Senator claims cutting transgender surgeries could save on Medicaid

Gazette-Mail file photo
Sen. Robert Karnes, R-Upshur

A West Virginia senator suggested Wednesday, on the Senate floor, that the state could save Medicaid money if providers could refuse some treatments, such as “transgender surgery.”

Thursday, a state Department of Health and Human Resources spokeswoman said Medicaid doesn’t pay for the referenced procedure.

Transgender people, or those who do not feel the gender listed on their birth certificates is an accurate representation of themselves, sometimes seek hormonal and surgical treatments so that their bodies more closely match their identities.

During a discussion about the state budget Wednesday afternoon, Sen. Mike Woelfel, D-Cabell, asked Sen. Robert Karnes, R-Upshur, if Karnes’ proposed revenue plan accounted for the loss of Medicaid dollars flowing into the state, if the Affordable Care Act is repealed and Republicans’ replacement, the American Health Care Act, is enacted.

Karnes was the lead architect of the revenue plan passed by the Senate Wednesday. The Legislature currently is on hiatus, because the Senate and House could not agree on a spending plan.

The Congressional Budget Office has estimated that the American Health Care Act would cut federal contributions to Medicaid by $834 billion, nationwide, and result in 14 million fewer Medicaid enrollees by 2026. About 30 percent of West Virginia is covered by Medicaid.

“Does your budget anticipate that Medicaid hole or are those folks just going to be left out there?” Woelfel said.

Karnes told him, “my understanding of what the president’s proposing is to convert a lot of that into block grants, which gives us a lot more flexibility in terms of how we spend those dollars. For example, we won’t necessarily have to cover transgender surgery. We can choose to treat the child with cancer instead.”

“See, I thought we were having a rational discussion and you want to talk about transgender surgery,” Woelfel responded. “That’s enough, thank you.”

Sen. Mike Romano, D-Harrison, who spoke next, said: “I’d like to know how many transgender surgeries there were in West Virginia last year.”

That number is unclear. But according to DHHR spokeswoman Allison Adler, Medicaid doesn’t pay for them.

“This is a non-covered service,” she wrote in an email Thursday.

Later on Twitter, Karnes referred to the procedures as “disfigurements” and “indulging ... mental illness.”

The American Psychological Association says that a “psychological state is considered a mental disorder only if it causes significant distress or disability.”

“Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder,” the organization continues. “For these individuals, the significant problem is finding affordable resources, such as counseling, hormone therapy, medical procedures and the social support necessary to freely express their gender identity and minimize discrimination.

The American Psychological Association also said, in 2015 guidelines, that “TGNC people (transgender and gender non-conforming people) have difficulty accessing necessary health care and often feel unsafe sharing their gender identity or their experiences of anti-trans prejudice and discrimination due to historical and current discrimination from health care providers. Even when TGNC people have health insurance, plans may explicitly exclude coverage related to gender transition.”

Karnes was also one of the leading proponents of the Religious Freedom Restoration Act, which some supporters openly said was a reaction to same-sex marriage’s legality, considered by the Legislature in 2016. He has also urged state lawmakers to take up a “bathroom bill,” which would ban some transgender people from the bathrooms in which they feel most comfortable.

Reach Erin Beck at, 304-348-5163, F, or follow @erinbeckwv on Twitter.

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