The taxpayer-funded agency in question is Medicare, so if you have a grandma or grandpa who’s itching to endure complex surgery and hormone therapy to rid themselves of a gender they’ve already lived with for 65 years or more, good news. Help is on the way.

Sort of.

The Department of Health and Human Services’ Departmental Appeals Board, an internal review structure within the byzantine federal agency, issued a ruling that ended a ban on Medicare even considering covering sex reassignment surgery and related care because a fear of “serious complications” resulting from the “experimental” surgery. That language was issued in 1981, and most medical professional organizations now consider sex reassignment surgery a safe and accepted procedure. The DAB ruling noted the change in how sex reassignment surgery is understood 33 years after the Medicare ban was issued… Experts say the change to Medicare could have far-reaching implications for American medicine, helping to drive more private insurers to offer coverage for sex reassignment surgery and related care. Though it fits within President Obama’s promise to make the government fairer to LGBT Americans, the DAB announcement was a relatively quiet one. The White House did not trumpet the move, and advocates for the change issued a joint statement hailing it but downplaying it as a revolutionary change for transgender people, instead casting it as bringing Medicare up to speed with the rest of the medical profession.

The demand for sex-reassignment surgery among septuagenarians is small, as you might expect, and the new ruling doesn’t guarantee that a request for coverage will be granted as medically necessary. It simply says that Medicare is no longer required to deny coverage. It’s a gesture, designed to nudge Obama’s new best friends in the insurance industry to follow suit and to impress his base, particularly during a week when transsexuals are already in the news. And it’s not the first time he’s used health-care policy for ideological/gestural reasons, either. (Here’s another gesture in the news, albeit outside the health-care realm.) Releasing this today, with the public distracted by Shinseki and the VA, is a smart bit of media management by the White House and HHS. People who care about this subject will notice. Most people who don’t, won’t.

Is sex-reassignment surgery ever medically necessary? Maybe:

“For someone who cannot get treatment the impact can be devastating,” Levi said. They can be depressed, have serious problems with self-esteem and have difficulty working and forming social relationships, she said. In some ways the ruling on Friday was more important from a symbolic standpoint than a practical one. Only a small percentage of the population is estimated to be transgender and various surveys have shown that very few opt for surgical interventions. As a result, several studies have shown that the cost — which can be anywhere from $10,000 or more per surgery — to insurers is often negligible.

The Army recently refused to provide Bradley/Chelsea Manning with taxpayer-funded reassignment surgery but has begun to look into transferring him to a civilian prison so that he can get treatment. That’s an interesting accommodation for a person who’s doing time for espionage.

To fully grasp the political significance of this gesture, have a look at WaPo’s digest of Gallup’s new poll on moral issues. On the question of whether homosexuality is morally acceptable (not a perfect proxy for transgender issues but close enough), Republicans have barely shifted since 2005. Thirty-six percent found it acceptable nine years ago versus 39 percent now, a spread that’s within the margin of error. It’s Democrats who have moved considerably, from 51 percent agreement in 2005 to 71 percent now. The White House is getting right with its base before the midterms in ways large and, in this case, small.

Update: While we’re on the subject of gay-themed flashpoints in the culture wars, news today from Colorado:

Colorado’s Civil Rights Commission on Friday ordered a baker to make wedding cakes for same-sex couples, finding his religious objections to the practice did not trump the state’s anti-discrimination statutes… Phillips, a devout Christian who owns the Masterpiece Cakeshop in the Denver suburb of Lakewood, said the decision violates his First Amendment rights to free speech and free exercise of his religion. “I will stand by my convictions until somebody shuts me down,” he told reporters after the ruling. He added his bakery has been so overwhelmed by supporters eager to buy cookies and brownies that he does not currently make wedding cakes.

Rather than fine him or force him to pay damages, they’re actually going to … force him to provide a product he doesn’t currently offer? Compulsory labor? Or, as I suspect, is the order here just a procedural formality to fine him when he inevitably refuses to make the cake? The state’s discrimination statute should provide that remedy already, I would think.

By the way, he says he’s perfectly willing to serve gay customers, just not for a wedding. I believe that’s also true of other bakers and photographers who’ve run afoul of state discrimination laws. Unless I’m mistaken, no one’s categorically refused to accept gay customers a la racist business owners refusing to accept blacks 50 years ago. A belated exit question via Ben Domenech: If gay marriage is illegal in Colorado, how can refusing to cater a gay wedding also be illegal?