Ugh: PBS Hails ‘Gender-Affirming Care’ Court Win for Minors, Including Mastectomy

News & Politics

The PBS NewsHour was back to its old rhetorical tricks this week on the LGBTQ front. Lately the outlet has been reacting with pro-transgender alarm when yet another state restricts transgender surgery for minors. But it had cause to celebrate on Tuesday, covering a “groundbreaking ruling” that somehow didn’t shake up the other media outlets enough to cover.

PBS teamed up with its fellow taxpayer-funded outlet National Public Radio to bring the joyful news that a federal appellate court in Richmond had ruled that so-called “gender-affirming care” must be covered by state health care plans in West Virginia and North Carolina. They used that Orwellian term no less than ten times in the segment. including in the supportive introduction from host Amna Nawaz: “A federal appeals court issued a groundbreaking ruling last night ensuring that gender-affirming surgery is covered by state-run health insurance programs.”

The entire exchange took place in a liberal bubble, with zero mention of conservative counterpoints — no  inconvenient questions about gender transition, or how a biological man can become a woman, or if the government should be obligated to pay for such a change. NPR health reporter Selena Simmons-Duffin — who provided a similar bubble of an interview to transgender Biden appointee Adm. Rachel Levine two years ago, that there was “no scientific debate” on these surgeries — only cared about how the “trans community” greeted the news.

Reporter Stephanie Sy explained: …this decision centered around two lawsuits, with trans people in West Virginia and North Carolina suing to secure insurance coverage for gender-affirming care, such as hormone therapy and surgery.” Sy crowed, “It is a win for the trans community, but it may not be the final word on the issue.”

Selena Simmons-Duffin, health-policy reporter, NPR: I think this is a really significant ruling. The Fourth Circuit’s majority opinion was really strong and called discrimination against trans patients on these plans to be — quote — “obviously discriminatory.” I think that the big takeaway is that insurers are not going to be able to say that they’re going to cover this care for some patients with some diagnoses and not for others. If they’re going to be covering things like sex hormones and mastectomies for some patients, they’re going to have to cover it for trans patients as well. And I do think that it’s really seen in the trans community as a major win, and it cuts against some of the trends of more litigation and more restrictions that we have seen in statehouses across the country.

Sy: Selena, how far-reaching is this ruling? Does this mean trans people with state medical plans are now covered for gender-affirming care where they couldn’t or where they weren’t before?

Simmons-Duffin explained that the ruling was a signal that “trans people are protected under the law,” as if they weren’t protected by law before. Both reporters ignored the traumatic effects of gender surgery (including hormone replacement theory and even chemical and physical castration) on children in their eagerness over the medical insurance decision, while continuing their happy talk about “gender-affirming care.”

Sy: We have seen in the last few years some two dozen states pass restrictive laws on gender-affirming care specifically for minors. Does this decision, Selena, apply to minors covered by state medical plans, even in states where legislatures have banned care?

Simmons-Duffin: ….it is important to differentiate this from some of the other cases around gender-affirming care for minors, because this is really about insurance coverage and whether insurers can make the distinction that they’re going to cover hormones and mastectomies with certain conditions, but not for people with gender dysphoria. In this case, they said that’s not going to fly and that needs to stop….

A transcript is available, click “Expand.”

PBS NewsHour

4/30/24

7:13:54 p.m. (ET)

Amna Nawaz: A federal appeals court issued a groundbreaking ruling last night ensuring that gender-affirming surgery is covered by state-run health insurance programs.

Stephanie Sy has that report.

Stephanie Sy: Amna, this decision centered around two lawsuits, with trans people in West Virginia and North Carolina suing to secure insurance coverage for gender-affirming care, such as hormone therapy and surgery.

The federal appellate court in Richmond, split 8-6, ordered that the state health care plans — quote — “reinstate coverage for medically necessary services for the treatment of gender dysphoria.” The American Medical Association and the American Academy of Pediatrics wrote briefs in support of the trans plaintiffs.

It is a win for the trans community, but it may not be the final word on the issue.

For more on all of this, I’m joined by NPR’s Selena Simmons-Duffin, who covers health policy for NPR.

Selena, it’s good to see you on the “NewsHour.”

So, as you know, there are numerous court cases around the country about transgender rights and access to gender-affirming care. How significant was this ruling, and what are the big takeaways to you?

Selena Simmons-Duffin, NPR: I think this is a really significant ruling.

The Fourth Circuit’s majority opinion was really strong and called discrimination against trans patients on these plans to be — quote — “obviously discriminatory.” I think that the big takeaway is that insurers are not going to be able to say that they’re going to cover this care for some patients with some diagnoses and not for others.

If they’re going to be covering things like sex hormones and mastectomies for some patients, they’re going to have to cover it for trans patients as well. And I do think that it’s really seen in the trans community as a major win, and it cuts against some of the trends of more litigation and more restrictions that we have seen in statehouses across the country.

Stephanie Sy: Selena, how far-reaching is this ruling? Does this mean trans people with state medical plans are now covered for gender-affirming care where they couldn’t or where they weren’t before?

Selena Simmons-Duffin: Well, actually, in both of these cases, the state plan in North Carolina and Medicaid’s — Medicaid in West Virginia, they already had to start covering this care after the district court ruled in the plaintiff’s favor in 2022.

So people have been able to bill for this and get coverage for this in the last two years, but what the appellate ruling does is really solidify that coverage. And as I said, it also signals to other plans in other states around the country that this is care that needs to be covered and that trans people are protected under the law.

Stephanie Sy: We have seen in the last few years some two dozen states pass restrictive laws on gender-affirming care specifically for minors. Does this decision, Selena, apply to minors covered by state medical plans, even in states where legislatures have banned care?

Selena Simmons-Duffin: I should say that there were plaintiffs in these cases that were minors. So, for example, in North Carolina, there were some members of the plan who joined the case on behalf of their dependent minor child who was transgender. And so they were seeking coverage for the care of that child.

But I think it is important to differentiate this from some of the other cases around gender-affirming care for minors, because this is really about insurance coverage and whether insurers can make the distinction that they’re going to cover hormones and mastectomies with certain conditions, but not for people with gender dysphoria.

In this case, they said that’s not going to fly and that needs to stop. But one thing I also wanted to mention is that, in the realm of bans across the country in different states for gender-affirming care for youth, just today, in Kansas, the Statehouse was unable to override the veto of the governor who had vetoed the ban on gender-affirming care for youth in that state.

So I think advocates are really hoping that this does — even beyond the realm of its actual reach, it does send a signal to different places, to governors, to statehouses to say, this isn’t a winning issue and the courts are starting to fall in their favor, although it has been a mixed bag in the courts.

Stephanie Sy: Yes, absolutely.

In this particular case — and you quoted it — the majority wrote that, when it comes to the state’s exclusion of gender-affirming care for medical plans — quote — “We hold that the coverage exclusions facially discriminate on the basis of sex and gender identity.”

It said the exclusions, in essence, violate the 14th Amendment and provisions in the Affordable Care Act. There are so many transgender rights issues mired in the courts right now. Selena, do you see the Supreme Court taking all this up any time soon? I know, in this case, West Virginia’s attorney general has already said he is appealing.

Selena Simmons-Duffin: Yes, I mean, court watchers and policy watchers that I have talked to really think that a case is going to reach the Supreme Court at some point, and probably soon.

But the Supreme Court has been sending some mixed messages on this. So there was a gender-affirming caravan in Idaho that the Supreme Court allowed to take effect. But then there are other cases, including one from the Fourth Circuit that was related to transgender students participating in sports, that the Supreme Court declined to take.

And that was a win for the transgender plaintiff in that case. Court watchers suggest that it seems like the Supreme Court is maybe reluctant to jump into the fray, but there has been so much litigation in this area and so many laws being passed that it just seems inevitable that the Supreme Court will have to weigh in and give some clarity.

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