Metro Weekly

Pennsylvania’s Children’s Health Insurance Program held hostage by anti-transgender amendment

Amendment is so broad that bureaucrats might interpret it to justify denying medically necessary care to trans youth

Pennsylvania State Capitol – Photo: Ken Fager/flickr.

A Pennsylvania Senate committee has tacked on an anti-transgender amendment to a bill aimed at renewing the state’s Children’s Health Insurance Program, or CHIP, through 2019. If the bill is not approved by Dec. 31, the entire CHIP program will lapse.

As a result, lawmakers in the Keystone State may be forced to approve a ban on providing health care for transgender youth in order to salvage the program for an estimated 176,000 children across the state, whose parents make too much money to qualify for Medicaid but not enough to purchase private insurance.

The amendment, sponsored by State Sen. Donald White (R-Indiana), would prohibit CHIP from covering the costs of any services related to gender transition.

Specifically, the amendment states: “The benefit package for eligible children may not include reimbursement for gender or sex reassignment surgery or gender or sex transition services, including, but not limited to, physician’s services, inpatient and outpatient hospital services, prescribed drugs or counseling services related to such surgery or services.”

“It is completely inappropriate to use state funds to pay for sex change operations for children,” White said in a statement. “This program provides vital health care services for Pennsylvania’s children. It is irresponsible to allow its limited resources to be used for sex change procedures.”

But while White is obsessed with the idea that doctors will be green-lighting young children for gender confirmation surgery en masse, the wording of the amendment is so vague and overly broad that it could potentially be used to deny other types of medically necessary care to transgender youth.

For example, depending on how the state interprets “gender or sex transition services” and “medications,” the prohibition could be used to prevent doctors from prescribing puberty blockers, hormones, or non-surgical treatments for gender dysphoria to transgender children who get their insurance through CHIP.

Additionally, as the progressive website ThinkProgress notes, the World Professional Association for Transgender Health recommends in its standards of care that youth should only undergo gender confirmation surgery after they reach the age of medical consent, which is 18 in Pennsylvania. While CHIP provides coverage up to an individual’s 19th birthday, the number of transgender youth who 1) qualify for CHIP; 2) actually opt for surgery; and 3) fall between the ages of 18 and 19 makes them a minority within a minority.

Thus, the language of White’s amendment — depending on how it is interpreted by government bureaucrats — could punish a larger number of transgender youth by denying them care, based on an unsubstantiated fear that a handful of 18-year-olds might opt for surgery. For instance, the state could refuse to cover a transgender youth’s regular doctor checkups, prescriptions, and even their ability to access mental health services or counseling if they deem such things to be “related” to gender transition.

The original version of the CHIP reauthorization bill, without the transgender prohibition, unanimously passed the state House in June. Last week, the GOP-led Senate Banking and Insurance Committee approved the anti-transgender amendment on a party-line vote. The amended CHIP legislation was subsequently approved by the Senate Appropriations Committee on Tuesday. The bill now heads to the full Senate for approval.

The American Civil Liberties Union of Pennsylvania blasted the amendment for being both divisive and discriminatory.

“Transgender youth, including those who participate in CHIP, deserve access to healthcare,” Reggie Shuford, the executive director of the ACLU of Pennsylvania, said in a statement. “In fact, the CHIP statute demands that the program covers all medically necessary care. The treatments that can’t be covered under this bill, such as counseling and hormone therapy, are medically necessary and sometimes life-saving for transgender youth.”

Pennsylvania Gov. Tom Wolf’s (D) office has expressed opposition to the amendment and called for Republican lawmakers in Harrisburg to pass a clean CHIP reauthorization bill. However, it is not clear whether Wolf would be willing to veto the bill should it reach his desk, as such a move could potentially torpedo the popular program altogether.

“The only amendment that has been added to the CHIP renewal bill is one that will harm transgender youth,” Naiymah Sanchez, the transgender advocacy coordinator at the ACLU of Pennsylvania, added. “Trans kids shouldn’t be used as a political ploy.”

Two transgender women challenge Iowa’s ban on Medicaid coverage for surgery[/crosslink]

John Riley is the local news reporter for Metro Weekly. He can be reached at jriley@metroweekly.com