Over the last several weeks, I have been asked by many of my new transgender and gender nonbinary patients if gender affirming top surgery will soon be banned due to the Trump Administration’s Executive Orders.
They truly are very fearful of this possibility.
We have also received numerous telephone calls expressing the same concerns.
There is a lot of fearmongering, hype, misinformation and disinformation presented by the media, online, by various interest groups and politicians which is fueling this hysteria. All of this has created misunderstanding and confusion and, of course, fear and anxiety.
This is extremely unfortunate.
So what is the truth?
Will gender affirming top surgery be prohibited going forward?
Do you need to drop everything and immediately seek out the procedure before it is too late?
The very short answer to this is: NO.
However, there is more to this story so let’s look into this more closely and objectively.
One caveat: This will not, however, delve into the effects of the executive orders on the delivery of non-surgical transgender care nor will this cover non-medical issues that will or may impact transgender and gender nonbinary individuals.
Will there be a ban on gender affirming top surgery for those of legal age?
Nowhere in the Presidential executive orders or in pending or passed Congressional legislation are there federal prohibitions of gender affirming top surgery for those of legal age. Additionally, this is not an issue that is being considered.
So, don’t worry about this if you are of legal age. Neither the President nor Congress is seeking to make top surgery an illegal procedure. In addition, no state has a complete ban on performing these procedures on adults.
Will there be a ban on gender affirming top surgery for minors?
In the Executive Order entitled “Protecting Children from Chemical and Surgical Mutilation”, federal support for top surgery in those under age 19 will be terminated. The surgery can still be performed but it will not be financially covered. This will likely apply to Medicare, Medicaid and the Affordable Care Act plans (Obamacare).
Presently, a total of 26 states, including Arizona, already have a ban on performing of gender related surgery on minors. This is, of course, fluid and will likely continue to change in the future.
Will there be an impact on insurance coverage for top surgery?
Yes, there will be a direct impact on insurance plans that are administered by or in association with the federal government. In particular, this includes Medicaid, Medicare and the Affordable Care Act plans (Obamacare). For those in the military, this would also include Tricare. VA Health Care has never covered gender affirming surgery and likely will continue with this policy.
Particular plans from insurance companies like Aetna, BlueCross BlueShield, Cigna and United Healthcare may also be adversely impacted if there is an association with the federal government. Again, this means your costs will be greater.
Will there be a financial impact on gender affirming top surgery?
Clearly, there will be a financial impact on your costs to undergo gender affirming top surgery if you are using one of the previously mentioned and affected plans. You will be paying out of pocket fully for top surgery which will no longer be “covered” by insurance. That means it will be far more costly for you as you will likely be responsible for all the related costs of surgery.
In Summary
Whether or not you will or may be affected by the recent Trump Administration’s Executive Orders depends on your particular situation and factors as covered above. There may also be changes to the above in the future for a variety of reasons.
Most importantly and reinforcing what has been already stated, if you are either a transgender or gender nonbinary adult, have gender dysphoria and are wanting to undergo gender affirming top surgery, you absolutely still will be able to do so.
So, take a deep breath now … and relax!
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
