Transgender Iowans Deserve Medicaid Services Too

This is a guest post from One Iowa board member Terri Hale and her husband, John Hale. The two co-own The Hale Group, a consulting, advocacy, and communications firm located in Ankeny, IA. They can be reached at [email protected].


Todd Blodgett’s guest opinion piece in the March 17th Des Moines Register, Taxpayer-funded transgender services jeopardize Medicaid was offensive, hurtful and full of inaccuracies.

The column disparaged transgender Iowans by making light of their legitimate health issues. It blasted the Iowa Supreme Court for a decision that said transgender Iowans are human beings who deserve access to medically necessary health care services. Mr. Blodgett called those receiving Medicaid services “hand-out seekers.” He alluded to “crooked doctors” and an “entitlement mentality” that’s sabotaging lives.

It was more hit-job and rant than worthwhile opinion. It fed into what seems to be in vogue in America these days – finding a category of people to belittle with sweeping, distorted generalizations and false allegations.

We’d like to provide clarity and balance beginning with the human side.

We’re a happily married heterosexual couple. While we’ve striven to be open, affirming and inclusive we admit that there was a time we didn’t understand transgender people or the challenges they face.

Rather than remaining afraid of or confused by the unknown, we learned the facts and took the time to get to know some transgender Iowans. They became our friends and we became their allies.

We were reminded that regardless of sexual orientation or gender identity, we’re all human beings who deserve to be accepted as equals and treated with respect.  Differences should be acknowledged and embraced, not shunned. Our acceptance and understanding of differences enriches our lives.

And then there’s the other side that Mr. Blodgett missed, the factual side.

He states that transgender Iowans and the Iowa Supreme Court are expecting taxpayers, via the Medicaid program, to pay for “cosmetic” surgery. That is simply not true. The fact is Medicaid will only pay for medically necessary procedures. Medically necessary means it is needed to meet legitimate health needs – as documented by a medical professional – not simply something wanted because it might be nice to do.

He states that private-sector health plans serving nearly all Iowans deny medically necessary services to transgender individuals. Once again, his allegation is false. A little research would have informed him that many of Iowa’s largest employers, including Principal, Wells Fargo, Wellmark, Collins Aerospace, Cargill, Nationwide, and others offer such coverage.

He implies that coverage of medically necessary health services for transgender Iowans will lead to large expenditures that will burden Iowa taxpayers. Again, his allegations are inflammatory and hollow. Data from a variety of sources, including the Defense Department and the RAND corporation, shows:

  • The transgender population makes up only 0.3 percent of the total United States population.
  • Out of that 0.3 percent, some do not need or want surgical care to transition.
  • The total cost of treating such a small population is a minor percentage of overall medical expenses. In the military, the estimated cost of transgender health care represents approximately $8 million, 0.017 percent of the overall budget.
  • The costs of not treating the medically necessary health needs of transgender people far exceed the costs of treatment. Lack of treatment leads to other, more costly health issues.

Mr. Blodgett aims much of his fire at Iowa Supreme Court Justices, a group he does not support because they make decisions he doesn’t like. It’s apparent he believes that the Supreme Court should make decisions based on popular opinion rather than Constitutional law.

We applaud the Iowa Supreme Court, even when we disagree with them. We encourage Iowans to read their decisions – the Justices are smart, thoughtful people who take their role seriously. We are thankful they believe the protections in the Iowa Constitution apply to every human being, including those in minority groups who don’t have political clout.

We are saddened to see an Iowa where some people are labeled as good, some as bad; some as righteous, some as undeserving; and some more equal than others.

A good first step toward change is for more Iowans, including Mr. Blodgett, to make an effort to get to know people who are not like them – be more accepting of differences, and show a little compassion.

Now is a good time to start.