Not one but two transgender women, both named Misty, won Democratic Primaries held on Tuesday. This is a big step forward for the LGBT community and is well timed since June is National LGBT Pride Month.

In Utah, Misty Snow won the Democratic nomination for the U.S. Senate, while in Colorado, Misty Plowright won a House primary.

JoDee Winterhof, from the Human Rights Campaign, said to NBC:

It is historic that this November, the top Utah Democrat on the ballot in that state will be a transgender woman. Regardless of the outcome in the fall, both of these candidates have demonstrated to transgender people across the country that our politics are stronger when diverse voices are not only heard, but also included.

Neither of the women have much experience in politics, but want to offer voters an alternative to the other candidates that are running.

Misty K. Snow & Misty Plowright made history yesterday, and also they are my favorite political figures in ages https://t.co/7OoxouQ61Z

— J. Escobedo Shepherd (@jawnita) June 29, 2016

Misty Snow, from Utah, is the first transgender person to run for a Senate seat from a major party. Her day job is at a grocery store and she doesn’t have a college degree, but she beat marriage therapist Jonathan Swinton by a big margin. She is challenging Utah Senator Mike Lee, who is very conservative, with Bernie Sanders-inspired ideas such as $15 minimum wage, paid parental leave, and free college tuition.

Misty Plowright works in tech in Colorado and described herself as “the anti-politician” and an IT nerd. She also beat her opponent, an Iraq war veteran, easily and wants to get private money out of politics and for the whole country to have access to high speed Internet.

Neither of the candidates focused on the fact that they’re transgender women in their campaign, but rather on progressive Democratic ideas. However, winning in November might be harder to do considering how relatively conservative both of their states are. However, after the recent bathroom debate in North Carolina, and the shooting in Orlando, Snow and Plowright provide some positive news for the LGBT community, no matter the outcome of these elections.

Emma Von Zeipel

Emma Von Zeipel is a staff writer at Law Street Media. She is originally from one of the islands of Stockholm, Sweden. After working for Democratic Voice of Burma in Thailand, she ended up in New York City. She has a BA in journalism from Stockholm University and is passionate about human rights, good books, horses, and European chocolate. Contact Emma at EVonZeipel@LawStreetMedia.com.

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Even though only 19 percent of Americans surveyed by the Public Religion Research Institute said they would oppose a lesbian or gay athlete signing onto a professional sports team, there are still many obstacles that exist to LGBTQ players being out in pro sports.

Women have been coming out publicly in professional sports for years, but men in the big leagues have faced a great deal of obstacles keeping their positions on teams.

As more and more professional athletes are coming out, what are the legal rights and difficulties of LGBTQ athletes in professional sports?

Out Athletes in Pro Sports

Not only have queer women been coming out publicly in professional sports for quite some time, several have been actively outspoken against homophobic laws. Speaking out against Minnesota’s 2012 attempt to ban gay marriage in the state, WNBA star and Olympic gold medalist Seimone Augustus told the Associated Press:

I felt like it was the perfect time for me, being on a platform where I can make a change with my voice and my situation… Maybe inspire someone else to come out and be comfortable with themselves. Or maybe someone else’s parents will see my parents saying that it’s OK to be with your child and love your child unconditionally regardless of your sexual preference.

This outspokenness accompanies the activism of fellow out WNBA star Brittney Griner against the constraints placed on her at Baptist school Baylor University.  Griner has commented candidly on the hypocrisy of homophobia in sports:

The more I think about it, the more I feel like the people who run the school want it both ways: they want to keep the policy, so they can keep selling themselves as a Christian university, but they are more than happy to benefit from the success of their gay athletes. That is, as long as those gay athletes don’t talk about being gay.

We’ve got a culture that is OK with casual homophobia and sexist language… What Jason Collins’ presence does–now people have to be held accountable. Because what people said before was, ‘Well, he said that, but he wasn’t talking to anyone, and no one’s gay here, so no one’s offended by it.’ Now that Collins is in existence, people realize there are more Jasons out there, more Michael Sams out there, that when you say something homophobic, you’re actually affecting someone who you truly believe exists now.

Rights and Responsibilities

Advocates of LGBT rights in professional sports have argued that it is the responsibility of professional sports leagues to proactively protect players–and coaches and staff–from discrimination.

In Sam’s case, however, Dr. John Fitzgerald Gates, National Diversity Expert, Principal, and Chief Strategist of Criticality Management Consulting and Former Associate Dean of Harvard College, wrote the following about NFL Commissioner Roger Goodell:

(He) did nothing to assure that Sam would be treated with the respect and fairness accorded other players, or to protect him against being fired because he is gay. According to Goodell, in the NFL: ‘We do things the right way. We will give them that education and training. I hope that will solve the problem.’ But Goodell’s deduction is flawed, for if education and training solved discrimination we surely would have educated and trained our way beyond it by now. As with racial and gender bias, laws must be constructed and enforced to ensure equal protection to LGBT professional athletes. Goodell welcomed Sam onto the field of play without providing him the protection from discrimination that other players have, thereby leaving him uniquely and unfairly vulnerable. Goodell codified the NFL’s right to discriminate when he should have had the courage, like President Obama, to ban it.

It is worth noting that the NFL does, in fact, have provisions in place to protect players from discrimination and harassment based on their sexual orientation. Indeed, when the MLB spoke out against homophobia in the major leagues, it was following the precedent of the NFL, stating that:

Public Religion Research Institute: Ahead of Super Bowl, Nearly Three-in-Ten Americans Support Lifetime Ban for Football Players Who Commit Domestic Violence

OutSports: Trans Athletes

Sports Illustrated: Why NBA Center Jason Collins is Coming Out Now

Huffington Post: The Moment is NOW for Professional Sports to Ban LGBT Discrimination

Huffington Post: Michael Sam: The Practical and Legal Implications of a Gay Professional Athlete

CBS News: NFL Agrees to Do More to Protect Gay Players

Daily Mail: Basketball Star Brittney Griner Opens up About Being a Lesbian at Baylor University and How She was Told to Keep ‘Her Business’ to Herself

Jurist: How Four Major Sports Leagues Influence LGBT Rights

Think Progress: The Benchwarming Journeymen Who Changed American Sports Forever

Think Progress: Dallas Cowboys Cut Michael Sam from Practice Squad

Jennifer Polish

Jennifer Polish is an English PhD student at the CUNY Graduate Center in NYC, where she studies non/human animals and the racialization of dis/ability in young adult literature. When she’s not yelling at the computer because Netflix is loading too slowly, she is editing her novel, doing activist-y things, running, or giving the computer a break and yelling at books instead. Contact Jennifer at staff@LawStreetMedia.com.

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The blanket ban on Medicare coverage of sexual reassignment surgery, which had been in place since 1989, was lifted in May 2014. With this move, Medicare officially recognized sexual reassignment surgeries as non-experimental and medically necessary for some suffering from gender dysphoria. Many consider the lifted ban a major victory for transgender rights; however, the move also sparked controversy as many people felt Medicare needs to prioritize the coverage of other medical concerns. Read on to learn how and why Medicare made the decision to lift its ban on sexual reassignment surgery.

What does it mean to be transgender?

According to GLAAD, transgender is “an umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth.” “Transsexual” is an older term “preferred by some people who have permanently changed–or seek to change–their bodies through medical intervention.” Gender identity is a person’s innate sense of being female, male, or other. Gender expression is how “a person communicates gender identity to others through behavior, clothing, hairstyles, voice, or body characteristics.”

It’s important to note that being transgender is not considered a mental disorder as it does not cause significant distress or disability; however, those who identify as trans* have difficulty 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 culmination of these experiences can lead to higher levels of anxiety and/or depression than among the cisgender population.

What is Gender Dysphoria?

Gender Dysphoria It is a diagnosis given to people who “experience intense, persistent gender incongruence.” They do not identify with the physical sex they were assigned at birth. For an official diagnosis, the incongruence must last for at least six months. For children, the wish to be a different gender must be apparent and verbalized. People with gender dysphoria exhibit an overwhelming desire to be rid of his or her biological gender characteristics or “strong conviction that one has feelings and reactions typical of the other gender.” In order to cure gender dysphoria, some opt to undergo hormone therapies and or/medical surgeries.

The World Professional Association for Transgender Health (WPATH) recommends a “real-life experience” and hormone therapy before surgery. A real-life experience is a specific duration of time that a transgender person must completely live as their desired gender while maintaining a mentally healthy and active lifestyle. People transitioning from male to female take testosterone-blocking agents along with female hormones like estrogen and progesterone in order to develop characteristics such as breasts, softer skin, and less body hair. Female to male candidates take testosterone in order to deepen the voice, shrink the breasts, and increase physical strength.

After hormone therapy, there are a plethora of surgical options. People transitioning from male to female may choose to undergo a breast augmentation, orchiectomy (removal of the testicles), penectomy (removal of the penis), vaginoplasty (creation of the vagina), clitoroplasty (creation of the clitoris), and/or labiaplasty (creation of labia). The new constructions are generally built from penile tissue. There is also voice modification surgery to deepen the voice. Transitioning from male to female generally costs $40,000 to $50,000. Female to male transition surgeries are less medically successful. Trans males can undergo a mastectomy (removal of the breast tissue), hysterectomy (removal of the uterus), and salpingo-oophorectomy (removal of the fallopian tubes and ovaries). Patients can have a metoidioplasty (enlargement of the clitoris), but the construction of a penis has yet to be medically perfected. Collectively, transitioning from female to male costs about $75,000. Both trans females and trans males can receive cosmetic surgeries as well.

Medicare’s Prior Policy

Since 1989, Medicare specifically denied coverage for sex reassignment surgery under the National Coverage Determination 140.3. The decision was based on a 1981 National Center of Health Care Technology report, which stated:

Because of the lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexuals, the treatment is considered experimental. Moreover, there is a high rate of serious complications for these surgical procedures. For these reasons, transsexual surgery is not covered.

Basically, the surgeries were considered too risky and dangerous.

Since then, the American Medical Association, the American Psychological Association, and the American Psychiatric Association began advocating sex reassignment surgery as a productive, effective relief for victims of Gender Dysphoria. The U.S. Department of Health and Human Services Departmental Appeals Board overturned the decision in May 2014. The board stated that the policy was “based on outdated, incomplete, and biased science, and did not reflect contemporary medical science or standards of care.” This doesn’t mean candidates will automatically be approved for sex reassignment surgery, but approval or denial will be given based on individual cases, not a blanket policy.

Case Study: Denee Mallon

Medicare’s reevaluation of the ban started when 74-year-old army veteran Denee Mallon was denied her request for gender reassignment surgery by Medicare. In turn, she challenged the government insurance ban against sex reassignment surgeries.

After receiving the surgery, Mallon happily stated, “I feel congruent, like I’m finally one complete human being where my body matches my innermost feelings, my psyche. I feel complete.”

Mallon initially realized her gender identity when she was a 12 year old child in the 1940s. She continued to live as a man, having five kids and entering three marriages. When she could afford sex reassignment surgery in the late 70s and early 80s, her doctors refused to approve it because she was participating in consensual sex with women. When she finally received approval in the late 80s, she could no long afford it. She lived her life as a woman aided by hormonal therapy starting at age 40. She hid the fact that she was born male until 2012 when she became open about it and came out of what she calls “stealth mode.”

In response to critics calling being transgender a “lifestyle” choice, Mallon stated, “It’s far deeper than that. It’s so a part of my basic psyche, there’s no escaping it. I’ve tried to be the kind of man that society wanted and my feminine self just kept creeping up.”

Mallon decided to challenge Medicare after she was refused sex reassignment coverage by both her secondary private insurer and Medicare. She could not afford the expensive surgery living on $650 a month in Social Security income. The challenge and review process took about 18 months, before Medicare decided to lift the ban.

Pros of Lifting the Ban

Health Benefits

According to a British study, 88 percent of patients whounderwent male to female sexual reassignment surgery were content with the results. Those with Gender Dysphoria that undergo the transition process have substantial mental health improvement and a decrease in substance abuse and depression. According to a 2010 U.S. study, 41 percent of transgender people have attempted suicide. Sex reassignment surgery is a critical step in creating mental stability for some.

Marci Bowers, a transgender obstetrician and gynecologist in Burlingame, California, reported only two out of 1,300 people on whom she has performed sex reassignment surgery wanted to reverse the procedure. This is a 99.85 percent success rate.

Starting a Trend

The lifted ban is not only a significant win for transgender rights, but perhaps a catalyst for more change to come. Many public and private insurers take cues from the government. This could be the start of a long line of insurers securing coverage for these types of surgeries. In 2002, zero Fortune 500 companies offered transgender benefits. Ten years later, 19 percent did, and by 2014 it was 28 percent.

As of today, California, Colorado, Connecticut, Oregon, Massachusetts, Washington, Illinois, New York, Vermont, and Washington D.C. have banned anti-transgender discrimination in health insurance, and they legally require insurers to provide transgender health insurance.

Backlash

The first attempt to lift the ban came in 2013, but there were protests from conservative and religious groups. Defenders of the ban don’t believe these types of surgeries should be paid for by tax payer money.

Leanna Baumer, a senior legislative assistant with the Family Research Council, stated:

Real compassion for those struggling with a gender identity disorder is to offer mental health treatments that help men and women become comfortable with their actual biological sex — not to advocate for costly and controversial surgeries subsidized by taxpayers.

Frank Schubert, national political director for the National Organization for Marriage, doesn’t believe condoning the surgery sends the right message to America’s youth “to respect who they are, how they were born.”

Conclusion

There’s plenty of evidence to suggest that an overwhelming majority of those who undergo sex reassignment surgery for Gender Dysphoria find a substantial increase in their quality of life. In a demographic that experiences high rates of depression and suicide, the importance of these procedures is clear. The high expense of these surgeries essentially eliminates the option if they aren’t covered by insurance. Most people don’t have an extra $50,000 to spend on treatment for any medical condition. The lifted ban holds important symbolic value for the future and what’s to come.

Resources

Primary

American Psychological Association: What Does Transgender Mean?

Additional

Advocate: HHS to Reevaluate Ban on Gender-Confirming Surgeries

How Stuff Works: Stages of Gender Reassignment

NBC News: Sex Reassignment Surgery at 74

GLAAD: GLAAD Media Reference Guide

National Center for Transgender Equality: Know Your Rights

Trans Health Care: List of U.S. States That Have Banned Anti-Transgender Discrimination in Health Insurance

USA Today: Medicare ban on sex reassignment surgery lifted

Washington Post: Ban Lifted on Medicare Coverage For Sex Change Surgery

Washington Post: Here’s How Sex Reassignment Surgery Works

Jessica McLaughlin

Jessica McLaughlin is a graduate of the University of Maryland with a degree in English Literature and Spanish. She works in the publishing industry and recently moved back to the DC area after living in NYC. Contact Jessica at staff@LawStreetMedia.com.

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