House votes down proposal to ban DOD payments for gender transition surgeries

The House voted down a Republican proposal that would have prohibited the Pentagon from paying for gender transition surgeries for transgender service members, 209-214. Twenty-four Republicans joined Democrats in opposing the measure. 

GOP Rep. Vicky Hartzler, of Missouri, had introduced an amendment to the 2018 National Defense Authorization Act (NDAA) that would have rolled back an Obama directive requiring the Defense Department to pay for transgender surgeries. In a statement about the amendment, Hartzler argued that the government shouldn't be paying for "very expensive gender change surgeries that even most private insurance plans don't cover."

She also suggested that spending funds on the surgeries -- which she pointed out would cost about a billion dollars over the next decade -- would damage the country's military readiness, and she said that her proposal would ensure "our defense resources are allocated in a way that is smart and good for our national defense." 

Rep. Duncan Hunter, of California, who supported the bill, doesn't believe American taxpayers shouldn't have to pay for the treatments. "Figure out whether you're man or a woman before you join," Hunter said. 

House Democratic Leader Rep. Nancy Pelosi, of California, said in a statement that Republicans "should be ashamed." 

"[I]nstead of protecting the men and women who risk their lives to defend our freedoms, they are fighting to rip away the health care of thousands of brave service members," Pelosi wrote. "This cowardly Republican amendment targeting transgender men and women in uniform effectively bans these patriotic Americans from serving their country."  

Starting last October, Tricare, the program covering all uniformed service members and their beneficiaries, began covering therapy and hormone treatments, including gender reassignment surgeries for eligible soldiers.  A year ago, RAND released a study about the implications of covering these treatments. It estimated that there are between 1,320 - 6,630 transgender service members in active service but also projected, based on survey and private health insurance claims data, that only a small fraction --  between 29 and 129 -- of those active service members would seek transition-related care that could interfere with deployment.

RAND estimated that the cost of care related to transition treatments would mean an increase of between $2.4 million and $8.4 million each year, or a 0.04 - 0.13 percent increase overall in active-duty health care expenditures.