Iowa lawmakers have approved a health and human services appropriations bill containing a provision that would allow government entities to opt out of using public insurance dollars, including Medicaid, to pay for transition-related surgeries.
On Saturday, the Iowa House approved the legislation, which would overrule a March decision by the Iowa Supreme Court that found that the Hawkeye State’s Medicaid program may not discriminate against transgender people by refusing to cover the costs of any gender confirmation surgery that has been deemed medically necessary. The bill passed on a largely party-line vote, with all Democrats voting against passage.
The bill was passed by the State Senate just a day earlier, on Friday.
Under the bill, any state or local government unit or tax-supported district would be allowed to refuse to use taxpayer dollars to pay for “sex reassignment surgery” or “any other cosmetic reconstructive or plastic surgery procedure related to transsexualism, hermaphroditism, gender identity disorder, or body dysmorphic disorder.”
Opponents of transgender rights have long used similar language to justify Iowa’s previous Medicaid ban by claiming that gender confirmation surgery is merely cosmetic and not medically necessary, even in cases where surgery has been deemed necessary for the treatment of an individual’s gender dysphoria.
The bill now heads to Gov. Kim Reynolds (R), who can decide to either sign the full bill into law, or use a line-item veto to block the provision, known as the “Costello amendment,” reports the Des Moines Register.
The ACLU of Iowa, which successfully challenged a nearly identical provision in the Iowa Code, previously sued the state on behalf of two transgender Iowans, arguing that the Medicaid ban violated the Iowa Civil Rights Act, which prohibits discrimination based on sexual orientation or gender identity. As evidence, the ACLU pointed to evidence that Medicaid covers medically necessary surgeries for cisgender individuals — such as mastectomies — that are identical to those sought by transgender Medicaid recipients.
The state argued that the ban is not discriminatory because the department denies all surgeries performed primarily for psychological reasons. But the Iowa Supreme Court agreed with the ACLU and their clients, ruling that the state had failed to provide evidence that gender confirmation surgery was not medically necessary for those with gender dysphoria.
Following passage of the appropriations bill, the ACLU referred reporters to a statement by Mark Stringer, the executive director of the ACLU of Iowa.
“The Costello amendment to the Health and Human Services budget bill is dangerous and harmful. It risks people’s health and lives to score political points,” Stringer said. “Banning Medicaid coverage for gender-affirming surgery would bring significant harm to people who rely on Medicaid and who desperately need this surgery. This is a matter of life and death.
“This cruel amendment has no basis in medicine or science. Every major medical association agrees gender dysphoria is a serious medical condition and that surgical treatment is medically necessary for some transgender people,” Stringer added. “It is a clear violation of equal protection under the Iowa Constitution because it would discriminate against people simply because they are transgender.”
The ACLU has not said whether it will sue the state again should Reynolds refuse to use her line-item veto.
One Iowa Action Executive Director Daniel Hoffman-Zinnel blasted the passage of the bill with the Costello amendment intact and urged Reynolds to use her power to block the harmful provision from becoming law.
“Accessing medically necessary treatment is a matter of life and death for many transgender Iowans. By passing this legislation, our state has sent the appalling message that transgender people are second-class citizens in our state,” he said. “Protecting transgender people from discrimination is settled law in Iowa, and has been since 2007. The Iowa Supreme Court made clear that the Iowa Civil Rights Act protects transgender Iowans against Medicaid discrimination in their unanimous ruling just over one month ago. If this bill becomes law, it will not stand up to legal muster and stick taxpayers with the bill for ensuing lawsuits.”
Two Republican members of Congress attacked Dr. Rachel Levine, the assistant secretary of health, following her being sworn in as an admiral of the U.S. Public Health Service Commissioned Corps.
On Tuesday, Levine became the first out transgender officer in all eight of the uniformed services, and the first female four-star officer in the PHSCC. In that role, Levine will lead a team of more than 6,000 officers in responding to public health crises and natural disasters.
Following her promotion to admiral, Levine's historic accomplishment was praised by LGBTQ advocates as a milestone for the transgender community. But she was criticized by conservatives due to her gender identity, with many disputing the notion that she is a woman.
Reality star and former Olympian Caitlyn Jenner is claiming that, during her unsuccessful run for California governor, Republican party leaders refused to be appear alongside her in public, despite supporting her in private.
"I had elected officials and party leaders who would gladly take private meetings with my campaign team and me, but would balk at the mere notion of being seen publicly with me," Jenner wrote in a recent USA Today column.
"To a point, I understand they have to protect themselves from their voters and the base who might not be as open-minded as they are," Jenner wrote, noting that the problem "for someone like myself" is "partly generational."
The Biden administration has approved a request by Colorado officials to modify their state's health exchange under the Affordable Care Act to require private health insurers to cover transition-related care for transgender patients.
The change, which will take effect on Jan. 1, 2023, would mark the first time the federal government has approved a requirement for individual and small-group health plans to cover medical treatments for transgender patients. Colorado already requires its state Medicaid program to cover the costs of transition-related care for low-income residents.
Colorado Gov. Jared Polis, accompanied by Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services, and other officials, announced the policy in Denver last week. Under the new policy, insurers will no longer be able to refuse to cover treatments that have been deemed medically necessary by a patient's medical provider by claiming such procedures are "elective" or "cosmetic."
These are challenging times for news organizations. And yet it’s crucial we stay active and provide vital resources and information to both our local readers and the world. So won’t you please take a moment and consider supporting Metro Weekly with a membership? For as little as $5 a month, you can help ensure Metro Weekly magazine and MetroWeekly.com remain free, viable resources as we provide the best, most diverse, culturally-resonant LGBTQ coverage in both the D.C. region and around the world. Memberships come with exclusive perks and discounts, your own personal digital delivery of each week’s magazine (and an archive), access to our Member's Lounge when it launches this fall, and exclusive members-only items like Metro Weekly Membership Mugs and Tote Bags! Check out all our membership levels here and please join us today!