For the first time since 1981, when it dubbed sex-change operations "experimental," Medicare has opened the door to covering transexual operations, adding to the growing list of operations that would be allowed under Obamacare.

Acting on a new request, the Centers for Medicare & Medicaid Services said it is starting a new analysis that could lift the spending ban for sex-change operations with a goal of making a decision two days after Christmas and on the eve of Obamacare kicking in Jan. 1.

A 30-day public comment period just opened on the proposed "National Coverage Determination."

"Surgical Treatment for Gender Identity Disorder, formerly referred to as transsexual surgery in 140.3, is currently noncovered under the Medicare Part A and Part B programs. The existing policy, which became effective in 1981, states that transsexual surgery is considered experimental," said the notice just posted on the CMS.gov site.

"Please note that we are making an administrative change to the NCD title under this reconsideration to reflect current medical terminology. The new title for Section 140.3 will be Surgical Treatment for Gender Identity Disorder," it adds.

The National Center for Transgender Equality is among those pushing for the changes.

In supporting letters to CMS, one of the proponents claims that the experimental status of sex-change operations has long passed and that studies confirm it works. "These medical procedures and treatment protocols are not experimental: decades of both clinical experience and medical research show they are essential to achieving well-being for the transsexual patient," said the letter.

A second letter called the federal policy discriminatory, and added that failure to get the operation by those who needed can cause death. "The net effect is a failure to treat a treatable disorder which in many cases leads to death. The discrimination (is) clearly un-American," added the letter.