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    Monday, July 31, 2017

    Transgender Policy Could Cost Military Billions Over Ten Years

    On July 1, 2016, without any systematic study of the consequences, the Obama administration reversed longstanding policies that excluded those who identify as transgender from serving in the U.S. military on both psychological and medical grounds.1 As of that date, the armed services stopped discharging existing service members who suffer from gender dysphoria

     (unhappiness with their biological sex at birth) or who seek gender reassignment surgery, and as of October 1, 2016, began providing medical services to aid in their “transition” to living as the opposite gender.

    Phase 2 of this policy—allowing persons who identify as transgender to join the military—was scheduled to take effect on July 1, 2017. Just hours before this deadline, the Department of Defense announced a six-month delay in implementation of this policy.2 On July 13, 2017, Rep. Vicky Hartzler (R-Mo.) introduced an amendment to the National Defense Authorization Act (NDAA) which would prohibit the military from paying for gender reassignment surgery or hormone therapy for service members,3 but the amendment was narrowly defeated, 209-214, with 24 Republicans joining the opposition.4 However, the Trump administration still has the power to reverse Phase 1 and/or permanently foreclose implementation of Phase 2 of the Obama policy.

    Family Research Council has concerns about the psychological fitness of persons who identify as transgender to serve (because of high levels of psychopathology within that population5), and about the effect of allowing people to present themselves as the opposite of their biological sex on good order and discipline, readiness, recruitment, and retention.6 However, in addition to these concerns, there are specific costs that will be associated with allowing people who identify as transgender to serve, such as particular medical issues associated with the practices of gender reassignment surgery and hormone replacement therapy.

    It is difficult to estimate these costs due to numerous unanswered questions. For example, we cannot know with certainty how many persons suffering with gender dysphoria are already in the military; how many will seek a military career as a result of the change of policy; or what percentage of those will seek hormone therapy, gender reassignment surgery, or other related medical or surgical procedures.

    The RAND Corporation undertook an analysis of this question in 2016, and came up with a broad-range estimate that the health-related costs of gender transition would total between $2.4 million and $8.4 million annually (i.e., between $24 million and $84 million over ten years). However, these estimates were drawn from actuarial data based on the estimated increase in insurance premiums for private employers who adopted coverage for gender transition.7 Since the military pays for the health care of active duty service members directly, it is more logical to look at the direct costs of such procedures. In addition, the RAND study made estimates of lost time due to recovery from gender reassignment surgery, but placed no dollar value on this indirect, but very real cost to the armed forces.8

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