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Iowa Republican Lawmakers Vote To Ban Medicaid Coverage For Transgender Surgery

Katarina Sostaric
Alexandra Gray speaks out against a proposal to block publicly-funded insurance coverage for transgender Iowans' transition surgery at the Iowa Capitol Friday, April 26, 2019.

This post was updated Saturday, April 27, 2019 at 2:48 p.m.

Republicans at the Iowa Capitol voted Friday and Saturday to ban publicly-funded health insurance, including Medicaid, from covering transition-related surgery for transgender Iowans.

This change to the Iowa Civil Rights Act was embedded in a budget bill on one of the last days of Iowa’s legislative session.

The ban would also apply to “any other cosmetic, reconstructive, or plastic surgery procedure” to treat transgender and intersex people, and Iowans diagnosed with gender dysphoria.

It’s a direct response to a unanimous Iowa Supreme Court ruling from March 2019 that struck down a ban on Medicaid coverage for these procedures based on protections in the Iowa Civil Rights Act.

Keenan Crow, a lobbyist for LGBTQ advocacy group One Iowa, said this move is devastating and potentially life-threatening for people who are expecting these health care services.

“What they’re saying is these folks are not going to get the medically necessary care that their doctors say they need,” Crow said. “Not because it’s not medically necessary, but because they are a certain way. They’ve excluded a specific class of folks.”

If signed into law, it’s very likely this policy would be challenged in court.

Sen. Jake Chapman, R-Adel said he does not believe these surgeries are medically necessary, even though major medical organizations agree that they are.

“Let them do it on their own,” Chapman said. “But don’t force Medicaid and taxpayer money—don’t force them to pay for these operations.”

Some Republicans say the ban would save the state millions of dollars. But Crow said it is nearly impossible to estimate the cost, especially because there is a very wide range of transition-related health services transgender people may seek out.

“Whether it’s $5,000, $50,000 or $100,000, the fundamental question is, should taxpayer money be used for that purpose?” Chapman said.

Alexandra Gray is a transgender woman from Des Moines who was at the Statehouse speaking out against the proposal. She said she has been “jumping through hoops” to get her own gender affirming surgery.

“We don’t do this because it’s a joke,” Gray said. “We don’t do this because it’s cosmetic.”

Gray said she has seen firsthand what not having medical care can do to transgender people when she lived in Chicago and was contacted by someone in the Cook County coroner’s office.

“They’d found a 16-year-old trans girl in a storage unit, where she’d gone to have surgery, because she did not have access to medical care,” Gray said. “It went wrong. It went very wrong.”

Because of a procedural strategy by Republicans, Democrats were not able to offer amendments to remove this policy from the bill.

Sen. Joe Bolkcom, D-Iowa City, said this threatens the health and wellbeing of transgender Iowans.

“The language in this bill targets coverage for their essential and necessary medical treatments. It’s ignorant. It’s discrimination of the worst kind,” Bolkcom said.

The Iowa Senate passed the bill 31-19, with Sen. Tom Greene, R-Burlington, joining the Democrats in voting against it. The Iowa House passed the changes 52-47, with Rep. Megan Jones, R-Sioux Rapids, joining the Democrats in voting no. 

It now goes to Republican Gov. Kim Reynolds for her signature. She has the power to veto sections of the budget bill. 

Katarina Sostaric is IPR's State Government Reporter