Iowan taxpayers must fund transgender surgeries through Medicaid, rules court

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Iowa taxpayers will be forced to fund gender reassignment surgery through Medicaid after the state Supreme Court ruled that such procedures are “medically necessary” for transgender individuals.

On Friday, Iowa’s Supreme Court ruled that transgender people can now use Medicaid for “gender-affirming surgeries,” overturning the state’s previously held administrative code regarding Medicaid, which classifies transition-related surgeries as "cosmetic, reconstructive or plastic surgery" and explicitly bans "surgeries for the purpose of sex reassignment,” the Des Moines Register reports.

The justices agreed with a district judge's ruling that the rules contradicted protections in the Iowa Civil Rights Act, which added gender identity to the state's list of protected classes.

That law's "gender identity classification encompasses transgender individuals — especially those who have gender dysphoria — because discrimination against these individuals is based on the nonconformity between their gender identity and biological sex," Justice Susan Christensen wrote for the court.

The ruling ends a two-year legal battle between EerieAnna Good and Carol Ann Beal, transgender individuals backed by the ACLU, and the Iowa Department of Human Services. The two individuals had sued the DHS for its policy against funding transition surgeries, calling it “discriminatory” and claiming the surgery was “medically necessary to treat their gender dysphoria.”

“The record evidence shows that this surgery is medically necessary,” John Knight, an attorney with the ACLU representing Beal and Good, told justices when the case was argued. “It’s really lifesaving treatment for a number of individuals.”

However, Iowa Assistant Attorney General Matthew Gillespie, who represented the DHS, had argued that the ACLU attorneys could not prove that the measure was discriminatory in nature. He said the case was really about whether the state denied coverage for surgeries meant to treat psychological problems rather than those that are medically necessary.

The DHS also resisted on the grounds of the high cost of transition-related care, explaining that its regulation against such coverage "serves the purpose of conserving limited state resources." The Philadelphia Center for Transgender Surgery prices the full suite of procedures for transgender individuals at more than $100,000.

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The Supreme Court's decision upheld a lower court ruling to undo the ban, which had been appealed by the state. According to USA Today, the decision is the first by a state's highest court holding that transgender people have the right to use public money for transition-related surgeries.

While the ACLU praised Friday’s ruling as a “landmark win,” Peter Sprigg, senior fellow for Policy Studies at the Family Research Council in Washington, D.C., told The Christian Post that “political correctness, not the law or medicine, dictated the ruling forcing taxpayers to fund gender reassignment surgery through Medicaid.”

“Iowa’s regulatory exclusion of procedures which are ‘performed primarily for psychological purposes’ rather than for ‘restoring bodily function’ fully justified the exclusion of such surgery from Medicaid coverage,” Sprigg argued. “All such ‘cosmetic’ procedures were excluded from coverage—gender reassignment surgery is merely one example that falls under that more general exclusion. There was no ‘discrimination’ based on ‘gender identity’—it was the nature of the procedure, not the identity of the person, that was at issue.”

Sprigg told CP it is “unfortunate” that the court did not even consider the 2016 decision by the federal Centers from Medicare and Medicaid Services, which concluded that “there is not enough high-quality evidence to determine whether gender reassignment surgery improves health outcomes.”