VA sparks dismay with new gender affirming care coverage plans
The Department of Veterans Affairs axed gender affirming care for transgender veterans, the latest in the Trump administration's push to eradicate trans-inclusive policies from the federal government.
“I mean no disrespect to anyone, but VA should not be focused on helping veterans attempt to change their sex," VA Secretary Doug Collins said in a statement.
"All eligible veterans – including trans-identified veterans – will always be welcome at VA and will always receive the benefits and services they’ve earned under the law. But if veterans want to attempt to change their sex, they can do so on their own dime.”
The new policy applies only to transgender veterans who are not already receiving gender affirming care. Transgender veterans who are already getting such care will be exempt.
The announcement triggered widespread alarm among transgender veterans who accused the VA of abandoning Americans who had fought and died in the military.
"We feel defeated," said Rebekka Eshler, president of the Transgender American Veterans Association, or TAVA. "We've served our country, and now they're going back on promises."
Transgender veterans "stepped up to serve their country with honor and dignity, but the country is now turning their back on them and denying that care that they've earned," said Alleria Stanley, a 20-year Army combat veteran who receives gender affirming care through the VA. "There is incredible heartache."
President Donald Trump already reinstated a ban from his first term on transgender people joining the military and stopped the Pentagon's health care system from covering gender affirming care.
A federal judge is expected to decide this week whether the ban is lawful in a case brought by a group of transgender service members. Last week, the judge criticized the Pentagon for citing studies it claims show that transgender people were not deployable.
VA to start 'comprehensive review' of transgender treatments
On Friday, the VA quietly rescinded a directive that outlined "respectful delivery of health care to transgender and intersex veterans," including guidance for VA health care providers and facilities to use veterans' preferred pronouns and allowing veterans to use the bathrooms they choose. The VA will now undergo a "comprehensive review" of transgender veterans' health care, according to a notice announcing the policy's dissolution.
The VA will now require transgender veterans to use patient rooms corresponding to their sex at birth. "Previously, VA had allowed males who identify as females to share patient rooms with other females and vice versa. This administration has stopped that," said Peter Kasperowicz, a spokesperson for the VA.
The VA initially denied the policy change to NPR and other news organizations, then posted it publicly later that day and issued an official news release Monday.
Veterans such as Stanley who already receive hormone therapy or were receiving it as part of their military service are exempted from the ban. The money the VA no longer spends on gender affirming care will go toward paralyzed veterans and amputees, according to the news release.
Eshler said diverting funding toward another veteran group was an attempt to pit the two communities against each other and "cause problems and division in the veteran community."
'Arbitrary act'
The policy change prompted fears from the transgender community that cutting off gender affirming care could further endanger a population already at an extreme risk of suicide. Trans veterans die by suicide at twice the rate of veterans who are not trans and 5.85 times the rate of the general population. Studies show gender affirming care reduces that risk.
"This is an arbitrary act that is very harmful, and there will be repercussions that will be seen, but also, unfortunately, repercussions that may not be seen as the harm takes place," said Stanley, who came out as transgender while serving when the Obama administration repealed "don't ask, don't tell" in 2011, allowing LGBTQ people to serve openly.
Though it is unclear how many transgender veterans are receiving gender affirming care through the agency, the cost to the agency is negligible – less than one-tenth of 1% of the 9.1 million veterans who receive VA health care identify as transgender, according to the Veterans Health Administration. The VA "has not kept consistent and reliable records" on that number or the cost it incurred, according to the news release.
The Pentagon spent $15 million to provide gender affirming care to nearly 1,900 service members from 2016 to 2021, according to the Congressional Research Service. The military's total health care costs are about $25 billion a year.
A 2014 study from the Wilson Institute at the University of California, Los Angeles' law school estimated there are 134,300 trans veterans and retired National Guard or Reserve servicemembers. That number is likely higher now.
VA never provided gender affirming surgeries
The VA has been providing gender affirming care to trans service members since 2011, including hormone therapy and mental health care. It has never covered gender affirming surgeries, despite a push during the Biden administration to require the procedure as essential for veterans suffering from gender dysphoria.
In 2021, then-VA Secretary Denis McDonough vowed to work toward overturning a 2013 ban on agency funds going toward gender affirming surgeries, saying the agency would begin covering the procedures within two years.
But the effort never came to fruition. Last April, TAVA sued the Biden administration, accusing it of failing to fulfill its promise.
Though the surgeries were off the table, the VA provided support letters for veterans seeking the procedure from outside providers. The new policy also ends that service.