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