photo by Carol Duff Health Editor’s Note: In June of 2011, the Veterans Health Administration (VHA) issued a Directive to establish a policy for delivery of healthcare to transgender and intersex veterans who were registered in the Department of Veterans Affairs (VA) healthcare system or was eligible for VA care. The main gist of this Directive was to set an example for providers in both the private and public healthcare sectors that would be respectful and would also secure equal access for transgender veterans
The new directive was to accomplish several things:
All VA staff was to provide care to transgender veterans without any discrimination
All personal information about transgender status and medical care would be kept confidential
States that under existing regulations, sex reassignment surgery cannot be performed or paid for by the VA
States that all other medically necessary healthcare for transgender veterans is covered, including sex-specific care such as pap smears, mammograms, mental health services, and transition related care, such as hormone therapy.
Since the Directive was issued by the Veterans Health Administration (VHA) which oversees mental and medical healthcare for military veterans, there was no authority to change policies for CHAMPVA or TRICARE programs. The Directive applies to military veterans, not active duty members or dependents of active duty, retired, or veteran service members. TRICARE and CHAMPVA have different sets of rules than the VHA. TRICARE, of course, is the healthcare program run by the DOD that serves retired and active duty members of the uniformed services and their dependents. CHAMPVA does the same for retired members of the military.
The existing sex reassignment surgery exclusion applies to actual surgical procedures, but does not bar VA facilities from giving pre- and post-operative care or evaluations. The VA will not pay for or perform sex reassignment surgery.
In the 2016 VA Impact Analysis, the VA was planning to continue it previous policy, to not cover sex reassignment surgery, because there was the assumption, on the part of the VA, that surgical treatments were not medically necessary. The VA also gave the excuse that surgical treatment for gender dysphoria could lead to suicide. Any sane person would understand that if one feels like a male person and is in female body or vice versa, that would lead to immense emotional issues that could cause someone to feel so out of control of his or her life that he or she thinks about ending his or her life. Feeling hopeless since you cannot have surgery. I believe there is another reason why the VA does not want to cover the expenses for sex reassignment surgery. The VA does not want to spend money on its veterans.
I did look at the approximate actual costs of sex reassignment surgeries. These surgeries on the average run about $140,450 from male to female and $124,400 from female to male. This involves surgery and alterations for the face, upper body, and bottom.