A study in a well-respected medical journal released last week has estimated that the cost of transition-related care for transgender military personnel would be “negligible,” giving LGBT advocates hope that the study may bolster their push for allowing transgender servicemembers to serve openly.
The study, authored by Aaron Belkin and published in the New England Journal of Medicine, estimates that 12,800 of the estimated 15,500 transgender military personnel currently serving would be eligible for medical benefits. Of those 12,800, Belkin then estimates that 188 would require treatments such as hormone therapy each year. In terms of monetary cost — based on the average estimate of transition-related care — that means that the military could spend as little as 22 cents per servicemember per month, or a total of $5.6 million each year. Belkin says this “amounts to little more than a rounding error in the military’s $47.8 billion health care budget.”
“Actual costs could be lower than expected, because transition-related care has been proven to mitigate serious conditions including suicidality that, left untreated, impose costs on the military, and addressing symptoms might conceivably improve job performance as well,” Belkin writes of his estimates. “There are costs, in other words, of not providing transition-related care, due to potential medical and psychological consequences of its denial, paired with the requirement to live a closeted life.”
Belkin says that his average estimate of $29,929 per transgender servicemember — which could include hormones, surgery or both depending on the individuals’ own necessary treatment — was derived from private-sector care. But he also notes that “the military provides care more efficiently than civilian systems do.” Factors that could raise the cost of providing transition-related care would be if the military covers more procedures than the typical private insurance plan, if care is extended to servicemembers’ family members or dependents, and if an influx of transgender people join the military for the purpose of medical benefits. But Belkin also adds that more civilian insurance plans are also covering transition-related care, decreasing the likelihood that a large influx of transgender people will join the military solely to obtain medical benefits.
“Some observers may object to the concept that the military should pay for transition-related care, but doctors agree that such care is medically necessary,” Belkin writes. “And though costs can be high per treated person, they are low as a percentage of total health spending, similar to the cost of many other treatments that the military provides. Even if actual costs exceed these estimates on a per-capita basis for persons requiring care, the total cost of providing transition-related care will always have a negligible effect on the military health budget because of the small number treated and the cost savings that the provision of such care will yield. The financial cost of transition-related care, in short, is too low to matter.”
Advocates for open service praised Belkin’s report, with Kris Hayashi, the executive director of the Transgender Law Center, telling CNN in a statement, “This detailed report underscores what we know to be true from the civilian world: That health care costs for transition-related care make up a fraction of a drop in the bucket of overall health care expenses for employers.”
In July, U.S. Secretary of Defense Ashton Carter announced the creation of a working group that would study the effect and implications of allowing transgender servicemembers to serve openly. Belkin’s study on cost could help contribute to the discussion of whether the military would be able to support the proposed policy change.
At the time of Carter’s announcement, the National Center for Transgender Equality (NCTE) issued a statement predicting an eventual end to the current ban on transgender military service.
“The Pentagon’s rickety system of discrimination against us is falling apart,” NCTE Executive Director Mara Keisling said. “…The Pentagon knows, as we do, how this review is going to end. The National Center for Transgender Equality urges the Department of Defense to quickly end the discriminatory policy and allow trans people to serve openly and with dignity.”
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