Post by Prosay on Dec 12, 2017 9:48:52 GMT -5
This is edited from a much more lengthy story about the "transgender community," but what's here tells the most important story: WE ARE PAYING FOR TRANSGENDER SURGERIES UNDER MEDICAID, all the while the politicians demand "something should be done" about Civil Service Employees' Pensions!
Don't be fooled by the claptrap from the politicians, who are dying to get their hands on the pension money to spend on their next re-election!
politico.com
Transgender programs flourish following New York Medicaid coverage
By DAN GOLDBERG
13-16 minutes
Gaines Blasdel, a Washington, D.C., native who was assigned female at birth, began hormone therapy seven years ago at the age of 18.
At 19, Blasdel underwent chest masculinization surgery with financial support from his brothers and father. But like most transgender people, Blasdel believed genital surgery — also known as bottom surgery — was simply out of reach.
After all, in 2010, most insurance plans did not cover the operation and no hospital in New York performed the surgery. That meant even people who could get covered, or could pay cash, had to move to another city for a few months to be near their surgeons while they recuperated. The closest hospital that performed a phalloplasty — the construction of a penis with erotic sensation — was 800 miles away in Chicago.
In short, the surgery was beyond Blasdel’s means — and the means of all but the most well-heeled New Yorkers.
“The only people who could access these surgeries were people who did this instead of buying a house,” Blasdel said.
But that began to change in 2015, when New York became the ninth state to allow its Medicaid program to cover gender affirmation surgery. Private insurers were beginning to cover it as well. Suddenly, there was a payment model that could support New York hospitals’ investments in transgender surgery programs.
The result has been a host of new, more affordable options for transgender people seeking surgery. Mount Sinai Health System became the first academic medical center to open a program in March 2016, and NYU Langone Health soon followed — that’s where Blasdel underwent a phalloplasty in September.
“It was awesome,” Blasdel said. “The first couple days in the hospital, I was like, ‘yes!’ It was just really great to know I got exactly what I wanted.”
The Cuomo administration’s decision to have Medicaid cover transgender surgery created a surge in demand, and four of the region’s largest academic medical centers — Mount Sinai, NYU Langone, Montefiore and Northwell — have opened or will soon open programs.
For a population that’s disproportionately low-income, decisions by New York and other states to allow Medicaid coverage of transgender procedures has been a game changer. In 2015, New York Medicaid paid for 115 procedures for those with gender dysphoria. In 2016, the number more than doubled to 257.
“I’m afraid to take vacation,” said Jess Ting, director of surgery at the Center for Transgender Medicine and Surgery at Mount Sinai. He is on pace to perform about 250 this year, and the waiting list at Mount Sinai is so long that another surgeon, currently a Mount Sinai fellow, will be brought on board next summer. “I’m afraid to take a sick day, because that means someone can’t have their surgery.”
“The need is incredible,” Ting said as he sat in his scrubs — and choked up — shortly after completing male-to-female surgery on a 78-year-old patient at Beth Israel Medical Center, a patient who had been living as a woman for many decades, and had known she had the wrong genitalia since she was 5 years old. When they first met, Ting said, she was so nervous she could barely speak, afraid that after all these years she’d be told that she was now too old for the surgery.
Perhaps not surprisingly, the trend reflects the political and policy divide surrounding transgender rights. Of the 15 state Medicaid programs that cover gender reassignment surgery — New Hampshire being the most recent — all are states that generally vote Democratic and, with the exception of Illinois and Colorado, all are along the coasts.
And amid the Trump administration’s desire to have states take a greater control of their Medicaid programs, it is unlikely that red-blue divide will change any time soon.
As with reproductive rights, where a person lives will likely determine their ability to access transgender surgery.
“I think that we will see for some time to come that there are inequities among the states,” said Jillian Weiss, executive director of the Transgender Legal Defense & Education Fund. “It takes a long time for a society to change and to recognize the importance of civil rights for people, and the importance of health care.”
"Medicaid is the government’s provision of services to those who can’t otherwise afford them,” Weiss said. “It also is the state’s announcement of whether this kind of health care is something that they consider to be important for people.”
Avoiding 'terrible outcomes'
The Williams Institute at the UCLA School of Law estimates that 0.6 percent of the population identify as transgender. The New York metro region has approximately 20 million people so, statistically speaking, there are roughly 120,000, of all ages and ethnic backgrounds, who identify as transgender.
But for a surgery that costs tens of thousands of dollars, money is obviously an issue. A 2011 National Transgender Discrimination Survey found that transgender people are four times more likely than the general population to be living below the poverty line.
“Before Medicaid covered these operations, patients would go to unlicensed providers and they’d get silicone oil injected into their breasts to make breasts,” Ting said. “Some patients would auto-amputate their own penises. They would travel to Mexico to very shady surgeons, whoever they could afford and end up with terrible outcomes.”
Poor outcomes weren’t limited to shady providers operating out of Mexican storefronts. With so few providers in the United States and patients having to travel so far, complications were alarmingly frequent, said Lee Zhao, assistant professor of urology and co-director of the transgender reconstructive surgery program at NYU Langone Health. Patients with complications were so frequently referred to him that he decided to help start his own program.
In the wake of the Cuomo administration’s decision, NYU Langone hired Rachel Bluebond-Langner, a plastic surgeon from the University of Maryland School of Medicine, to be co-director of the program with Zhao. They performed their first vaginoplasty and phalloplasty procedures in January.
"One great benefit of insurance paying for this is surgeons were previously constrained by hospital resources and what they could do in an outpatient setting,” Zhao said. “The latest and greatest advances in medical technology were not applied to gender affirming surgery before insurance paid for it. Now we can use the exact same technology that we’d use for a prostate operation or a heart valve operation, And apply it to this field. So I think outcomes will improve because of that.”
NYU Langone was the first hospital in New York to use robotics for transgender surgery, allowing for better visualization and decreased blood loss. That helps with, among other things, a cleaner resection of the vagina.
"It’s used in every other pelvic operation,” NYU Langone’s Bluebond-Langer said.
The sudden flourishing of transgender programs is not without precedent. Policy at the state and federal level often drives industry development. Ambulatory surgery centers in New York grew at a rapid clip following the passage of 2008 state law that required physicians to obtain new accreditation if they wanted to continue to perform medical procedures in their offices using moderate or deep sedation.
The shift toward population health payment models — the kind that encourage health systems to keep patients under their umbrella — also encourage health systems to offer nearly every service a patient might need. That’s why New York recently saw two medical centers apply to open heart transplant units, the first such applications in more than 20 years. No health system wants to be a patient’s primary care provider, responsible for a patient’s overall health, and then see that patient have a complicated surgery performed somewhere else.
Life-altering consequences
A state’s decision to have Medicaid cover these procedures can be life-altering or even lifesaving.
Don't be fooled by the claptrap from the politicians, who are dying to get their hands on the pension money to spend on their next re-election!
politico.com
Transgender programs flourish following New York Medicaid coverage
By DAN GOLDBERG
13-16 minutes
Gaines Blasdel, a Washington, D.C., native who was assigned female at birth, began hormone therapy seven years ago at the age of 18.
At 19, Blasdel underwent chest masculinization surgery with financial support from his brothers and father. But like most transgender people, Blasdel believed genital surgery — also known as bottom surgery — was simply out of reach.
After all, in 2010, most insurance plans did not cover the operation and no hospital in New York performed the surgery. That meant even people who could get covered, or could pay cash, had to move to another city for a few months to be near their surgeons while they recuperated. The closest hospital that performed a phalloplasty — the construction of a penis with erotic sensation — was 800 miles away in Chicago.
In short, the surgery was beyond Blasdel’s means — and the means of all but the most well-heeled New Yorkers.
“The only people who could access these surgeries were people who did this instead of buying a house,” Blasdel said.
But that began to change in 2015, when New York became the ninth state to allow its Medicaid program to cover gender affirmation surgery. Private insurers were beginning to cover it as well. Suddenly, there was a payment model that could support New York hospitals’ investments in transgender surgery programs.
The result has been a host of new, more affordable options for transgender people seeking surgery. Mount Sinai Health System became the first academic medical center to open a program in March 2016, and NYU Langone Health soon followed — that’s where Blasdel underwent a phalloplasty in September.
“It was awesome,” Blasdel said. “The first couple days in the hospital, I was like, ‘yes!’ It was just really great to know I got exactly what I wanted.”
The Cuomo administration’s decision to have Medicaid cover transgender surgery created a surge in demand, and four of the region’s largest academic medical centers — Mount Sinai, NYU Langone, Montefiore and Northwell — have opened or will soon open programs.
For a population that’s disproportionately low-income, decisions by New York and other states to allow Medicaid coverage of transgender procedures has been a game changer. In 2015, New York Medicaid paid for 115 procedures for those with gender dysphoria. In 2016, the number more than doubled to 257.
“I’m afraid to take vacation,” said Jess Ting, director of surgery at the Center for Transgender Medicine and Surgery at Mount Sinai. He is on pace to perform about 250 this year, and the waiting list at Mount Sinai is so long that another surgeon, currently a Mount Sinai fellow, will be brought on board next summer. “I’m afraid to take a sick day, because that means someone can’t have their surgery.”
“The need is incredible,” Ting said as he sat in his scrubs — and choked up — shortly after completing male-to-female surgery on a 78-year-old patient at Beth Israel Medical Center, a patient who had been living as a woman for many decades, and had known she had the wrong genitalia since she was 5 years old. When they first met, Ting said, she was so nervous she could barely speak, afraid that after all these years she’d be told that she was now too old for the surgery.
Perhaps not surprisingly, the trend reflects the political and policy divide surrounding transgender rights. Of the 15 state Medicaid programs that cover gender reassignment surgery — New Hampshire being the most recent — all are states that generally vote Democratic and, with the exception of Illinois and Colorado, all are along the coasts.
And amid the Trump administration’s desire to have states take a greater control of their Medicaid programs, it is unlikely that red-blue divide will change any time soon.
As with reproductive rights, where a person lives will likely determine their ability to access transgender surgery.
“I think that we will see for some time to come that there are inequities among the states,” said Jillian Weiss, executive director of the Transgender Legal Defense & Education Fund. “It takes a long time for a society to change and to recognize the importance of civil rights for people, and the importance of health care.”
"Medicaid is the government’s provision of services to those who can’t otherwise afford them,” Weiss said. “It also is the state’s announcement of whether this kind of health care is something that they consider to be important for people.”
Avoiding 'terrible outcomes'
The Williams Institute at the UCLA School of Law estimates that 0.6 percent of the population identify as transgender. The New York metro region has approximately 20 million people so, statistically speaking, there are roughly 120,000, of all ages and ethnic backgrounds, who identify as transgender.
But for a surgery that costs tens of thousands of dollars, money is obviously an issue. A 2011 National Transgender Discrimination Survey found that transgender people are four times more likely than the general population to be living below the poverty line.
“Before Medicaid covered these operations, patients would go to unlicensed providers and they’d get silicone oil injected into their breasts to make breasts,” Ting said. “Some patients would auto-amputate their own penises. They would travel to Mexico to very shady surgeons, whoever they could afford and end up with terrible outcomes.”
Poor outcomes weren’t limited to shady providers operating out of Mexican storefronts. With so few providers in the United States and patients having to travel so far, complications were alarmingly frequent, said Lee Zhao, assistant professor of urology and co-director of the transgender reconstructive surgery program at NYU Langone Health. Patients with complications were so frequently referred to him that he decided to help start his own program.
In the wake of the Cuomo administration’s decision, NYU Langone hired Rachel Bluebond-Langner, a plastic surgeon from the University of Maryland School of Medicine, to be co-director of the program with Zhao. They performed their first vaginoplasty and phalloplasty procedures in January.
"One great benefit of insurance paying for this is surgeons were previously constrained by hospital resources and what they could do in an outpatient setting,” Zhao said. “The latest and greatest advances in medical technology were not applied to gender affirming surgery before insurance paid for it. Now we can use the exact same technology that we’d use for a prostate operation or a heart valve operation, And apply it to this field. So I think outcomes will improve because of that.”
NYU Langone was the first hospital in New York to use robotics for transgender surgery, allowing for better visualization and decreased blood loss. That helps with, among other things, a cleaner resection of the vagina.
"It’s used in every other pelvic operation,” NYU Langone’s Bluebond-Langer said.
The sudden flourishing of transgender programs is not without precedent. Policy at the state and federal level often drives industry development. Ambulatory surgery centers in New York grew at a rapid clip following the passage of 2008 state law that required physicians to obtain new accreditation if they wanted to continue to perform medical procedures in their offices using moderate or deep sedation.
The shift toward population health payment models — the kind that encourage health systems to keep patients under their umbrella — also encourage health systems to offer nearly every service a patient might need. That’s why New York recently saw two medical centers apply to open heart transplant units, the first such applications in more than 20 years. No health system wants to be a patient’s primary care provider, responsible for a patient’s overall health, and then see that patient have a complicated surgery performed somewhere else.
Life-altering consequences
A state’s decision to have Medicaid cover these procedures can be life-altering or even lifesaving.