McDonough announced the move, plans of which were first reported by CNN, at a Pride event at the Orlando Vet Center in Florida on Saturday.
“We are taking the first necessary steps to expand VA’s care to include gender confirmation surgery — thereby allowing transgender vets to go through the full gender confirmation process with VA at their side,” McDonough said at the event.
The change marks a substantial shift in care for eligible transgender veterans. The National Center for Transgender Equality estimates there are approximately 134,000 transgender veterans.
While the VA Health Benefits package includes coverage of mental health services and hormone therapy, it has excluded coverage or funding for gender confirmation surgery, which is considered by to be a “medically necessary intervention” for people who have gender dysphoria, the condition medical professionals use to describe “distress at the incongruence between one’s gender and anatomy,” according to an opinion piece in the AMA Journal of Ethics.
McDonough said the decision to make this change was based on the “recommendation of our clinicians, so this is a health care decision that has very real physical health care impacts as well as significant mental health impacts.”
Gender confirmation or gender-affirming surgery is a procedure or series of procedures, often to reconstruct sexual organs, so that a person’s anatomy matches the gender with which they identify. Gender-affirming surgery was, at first, seen as a cosmetic or elective surgery, but research shows that the surgery is an effective treatment for people who have gender dysphoria.
Gender confirmation surgery has “been proven effective at mitigating serious health conditions, including suicidality, substance abuse, and dysphoria,” a VA spokesperson said.
“Due in part to minority stress, LGBTQ+ veterans experience mental illness and suicidal thoughts at far higher rates than those outside their community, but they are significantly less likely to seek routine care, largely because they fear discrimination,” McDonough said.
Because of this, it “perpetuates a cycle in which LGBTQ vets and individuals have lower rates of access to preventive care service, utilize health care services less frequently and have more negative experiences with health care,” McDonough said. He called this “unacceptable.”
McDonough acknowledged that “for far too long, and for far too many,” respect and care “were not the norm for our LGBTQ+ community and our veterans,” but he said that is why the VA is “determined to continue down that path. The path of progress.”
McDonough said the move to include gender confirmation surgery in VA health care was ultimately Biden’s decision.
“It’s the President’s decision, and we’ve just announced today that we’re executing that decision. That decision will carry out now over many, many months, but at the end of the day this is in the President’s authority to do,” McDonough said. “He’s made clear it’s time to do it and that’s precisely what we’ll do.”
Leading medical associations such as the American Medical Association, the American Psychological Association and the American Psychiatric Association have issued statements supporting gender-affirming coverage, which includes medical and surgical treatments for gender dysphoria. Major insurance companies, including Blue Cross Blue Shield in many states and Kaiser Permanente have also recognized gender affirming surgery as a medically necessary health benefit, not just a cosmetic surgery, according to an opinion piece in the AMA Journal of Ethics.
McDonough’s announcement is just the beginning of the process. For gender confirmation surgery to be covered by VA health care and included in coverage offered at VA hospitals, policy changes will need to be made. The process of creating a new federal regulation can take years. The VA plans to begin the federal rulemaking process to make this change this summer, a VA spokesperson said.
“There are several steps to take, and that will take time,” McDonough said. “But we are moving ahead, methodically, because we want this important change in policy to be implemented in a manner that has been thoroughly considered to ensure that the services made available to veterans meet VA’s rigorous standards of quality health care.”
McDonough said he has already been in contact with members of Congress to make sure they are aware of the move. He said the process would be carried out “transparently” and “in full coordination with Congress.”
McDonough also ordered a review at the end of February, which is ongoing, of all department policies to “ensure that transgender Veterans and employees do not face discrimination on the basis of their gender identity and expression.”
Changing the VA health care policy is a positive action towards creating real progress, Jennifer Dane, executive director of the Modern Military Association of America, an advocacy organization that supports LGBTQ+ veterans and military service members, told CNN.
“It takes more than words to make true progress and we are thrilled to hear Secretary McDonough’s announcement that the VA is expanding care to include gender confirmation surgery and updating health services to be more inclusive,” Dane told CNN in a statement. “These are clear examples of turning words into actions, the only way we can keep marching forward.”
National LGBTQ+ media advocacy organization GLAAD President and CEO Sarah Kate Ellis also praised the move.
“Transgender veterans deserve equal access to medically necessary and life-saving healthcare, including gender confirmation surgery,” Ellis said in a statement to CNN. “This news is not only an overdue victory for transgender veterans, but the latest move from Sec. McDonough and the VA in affirming LGBTQ veterans.”
This story has been updated with McDonough’s remarks.