The cataclysm caused by the president’s tweets forbidding transgender Americans from serving in the military caught many off guard this week, including VA Secretary David Shulkin who said he was not aware the ban was coming.
In an interview on 77WABC, Shulkin said “When you personalize care, there are added costs. Transgender veterans do require staff that are trained to be able to deal with their situation appropriately so that they can get the care that they want with the dignity and outcomes that they deserve.”
The VA’s policy, Providing Health Care For Transgender And Intersex Veterans (VHA Directive 2013-003), is simple. “It is Veterans Health Administration (VHA) policy that medically necessary care is provided to enrolled or otherwise eligible intersex and transgender veterans, including hormonal therapy, mental health care, preoperative evaluation, and medically necessary post-operative and long-term care following sex reassignment surgery. Sex reassignment surgery cannot be performed or funded by VA.”
The policy goes on to say that all patients will be addressed and referred to based on their self-identified gender. At VA’s medical centers, room assignments will be made based on self-identified gender, however, it should be done in a way that “respects the privacy needs of transgender and non-transgender patients alike.” VA started transgender cultural awareness and sensitivity training in 2013. The VA standard of zero tolerance for discrimination, harassment or abuse of Veterans applies to VHA treatment of transgender and intersex veterans.
One of the reasons for the transgender ban, as stated in the president’s tweet, was the “tremendous medical costs” that transgender military members would cost the government. While it’s nearly impossible to get a completely accurate count of transgender service members and veterans, it’s estimated that hormone treatments and therapy would cost anywhere between $2.4 million and $8.4 million per year.
To put this in perspective, the Department of Defense spent $41.6 on Viagra in 2014. (Please note: the Defense Health Administration filled 1.18 million prescriptions for erectile dysfunction in 2014. There are only 1.3 million people serving in the military.)
Shulkin said he didn’t think that the VA would have any issues handling an influx of transgender veterans, should there be one. “I don’t see this as a major complication for us,” Shulkin said. “I think that it’s important that veterans know that the VA is a safe place to get their care. Once a person signs up to defend our country, they have to know that the VA is there and committed to them through the end of their life.”