President Trump in a series of three tweets Wednesday announced plans to prohibit transgender individuals from serving in the U.S. military, saying the Pentagon should not be burdened with "the tremendous medical costs" associated with such individuals.
Help your patients escape the patient access maze
Trump tweeted, "After consultation with my Generals and military experts, please be advised that the United States Government will not accept or allow transgender individuals to serve in any capacity in the U.S. Military. Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail. Thank you."
Trump's tweets left many questions unanswered about when and how such a proposal would be implemented, the New York Times reports. White House Press Secretary Sarah Huckabee Sanders said the administration and Pentagon were still weighing implementation questions and whether active duty transgender service members would be affected, Reuters reports. However, Gen. Joseph Dunford, chair of the Joint Chiefs of Staff, in a letter Thursday to the joint chiefs, clarified that Department of Defense (DOD) will not change its current policy on who can serve in the U.S. military until Trump has sent his "direction" to DOD Secretary James Mattis and Mattis has "issued implementation guidance."
Expert perspectiveHow to equip your staff to care for diverse patient populations
According to the Times, several DOD officials said the announcement took many at the Pentagon by surprise, as they are in the process of studying, under the orders of Mattis, the effect transgender service members may have on other members.
Huckabee Sanders during a press conference Wednesday said Trump had made the decision and on Tuesday informed Mattis, who was opposed to the move, according to Politico.
The debate over transgender medical costs
Trump's announcement came about two weeks after a group of House conservatives unsuccessfully sought to amend the defense authorization bill for FY 2018 (HR 2810) to prohibit DOD from covering the cost of transition surgery or related hormone therapy for transgender individuals, the Washington Post reports.
Supporters of the amendment say the Pentagon should not bear the costs of such procedures. In his tweet, Trump also cited transgender service members' medical costs as a primary reason for the policy change.
How hospitals are changing to serve transgender patients
A 2016 RAND report attempted to quantify those costs and found that allowing transgender individuals to serve openly in the military would "have minimal impact on readiness and health care costs." Using private health insurance claims data, the researchers estimated that military health care costs would rise between $2.4 million and $8.4 million annually, accounting for a 0.04 percent to 0.13 percent increase in health care spending for active-duty service members. According to the Washington Post's "Wonkblog," the report did not account for retirees or military dependents, saying that those individuals may have "limited eligibility" for care at military treatment facilities.
RAND estimated about 2,450 of the 1.3 million active-duty service members in the U.S. military are transgender—though the Human Rights Campaign, an LGBT advocacy group, has said that number could be as high as 15,000 service members.
Trump's announcement was praised by the conservative Family Research Council for ending "the social experimentation of the Obama era that has crippled our nation's military." But both the mode of delivery and the message itself received swift condemnation from several lawmakers of both parties, the American Medical Association (AMA), and LGBT advocacy groups.
The AMA in a statement said, "There is no medically valid reason to exclude transgender individuals from military service."
Sen. John McCain (R-Ariz.) also pushed back against the announcement, saying, "The Department of Defense has already decided to allow currently-serving transgender individuals to stay in the military, and many are serving honorably today," adding, "Any American who meets current medical and readiness standards should be allowed to continue serving. There is no reason to force service members who are able to fight, train, and deploy to leave the military—regardless of their gender identity."
Sen. Kirsten Gillibrand (D-N.Y.) vowed to "introduce legislation and ... fight to overturn this discriminatory decision" (Hirschfeld Davis/Cooper, New York Times, 7/26; Bade/Dawsey, Politico, 7/26; Stewart/Chiacu, Reuters, 7/26; Edelman, NBC News, 7/26; Phillip et al., Washington Post, 7/26; Ingraham, "Wonkblog," Washington Post, 7/26; Stewart/Ali, Reuters, 7/27).
Help your patients escape the patient access maze
Too often, patients are forced to overcome a series of obstacles that make a maze out of care delivery.
Eliminate these barriers to create an experience that will both attract new patients and retain existing patients. Download our infographic to learn about the common barriers between you and a happy, healthy patient population.