Court Has Blocked DoD Efforts to Do the Same
Click to Enlarge: Previous to the new policy, the VA had been moving toward more services for the more than 130,000 transgender veterans it services. Source: Georgetown Medical Review
WASHINGTON, DC — VA has announced that it will be phasing out gender-affirming care for veterans. This is being done, officials said, in response to President Donald Trump’s Executive Order 14168, which excludes transgender people from the government’s definition of gender.
This discontinuation of services will require VA to go through the official agency rulemaking process for it to go into effect; however, the department has already taken the first step with the rescinding of VHA Directive 1341, “Providing Healthcare for Transgender and Intersex Veterans.” The directive, originally put in place in 2018, stated that VA would provide are to all transgender veterans consistent with their gender identity.
Specific therapies being cut by VA include hormone replacement therapy (HRT), voice and communication training and gender-affirming prosthetic care. While VA has never covered gender-affirming surgery, the department says it will also no longer be providing letters of support encouraging non-VA providers to offer such surgery on transgender veterans, which it has done in the past. Transgender veterans will still be welcome at VA facilities to receive other types of care, VA Secretary Douglas Collins said.
Directive 1341 also attempted to shift the culture of VA to be more welcoming to transgender veterans by directing facility leaders to adhere to “VA’s values of diversity, inclusion, and commitment to increasing awareness about the healthcare needs of veterans by assuring transgender and intersex veterans receive culturally appropriate, confidential care in a welcoming environment.”
VA’s memo announcing the change noted that it does not impact veterans who identify as lesbian, gay or queer and does not affect the roles of VA’s LGBTQ veteran care coordinator and VISN leads.
“I mean no disrespect to anyone, but the VA should not be focused on helping veterans attempt to change their sex. The vast majority of veterans and Americans agree on this, and that is why this is the right decision,” Collins said. “If veterans want to attempt to change their sex, they can do so on their own dime.”
Collins’ statement rang hollow with transgender veterans’ advocates, who said that this decision goes beyond mere disrespect.
“[This is] a direct attack on the dignity and well-being of transgender, nonbinary and intersex veterans—one that will have deadly outcomes,” said Minority Veterans of America Executive Director Lindsey Church as part of a joint statement with other veteran service organizations. “This decision will force our community to defer or delay care and opt out of VA services altogether. This decision will exacerbate our already high suicide rates and push more veterans into crisis for no reason other than hate.”
The joint VSO statement noted that, while services are still being offered until the rulemaking process can be completed, uninterrupted care is inevitable.
“The repeal of Directive 1341 strips away the very framework that ensured access to respectful, clinically appropriate, and affirming care,” the statement reads.
The decision by the department also sparked outrage from some VA staff. National Nurses United, which represents 15,000 nurses across 23 VA facilities, released a statement condemning the revocation of gender-affirming care, calling it “an attack on healthcare for vulnerable populations, not a decision made out of consideration for those patients.”
“Gender-affirming care is healthcare, and healthcare is a human right,” said Justin Wooden, RN, in the intensive care unit (ICU) at James A. Haley Veterans’ Hospital in Tampa, FL. “They served this country, but now it seems like the current administration is denying them healthcare, part of a bigger project to erase them completely. Our patients deserve this healthcare. Prohibiting the VA from prescribing hormone-replacement therapy for veterans is a clear attack on the existence of trans people.”
As with other recent cuts to VA staff and care, the department noted that all savings VA achieves by discontinuing medical treatments for gender dysphoria will go toward other veterans’ care.
‘Little Financial Savings’
According to Caleb Smith, director of LGBTQI+ policy at the American Progress Institute, a nonpartisan policy institute, these cuts would actually result in very little savings. In an article on the institute’s website, Smith noted how VA’s own estimates put the number of transgender veterans receiving care at the department at fewer than 9,100. With HRT being the highest cost treatment being cut, and fewer than half of transgender individuals reporting receiving HRT, the estimated cost saved by VA would be about $500,000 per year.
A separate executive order issued by Trump in February has also banned transgender people from serving in the military. The order declares that “adoption of a gender identity inconsistent with an individual’s sex conflicts with a soldier’s commitment to an honorable, truthful, and disciplined lifestyle, even in one’s personal life.” DoD has estimated there are less than 5,000 transgender servicemembers, while independent estimates have put that number as high as 15,000.
A memo, released by DoD as part of a lawsuit filed on behalf of six active duty transgender servicemembers and two others seeking to enlist, revealed more details on how the military plans to enforce the ban.
According to the memo, the Pentagon has been ordered to identify servicemembers with a current diagnosis or a history consistent with gender dysphoria and begin processing them out within 30 days of identification. These servicemembers could opt to separate voluntarily and “will be paid at a rate that is twice the amount the servicemember would have been eligible for involuntary separation pay.”
Servicemembers may also be granted a waiver on a case-by-case basis but must demonstrate 36 consecutive months “of stability in the servicemember’s sex without clinically significant distress or impairment in social, occupational, or other important areas of functioning.”
In March, Judge Ana Reyes of the U.S. District Court for the District of Columbia issued an order temporarily blocking DoD from carrying out the ban.
“[The] plaintiffs face a violation of their constitutional rights, which constitutes irreparable harm,” Reyes wrote in her decision. “Indeed, the cruel irony is that thousands of transgender servicemembers have sacrificed—some risking their lives—to ensure for others the very equal protection rights the military ban seeks to deny them.”
