EPPC Scholars Submit Public Comment Opposing HHS’s Proposed Insurance Mandate for Transgender Puberty-Blocking Drugs, Cross-Sex Hormones, and Surgeries

Published January 28, 2022

On January 27, 2022, EPPC scholars Ryan T. Anderson, Roger Severino, Rachel N. Morrison, and Mary Rice Hasson submitted a public comment opposing a proposed rule by the U.S. Department of Health and Human Services that would mandate health insurers cover a wide array of dangerous and irreversible medical and surgical transgender procedures, including for children.

“The rule as proposed is arbitrary and capricious, is without legal support, contradicts longstanding scientific understandings of the human person, attempts to evade court injunctions, promotes harm to patients (especially minors), tramples religious freedom, and places ideology ahead of sound medicine,” the EPPC scholars wrote.

Specifically, the rule would add “sexual orientation and gender identity” nondiscrimination provisions to insurance regulations administered by the Centers for Medicare & Medicaid Services (CMS). This would require insurers of individual market and small group plans (fewer than 51 employees) to recognize transgender treatments as a new “essential health benefit” to include, at a minimum:

  • Puberty blockers for children
  • Lifetime cross-sex hormones
  • Genital and non-genital surgical procedures (hysterectomy, penectomy, mastectomy)
  • Blepharoplasty (eye and lid modification)
  • Face/forehead and/or neck tightening
  • Facial bone remodeling for facial feminization
  • Genioplasty (chin width reduction)
  • Rhytidectomy (cheek, chin, and neck)
  • Cheek, chin, and nose implants
  • Lip lift/augmentation
  • Mandibular angle augmentation/creation/reduction (jaw)
  • Orbital recontouring
  • Rhinoplasty (nose reshaping)
  • Laser or electrolysis hair removal
  • Breast/chest augmentation, reduction, construction

Additionally, the proposal would amend benefit design requirements in fully-insured large group plans (above 50 employees), so that excluding coverage of these and other treatments for gender dysphoria could be considered “presumptively discriminatory.”

In their comment, the EPPC scholars state: “CMS is attempting to establish a medical standard of care through nondiscrimination provisions. But a nondiscrimination provision cannot establish what is ‘medically necessary’ or good or bad medicine.”

The comment includes extensive documentation of the significant harms that cross-sex transition treatments pose, particularly to minors, and argues that “requiring insurers and health plans to provide transition counseling, to be followed by hormones and medical procedures, as a one-size-fits-all ‘solution’ to gender dysphoria is arbitrary, capricious, and unsupported by the evidence. Worse, promoting abandonment of one’s biological sex to impressionable young people causes significant known harms and obscures underlying causes.”

Read EPPC’s press release about this issue here.

Ryan T. Anderson, Ph.D., is the President of the Ethics and Public Policy Center.

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