Federal agencies that deal with healthcare have been slowly tilting leftward on controversial social questions of how LGBT Americans should be treated, easing limits on blood donations from gay men and expanding coverage for sex-reassignment surgery.
While conservatives are dismayed at some of the policy shifts, things aren’t changing nearly fast enough for activists and some Democrats who are pressuring the Food and Drug Administration, Medicare and the Department of Veterans Affairs to further liberalize their approaches.
Blood donations from gay men
Until December, gay men were banned entirely from donating blood if they had sex with another man in their lifetimes. But under the FDA’s new policy, gay men must abstain from sex with other men for just one year.
Yet gay activists say that update doesn’t go far enough, and they’re pushing for the agency to lift the restriction entirely, instead requiring all potential donors to answer a questionnaire that indicates their risk of spreading an infection.
While Republicans have remained relatively silent on the question, the recent shooting in an Orlando gay nightclub has fueled the issue among House Democrats, who last week called on the FDA to base donation rules on a risk calculation rather then on sexual orientation.
Rep. Xavier Becerra, D-Calif., noted that under the current policy, a gay, monogamous man who practices safe sex faces more restrictions than a heterosexual man with many sexual partners who doesn’t use protection.
“We’re talking about a policy of the 20th century,” Becerra said. “This is not a time to let the 20th century dictate how we do things in the 21st century.”
“Due to the [men who have sex with men] deferral policy, many healthy gay and bisexual men are prohibited from donating desperately needed blood,” said a letter to the FDA from Reps. Mike Quigley, Barbara Lee, Debbie Wasserman Schultz, Jared Polis, Dianne DeGette and Alcee Hastings.
The Human Rights Campaign also wants the ban lifted. Government Affairs Director David Stacy said that gay men trying to donate blood for the dozens of injured victims in Orlando were being unfairly turned away.
“As we think about Orlando, we have to find ways to reduce the stigma,” Stacy said.
And on Tuesday, which was World Blood Donor Day, a group called the Blood Equity Campaign organized a protest in New York City of the FDA’s policy. The group says it is forming a medical advisory board comprised of experts on blood donation policies, HIV and blood safety to pressure the agency.
Medicare funds transgender surgery, sort of
Medicare opened up sex reassignment surgery to seniors two years ago, when it lifted a ban placed in the 1980s on paying for such procedures, saying they’re no longer considered experimental. Beneficiaries now can ask Medicare to pay for sex reassignment surgeries, which are decided on a case-by-case basis by regional contractors.
The next step would be for Medicare to set a national standard for regularly covering reassignment surgeries, since seniors aren’t guaranteed coverage under current rules.
But the Centers for Medicare and Medicaid Services said in May that there’s not enough evidence to support widespread Medicare coverage for sex reassignment. So few seniors seek sex reassignment that there aren’t enough clinical studies indicating health outcomes on which to base a decision, the agency wrote.
Some have pushed back against the decision, including the Whitman-Walker Health Center in the District of Columbia, which specializes in LGBT care. “Our experience caring for over 1,200 transgender patients each year has given us ample evidence that coverage of gender transition-related care is medically necessary,” said Dan Bruner, the center’s policy director.
Reassignment surgery for transgender vets
Meanwhile, the VA is considering following Medicare’s lead by lifting its comprehensive ban on reassignment surgery for veterans who want a sex change. The agency has allowed certain standardized care for transgender veterans since 2011, but excluded surgeries.
Early this month, the VA proposed a rule allowing veterans to be granted coverage for surgeries on a case-by-case basis. “Surgical procedures are now widely accepted in the medical community as medically necessary treatment for gender dysphoria,” the proposal says.
But any final policy change is a long way off, as the VA proposal still needs to be reviewed by the White House Office of Management and Budget and then continue through the rule-making process, which could take up to 22 months.
Obamacare providers can’t refuse care to transgender people
In general, conservatives aren’t pleased with federal agencies funding hormone therapy or reassignment surgery for transgender people. But what they’re really irked by are directives from the Obama administration about how schools and healthcare providers must treat transgender people.
The Department of Health and Human Services issued a rule in May that says any provider who accepts patients with Obamacare, Medicare or Medicaid coverage can’t deny healthcare based on someone’s gender identity or deny sex-specific treatments just because an individual prefers to identify as a different gender.
In the spring, President Obama issued an executive order that said school districts must allow students access to bathrooms and other areas that correspond to their psychological, not their biological, identity. Otherwise, they may face losing their federal funding.
“One of the worst parts of this guidance is that it does not require students experiencing gender identity dysphoria to obtain a doctor’s note for the special bathroom and locker room provision, nor does it even require the school to notify the parents if their child requests these special provisions,” Family Research Council President Tony Perkins wrote in a letter to the conservative group’s supporters earlier this month.
