State Senator Mark Costello of Imogene

State Senator Mark Costello of Imogene

(Des Moines) -- Republicans in the Iowa Legislature have successfully included language in a bill that would prevent Medicaid or any public health insurance from paying for sex reassignment surgery for transgender Iowans.

The language was included in the Department of Health and Human Services budget passed in the final hours of the 2019 session. State Senator Mark Costello -- a Republican from Imogene -- says the bill does not require Medicaid or any public health insurance to pay for a number of surgeries for transgender or intersex individuals.

"It specifies that no state or local government unit or tax-supported district are required to provide for sex reassignment surgery or any other cosmetic, reconstructive or plastic surgery procedure related to transsexualism, hermaphroditism, gender identity disorder, or body dysmorphic disorder."

Senator Joe Bolkcom -- a Democrat from Iowa City -- says denying coverage of gender reassignment or gender-affirming surgeries will have adverse effects on a number of Iowans.

"The language in this bill targets coverage for their essential and necessary medical treatments," said Bolkcom. "It's ignorant. It's discrimination of the worst kind. It's a clear violation of the equal protection under the Iowa Constitution. I hope somebody on your side has the guts to explain to us why this language is in this bill."

Bolkcom says the language is offensive, as it includes provisions for cosmetic, reconstructive and plastic surgeries, as well as sex reassignment surgery.

"Unlike elective cosmetic surgery that a person undergoes for aesthetic reasons, medically-necessary gender-affirming surgery is intended to alter a person's body to conform with the person's gender identity in order to address the life-altering and at times life-threatening consequences of gender dysphoria," said Bolkcom. "The undisputed medical evidence shows that gender-affirming surgical treatment may prevent social dysfunction, physical pain and even death."

Previously, DHHS had withheld Medicaid coverage for gender reassignment surgery under an administrative rule, but that practice was struck down by the State Supreme Court last month -- citing the Iowa Civil Rights Act. Costello says Republicans in the legislature are now taking that administrative practice and making it law.

"(It's) a pretty expensive surgery," said Costello. "I don't know that I agree with you that it is always medically-necessary, which is what Medicaid is about. We're just taking the code that was and saying that it is going to be the way it has been prior to this court decision. I think a lot of people might have trouble paying for this type of surgery thinking that it is not a proper use of our state monies."

An amended version of the DHHS budget passed the Senate 31-to-17 and the House 52-to-47.