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Thread: IA-State Supreme Court rules Medicaid must pay for trans-queeer surgeries

  1. #1

    Exclamation IA-State Supreme Court rules Medicaid must pay for trans-queeer surgeries

    Transgender Iowans can use Medicaid for transition-related care, Iowa Supreme Court rules

    https://www.desmoinesregister.com/st...ia/3098963002/

    Courtney Crowder and Luke Nozicka, Des Moines Register Published 9:11 a.m. CT March 8, 2019 | Updated 12:36 p.m. CT March 8, 2019

    Transgender Iowans can use Medicaid funds to pay for transition-related care, including surgeries, according to a unanimous Iowa Supreme Court ruling Friday.

    The court’s decision strikes down the administrative code governing Medicaid in Iowa that classifies transition-related surgeries as "cosmetic, reconstructive or plastic surgery" and explicitly bans "surgeries for the purpose of sex reassignment." The justices agreed with a district judge's ruling that the rules contradicted protections in the Iowa Civil Rights Act.

    That law's "gender identity classification encompasses transgender individuals — especially those who have gender dysphoria — because discrimination against these individuals is based on the nonconformity between their gender identity and biological sex," Justice Susan Christensen wrote for the court.

    This decision is thought to be the first by a state's highest court holding that transgender people have the right to use public money for transition-related surgeries. As issues of LGBT rights swirl nationally, the decision could help open the door for challenges to bans in other states, about half of which have language similar to Iowa’s in their administrative code.

    "As the ruling showed, this case presented a difficult question involving individual rights and the state’s interests," said Lynn Hicks, spokesman for the Attorney General's Office. "This issue was a first for Iowa’s courts, and we thank the court for its guidance and for resolving this issue."

    For next steps, Hicks directed the Register to the Department of Human Services. That department's spokesman, Matt Highland, said DHS would not be commenting.

    The verdict ended an almost two-year legal battle that hinged on whether transition-related surgery was “medically necessary” or a procedure provided solely psychological purposes.

    After years of dealing with denials and headaches regarding their health coverage, Carol Ann Beal, 42, of northwest Iowa, and EerieAnna Good, 28, of the Quad Cities, sued the Department of Human Services in 2017. They alleged that the state’s blanket ban denying their use of public funds for doctor-prescribed surgery violated the equal protection clauses in both the Iowa Civil Rights Act and the state constitution.

    “The record evidence shows that this surgery is medically necessary,” John Knight, an attorney with the ACLU representing Beal and Good, told justices when the case was argued. “It’s really lifesaving treatment for a number of individuals.”

    In his June decision, Polk County Chief District Judge Arthur Gamble concurred, saying the decades-old regulation "has not kept up with law and medicine." He ordered the department to approve the women’s request for coverage.

    But the state appealed, arguing the ban is not discriminatory because the department denies all surgeries performed primarily for psychological reasons — which is how it has characterized transition-related surgeries.

    “We are covering these surgeries in the same instances when the primary purpose is to address a non-psychological purpose,” Assistant Attorney General Matthew Gillespie said during oral arguments. “And we don't cover surgeries in the same instance, regardless of gender identity, when the surgery is performed primarily for a psychological purpose.”

    Gender identity — or the deeply held sense of who one is that may differ from the sex organs with which one was born — and sexual orientation were added to the Iowa Civil Rights Act as protected classes in 2007.

    Under that statute, transgender Iowans have legal protections against discrimination in education, employment, housing and public accommodations. Medicaid, a state and federally funded program, is considered a public accommodation.

    Daniel Hoffman-Zinnel, executive director of One Iowa, a statewide LGBTQ organization, said the ruling sets a strong judicial precedent for protecting transgender Iowans' civil rights. He called gender-affirming surgery "powerful, life-changing and absolutely essential."

    "This decision will, quite literally, save lives," Hoffman-Zinnel said.

    In a statement Friday, Beal and Good said they were thrilled with the decision. Beal described herself as "extremely happy for those people who will come after me."

    "It’s hard to believe that it’s taken so many years for Iowa laws to catch up with the reality of transgender Iowans," Good said, calling herself honored to "help the hundreds and thousands of other transgender people out there who definitely need this type of medical care."

    Beal has known she was a woman despite being born with male genitalia since before she started kindergarten.

    She started presenting as a girl at 10 and began taking hormones in her teens after being diagnosed with gender dysphoria, the medical term for feeling that one's inner masculinity or femininity is incongruent with his or her biological sex.

    Both her family and her spouse supported her decision to go through with this litigation, Beal said when the lawsuit was filed in 2017.

    "You go through so many years transitioning, and now I hit a brick wall with Iowa's discriminatory ban on Medicaid coverage for transition-related care," Beal said in 2017, her voice cracking with nerves. "It has caused me stress and depression and affects every aspect of my life."

    The question of the "medical necessity" of these procedures often lies at the heart of conversations about transition-related care.

    When prescribed by a doctor, all forms of transition care, including surgeries, are recommended by most professional medical organizations, including the American Medical Association, the American Psychological Association and the American Psychiatric Association.

    But not every transgender person is interested in surgery, Dr. Joe Freund, one of the most sought-after transition-care doctors in the state, previously told the Register.

    Transitioning is a spectrum, and some patients find alignment simply by dressing in gender-specific clothing. Other patients may find hormone-replacement therapy enough while some may need surgery to make themselves whole, he said.

    Dr. Nicole Nisly, co-founder of the award-winning University of Iowa LGBTQ Clinic, has said she has many patients on Medicaid, some of whom meet the medical criteria for surgical intervention and are in desperate need of that kind of care.

    Without these surgeries, those patients can experience extreme depression and anxiety and may have suicidal thoughts.

    "When they are denied this care it is heartbreaking for us and heartbreaking for them," Nisly previously said. "Imagine it from their perspective: They have been on hormones and transitioned in every other way for a year and then they find out they can't take that extra step to fully become themselves.

    "Some (of my patients) do become suicidal."

    In the district court ruling, Gamble wrote that DHS did not “rebut the medical evidence that gender affirming surgery is medically necessary treatment” and called the exclusion of coverage “unreasonable, arbitrary and capricious.”

    The denial was issued “without regard to the law and facts,” the judge wrote. “The agency acted in the face of evidence upon which there is no room for difference of opinion among reasonable minds.”

    What will it cost?

    DHS has also resisted on the grounds of the high cost of transition-related care. The agency has argued that its regulation against transition care "serves the purpose of conserving limited state resources."

    While Gamble agreed that cost savings is a "legitimate government interest," he wrote that the ban "achieves this goal through an extreme degree of underinclusiveness."

    Tabulating the cost of transition is difficult because of the variation of care needed or desired, but the Philadelphia Center for Transgender Surgery prices the full suite of procedures for both transgender women and transgender men at more than $100,000.

    However, single surgeries cost much less. For example, a vaginoplasty, the creation of a vagina, or a phalloplasty, the creation of a penis, costs about $20,000.

    Despite what could be considered high costs, transgender people make up a relativity small portion of the national population. One estimate found about 0.3 percent of the total population, or about 964,000 people nationally and 9,300 in Iowa, identify as transgender, according to The Williams Institute, a think tank at UCLA's law school.

    A smaller subset of that population would seek surgeries.

    At the time the original suit was filed, the ACLU and local doctors pointed to mastectomies as an example of the inherent unfairness of the ban.

    Breast-removal surgery costs the same whether it is covered as cancer treatment or as a treatment for gender dysphoria. Only one of those surgeries was banned — even if doctors in both cases deem the surgery to be "medically necessary."

    Advances in other court cases

    The 6-0 Supreme Court ruling came on the heels of another step forward for transgender rights in Iowa.

    Last month, Jesse Vroegh, a transgender man and former prison nurse, won his discrimination case against the state after he was denied access to the men's restrooms and locker rooms and denied transition-related care.

    He was awarded $120,000 in damages.

    The Iowa ACLU has also previously represented Meagan Taylor, a transgender woman discriminated against at a West Des Moines hotel. The highly publicized case resulted in an undisclosed settlement.

    In this case, Beal has said that she didn't set out to become a trailblazer, but wanted to "make it easier for younger people who need this surgery."

    "I look forward to the day when someone fighting to get the transition-related medical care they need isn't in the news,” she said.



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  3. #2
    "I look forward to the day when someone fighting to get the transition-related medical care they need isn't in the news,” she said.
    Count on it, dude.

    Your "struggle" is already old news, battle won and moving on.

    The kiddie - diddlers are next set of freaks who will demand rights on my dime.

  4. #3
    There is a bill going through Iowa house on how judges are selected. Should eliminate these judicial activists that select their own people.

  5. #4
    Dental not so important.

    The Iowa Health and Wellness Plan includes coverage for comprehensive dental benefits, equivalent to the Medicaid dental benefit for adults ages 19 through 64. The current Medicaid dental program has several deficiencies that, without changes, would not provide sufficient access to dental care to this new population.

  6. #5
    so I can be extorted to pay for someone to cut off their Johnson?

    seems legit...

    why I should worship the state (who apparently is the only party that can possess guns without question).
    The state's only purpose is to kill and control. Why do you worship it? - Sola_Fide

    Baptiste said.
    At which point will Americans realize that creating an unaccountable institution that is able to pass its liability on to tax-payers is immoral and attracts sociopaths?

  7. #6
    What about penis extensions?
    Quote Originally Posted by juleswin View Post
    I am not a rapist but there are some people I would never consider to rape if I was a rapist. I wouldn't rape someone who I wasn't attracted to, someone who could probably take me down and pound the hell out of me etc etc.



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  8. #7
    Quote Originally Posted by Danke View Post
    What about penis extensions?
    Excellent question! I’m sure some on this board would jump right on that. If they don’t, they absolutely should.
    “The right to life is the source of all rights—and the right to property is their only implementation. Without property rights, no other rights are possible. Since man has to sustain his life by his own effort, the man who has no right to the product of his effort has no means to sustain his life. The man who produces while others dispose of his product, is a slave.”

  9. #8
    Somebody is probably going to fancy them self a Man-Woman or Woman-Man and have the appropriate parts surgically installed.

    Imagine, somebody who can just stay home and have sex with sheit self and have a baby.

    Of course then sheit is going to demand that sheit's offspring have the surgery so the kids can look like their parent.



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  11. #9
    Didn't taxpayers foot the bill for Bradley Manning's transition?



    https://www.stripes.com/news/pentago...roops-1.430040

    Pentagon to pay for ‘medically necessary’ sex-change operations for active transgender troops

    WASHINGTON — The Pentagon will provide sex-change operations to some active-duty transgender servicemembers if a military doctor determines that surgery is required to treat the individual’s gender dysphoria, a Defense Department spokesman said Tuesday.

    The department will begin providing transgender servicemembers on active duty all “medically necessary” treatment starting Oct. 1, said Air Force Maj. Ben Sakrisson, the Pentagon spokesman. Treatment could include behavioral health care, hormone therapy, and in some cases gender reassignment surgery. Servicemembers must be diagnosed as stable in their preferred gender for 18 months before they can receive treatment.

    “The Secretary of Defense has made clear that servicemembers with a diagnosis from a military medical provider indicating that gender transition is medically necessary will be provided medical care and treatment for the diagnosed medical condition,” Sakrisson said.
    The department’s announcement of its determination came just days after lawyers representing imprisoned Army Pvt. Chelsea Manning said the Army had agreed to provide her gender-reassignment surgery. Manning, who is serving a 35-year sentence in the Fort Leavenworth Disciplinary Barracks in Kansas for leaking classified and sensitive material to the website WikiLeaks, was recommended for the surgery by a doctor in April, according to her attorneys with the American Civil Liberties Union.

    Manning, formerly known as Bradley, began a short-lived hunger strike Sept. 9 before the Army approved the surgery Sept. 13, according to the lawyers.

    I am unendingly relieved that the military is finally doing the right thing. I applaud them for that. This is all that I wanted — for them to let me be me,” Manning said in a statement.


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  12. #10
    Quote Originally Posted by Zippyjuan View Post
    Didn't taxpayers foot the bill for Bradley Manning's transition?



    https://www.stripes.com/news/pentago...roops-1.430040
    Yes, they did...and?

  13. #11
    There can't be that many transgenders in Iowa.
    "Perhaps one of the most important accomplishments of my administration is minding my own business."

    Calvin Coolidge

  14. #12
    Quote Originally Posted by Anti Globalist View Post
    There can't be that many transgenders in Iowa.
    How many will move there to take advantage of this?
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  15. #13
    Quote Originally Posted by Anti Globalist View Post
    There can't be that many transgenders in Iowa.

    have you ever been there and seen their "women?"
    Quote Originally Posted by juleswin View Post
    I am not a rapist but there are some people I would never consider to rape if I was a rapist. I wouldn't rape someone who I wasn't attracted to, someone who could probably take me down and pound the hell out of me etc etc.



    Quiz: Test Your "Income" Tax IQ!


    Short Income Tax Video

    The Income Tax Is An Excise, And Excise Taxes Are Privilege Taxes

    The Federalist Papers, No. 15:

    Except as to the rule of appointment, the United States have an indefinite discretion to make requisitions for men and money; but they have no authority to raise either by regulations extending to the individual citizens of America.

  16. #14
    Quote Originally Posted by Swordsmyth View Post
    How many will move there to take advantage of this?
    Most of the Colorado Republicans?

    Quote Originally Posted by Swordsmyth View Post
    You only show up to attack Trump when he is wrong
    DACA S**thole Dreamers - Make America Great Again?

  17. #15
    Quote Originally Posted by Danke View Post
    have you ever been there and seen their "women?"
    Do a lot of women there look like men?
    "Perhaps one of the most important accomplishments of my administration is minding my own business."

    Calvin Coolidge

  18. #16
    Quote Originally Posted by Zippyjuan View Post
    Didn't taxpayers foot the bill for Bradley Manning's transition?



    https://www.stripes.com/news/pentago...roops-1.430040
    I want my money back . No transition visually apparent . He was ripped off .
    Do something Danke



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  20. #17
    Oh yeah , Thanks Iowa . You douchebags have been screwing $#@! up since 1972.
    Do something Danke

  21. #18
    Quote Originally Posted by Zippyjuan View Post
    Didn't taxpayers foot the bill for Bradley Manning's transition?



    https://www.stripes.com/news/pentago...roops-1.430040
    Looks like we stopped short of fixing his Adam's Apple though. Anybody got some spare change?
    Quote Originally Posted by Andrew Ryan
    In Washington you can see them everywhere: the Parasites and baby Stalins sucking the life out of a once-great nation.

  22. #19
    Remember back in 2007? The things we talked about then?

    What the $#@! are we even talking about today?

    If it's gotten to this point in such a short span, what's the purpose?

  23. #20
    I identify as an elephant. Medicaid should pay for a graft of trunk to my junk.

  24. #21
    Quote Originally Posted by phill4paul View Post
    I identify as an elephant. Medicaid should pay for a graft of trunk to my junk.
    /* sniffs for elephants */

  25. #22
    Quote Originally Posted by Dr.3D View Post
    /* sniffs for elephants */
    Don't be sniffing my trunk o' junk. I've always been a monogamous kinda of fellow.

  26. #23
    Quote Originally Posted by phill4paul View Post
    Remember back in 2007? The things we talked about then?

    What the $#@! are we even talking about today?

    If it's gotten to this point in such a short span, what's the purpose?
    I think I have sussed out the purpose.

    I try to bring awareness to what I think the end game is.

    Most people dismiss it.

    It ain't pretty.

  27. #24
    You know if we didn't spend so much on sh1T that isn't medically necessary we might not have such a fk'd up healthcare system, even with all it's socialistic features.
    T.S. Elliot's The Hollow Men

    Only on Ron Paul forums will you find someone who espouses a belief in the Non-Aggression principle and then proceed to display the most intense measures of passive-aggressiveness of anyone you will ever meet.



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  29. #25
    The only good thing about this is that it fuels judicial reform in Iowa. The house and senate are pissed and should add an amendment this week on floor. The judges nominate their own buddies so liberal elitist have taken over Iowa's SC. The vote....6-0

  30. #26
    Has everyone paid their taxes?
    "The Patriarch"

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    The man did not think clearly. It was almost as if he had brain cancer of something.
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    The foreigners will take 100% of your income and then your life.

  31. #27
    Marxism is about constantly changing definitions. You can never be sure. 2+2=5.

    “Elective cosmetic plastic surgery” is now “medically necessary surgery”.

    The verdict ended an almost two-year legal battle that hinged on whether transition-related surgery was “medically necessary” or a procedure provided solely psychological purposes.
    ...
    “The record evidence shows that this surgery is medically necessary,” John Knight, an attorney with the ACLU representing Beal and Good, told justices when the case was argued. “It’s really lifesaving treatment for a number of individuals.”
    ...
    But the state appealed, arguing the ban is not discriminatory because the department denies all surgeries performed primarily for psychological reasons — which is how it has characterized transition-related surgeries.
    ...
    [At the same time... -B4L]
    ...
    But not every transgender person is interested in surgery, Dr. Joe Freund, one of the most sought-after transition-care doctors in the state, previously told the Register.

    Transitioning is a spectrum, and some patients find alignment simply by dressing in gender-specific clothing. Other patients may find hormone-replacement therapy enough while some may need surgery to make themselves whole, he said.
    ...
    Despite what could be considered high costs, transgender people make up a relativity small portion of the national population. One estimate found about 0.3 percent of the total population, or about 964,000 people nationally and 9,300 in Iowa, identify as transgender, according to The Williams Institute, a think tank at UCLA's law school.

    A smaller subset of that population would seek surgeries.
    LOL. This virtue signaling Court twisted itself into a pretzel. “It’s not psychological, it’s a medically necessary procedure that is only necessary in some cases due to psychological reasons.”

    Better tell the people who didn’t have the surgery that they will die without it.
    Last edited by Brian4Liberty; 03-09-2019 at 02:01 PM.
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