Oregon drops Medicaid coverage for risky surgery except in cases of ‘gender affirmation’

In Oregon, Medicaid no longer covers high-risk surgery to remove excess skin from the lower abdomen unless it’s part of “gender-affirming care,” raising questions about whether gender ideology is actually harming those it purports to help.

The Oregon Health Evidence Review Commission agreed June 12 to exclude panniculectomy surgery from its list of covered medical expenditures, citing concerns about the high rate of complications, except when performed as part of “gender-affirmation surgery.”

“Panniculectomy Surgery to remove extra skin after significant weight loss (panniculectomy) comes with high risks, including serious problems and even death,” said the commission’s Value Based Subcommittee in its meeting materials. “Staff recommend adding the codes for this treatment to the gender affirmation surgery line only. In other cases, these surgeries should not be covered because the risks are so serious.”

For transgender Oregonians, the decision comes as something of a mixed blessing: While they now have insurance coverage unavailable to other residents, it’s for a procedure deemed too dicey for the population at large.

Kurt Miceli, medical director at Do No Harm, which opposes identity politics in medicine, said that “Oregon’s decision is anchored in ideology, not science.”

He said a panniculectomy can be medically necessary for skin infections under the abdominal overhang. Oregon began offering Medicaid coverage for the surgery in 2021 for conditions such as dermatitis.

In “gender-affirming care,” however, a panniculectomy is typically used as a cosmetic procedure to contour the body to achieve a more feminine or masculine physique, or to enhance recovery after genital reconstructive surgery.

The commission staff had previously determined that complications from the surgery occurred in 30% to 50% of cases, an “extremely high rate,” according to the meeting materials.

“Curiously, those same risks are deemed acceptable when the surgery is part of so-called ’gender-affirming care,’ despite the fact a diagnosis of gender dysphoria does not provide any medically necessary justification,” Dr. Miceli said in a statement.

“In a striking reversal of medical priorities, coverage is denied for those Medicaid recipients suffering chronic infections under the pannus, while panniculectomies for ’gender-affirming care’ receive approval — a medically incoherent and dangerous distortion driven by politics, not clinical rationale,” he said.

Why the exception for “gender-affirming care”? During the commission meeting, a member asked if the carve-out was a “legislative imperative.” He was told, “Yes, correct, it’s part of the WPATH guideline.”

In 2023, Oregon Gov. Tina Kotek signed legislation that requires insurers to cover “medically necessary gender-affirming treatment that is prescribed in accordance with accepted standards of care,” including facial feminization surgery and laser hair removal.

The “acceptable standards of care” are determined by the World Professional Association for Transgender Health, an organization whose advocacy for medicalized gender-transition treatment has been hailed on the left and vilified on the right.

The WPATH’s latest guidelines, the Standards of Care Version 8 released in 2022, make no mention of panniculectomy surgery by that name, although the protocol does list “body contouring” procedures such as liposuction and monsplasty under “Gender Affirming Surgical Procedures.”

While Oregon defers to WPATH, the international organization suffered a major reputational hit after the issuance of the SOC-8 guidelines, which removed recommended age limits for gender-transition drugs and surgeries.

Documents from the Biden administration’s court battle against Alabama’s ban on gender-transition treatment for minors indicate that WPATH scrapped the age minimum under pressure from Health and Human Services Assistant Secretary Rachel Levine, who is transgender.

After President Trump took office in January, the federal government reversed its position. In a May 28 letter, Health and Human Services Secretary Robert F. Kennedy Jr. said state medical boards and healthcare providers “should avoid relying on” the WPATH guidelines, calling them “fraudulent.”

He cited the department’s May 1 review, “Treatment for Pediatric Gender Dysphoria,” which accused WPATH of placing political priorities over medical evidence, and recommended psychotherapy instead of drugs and surgeries to treat youth gender dysphoria.

WPATH defended its guidelines, saying they were “developed through evaluation of evidence, clinical expertise, patient values and preferences, and cultural and contextual considerations.”

“Healthcare decisions should remain in the hands of patients, their families, and qualified clinicians — not politicians,” said WPATH in a May 2 statement.

The Washington Times has reached out to the Oregon commission for comment.

About half the states cover “gender-affirming care” for adults under their Medicaid plans, spurring a fierce debate over whether the benefits of such treatment outweigh the costs.