Chelsea Manning decision points to shift in views on transgender health care

Army officials have approved hormone treatments for the male-to-female transition of Chelsea Manning, the transgender soldier convicted of espionage in 2013 after sending classified government documents to WikiLeaks, the Defense Department confirmed on Thursday.

Official approval to begin hormone treatments for Ms. Manning, formerly Pfc. Bradley Manning, who is currently in the Forth Leavenworth Army prison, marks a first for the Defense Department, which does not permit open transgender individuals to serve in the military, and had not previously provided transition-related health care in the past.

But the Army’s approval of Manning’s hormone therapy is part of a rapid and wide-ranging shift in how the nation sees transgender people and their health needs. Health providers and insurance companies across the nation, as well as the federal government and civil courts, have begun to reevaluate previous bans on sex-transition treatments, which have long been seen as elective procedures, like cosmetic surgery, that were done for personal, subjective reasons.

In past few years, however, the nation’s medical and psychological professions have increasingly shifted to considering transition therapy, in some cases including sex-reassignment surgery, medically necessary treatments of a condition referred to as gender identity disorder.

Though the idea of providing public funds for such treatments remains politically controversial, the nation’s health care structure has been changing.

In February, 2013, the Veterans Health Administration approved all “medically necessary care” for intersex and transgender veterans, including hormone therapy, mental health care, as well as pre-operative and post-operative care following sex-reassignment surgery. The VA does not provide such surgery, however.

Last year, the Obama administration ended the 33-year-old ban on Medicare coverage for both transition-related care and sex-reassignment surgery.

“We’ve had some really significant gains in the last few years,” says Dru Levasseur, director of the Transgender Rights Project for Lambda Legal, a New York-based lesbian, gay, bisexual, and transgender civil rights group. “And we see a growing number of states that are passing these private insurance bulletins that say that insurers cannot discriminate in the provision of health care for transgender people.”

In 2012, Oregon became the first state to tell private insurers to pay for transition procedures deemed medically necessary. Other states, including California, Colorado, Connecticut, Vermont, as well as the District of Columbia have done the same.

At the same time, much of corporate America has embraced more inclusive insurance coverage for transgender people – now included as a part of the Human Rights Campaign’s influential “corporate equality index” scores.

A third of Fortune 500 companies now cover transgender-related health care, including sex-reassignment surgeries, according to a Human Rights Campaign report released last fall. These include well-known companies such as Facebook, Starbucks, and Anheuser-Busch. 

Still, many object to the use of taxpayer funds, or even collective private insurance funds, to be used for what they say should be considered an elective procedure, like cosmetic surgery.  

"There are plenty of other ways to address this situation than to put taxpayers on the hook for it," said Pete Sepp, president of the National Taxpayers Union, about Manning’s hormone treatment, according to USA TODAY.

Advocates say the national movement is following the recommendations of the country’s top medical professionals and science-based research.