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The American Medical Association (AMA), founded in 1847 and incorporated 1897, is the largest association of physicians and medical students in the United States. The AMA's mission is to promote the art and science of medicine for the betterment of the public health, to advance the interests of physicians and their patients, to promote public health, to lobby for legislation favorable to physicians and patients, and to raise money for medical education.

2008

On June 1, 2008 the AMA passed a resolution affirming the medical necessity of treating gender identity disorders and supporting its coverage by health insurance plans. While this has no immediate or coercive effect on the coverage of transitional expenses by health insurance companies, the resolution will carry a great deal of weight in the future when legislative bodies deliberate whether to include the denial of coverage as part of the anti-discrimination laws protecting trans people. The entire text of the resolution is below.

American Medical Association House of Delegates Resolution: 122 (A-08)

Introduced by:  Resident and Fellow Section, Massachusettes Medical Society, California Medical Association, Medical Society of the State of New York
Subject:Removing Financial Barriers to Care for Transgender Patients
Referred to:Reference Committee A

Page 1

  1  Whereas, The American Medical Association opposes discrimination on the basis of
  2  gender identity[1] and
  3  
  4  Whereas, Gender Identity Disorder (GID) is a serious medical condition recognized as
  5  such in both the Diagnostic and Statistical Manual of Mental Disorders (4th Ed., Text
  6  Revision) (DSM-IV-TR) and the International Classification of Diseases (10th Revision),[2]
  7  and is characterized in the DSM-IV-TR as a persistent discomfort with one's assigned
  8  sex and with one's primary and secondary sex characteristics, which causes intense
  9  emotional pain and suffering;[3] and
 10  
 11  Whereas, GID, if left untreated, can result in clinically significant psychological distress,
 12  dysfunction, debilitating depression and, for some people without access to appropriate
 13  medical care and treatment, suicidality and death;[4] and
 14  
 15  Whereas, The World Professional Association For Transgender Health, Inc. (“WPATH”)
 16  is the leading international, interdisciplinary professional organization devoted to the
 17  understanding and treatment of gender identity disorders,[5] and has established
 18  internationally accepted Standards of Care[6] for providing medical treatment for people
 19  with GID, including mental health care, hormone therapy and sex reassignment surgery,
 20  which are designed to promote the health and welfare of persons with GID and are
 21  recognized within the medical community to be the standard of care for treating people
 22  with GID; and
 23  
 24  Whereas, An established body of medical research demonstrates the effectiveness and
 25  medical necessity of mental health care, hormone therapy and sex reassignment
 26  surgery as forms of therapeutic treatment for many people diagnosed with GID;[7] and
 27  
 28  Whereas, Health experts in GID, including WPATH, have rejected the myth that such
 29  treatments are “cosmetic” or “experimental” and have recognized that these treatments
 30  can provide safe and effective treatment for a serious health condition;[7] and
 31  
 32  Whereas, Physicians treating persons with GID must be able to provide the correct
 33  treatment necessary for a patient in order to achieve genuine and lasting comfort with
 34  his or her gender, based on the person's individual needs and medical history;[8] and
 35  
 36  Whereas, The AMA opposes limitations placed on patient care by third-party payers
 37  when such care is based upon sound scientific evidence and sound medical opinion;[9][10]
 38  and

Page 2

  1  Whereas, Many health insurance plans categorically exclude coverage of mental health,
  2  medical, and surgical treatments for GID, even though many of these same treatments,
  3  such as psychotherapy, hormone therapy, breast augmentation and removal,
  4  hysterectomy, oophorectomy, orchiectomy, and salpingectomy, are often covered for
  5  other medical conditions; and
  6  
  7  Whereas, The denial of these otherwise covered benefits for patients suffering from GID
  8  represents discrimination based solely on a patient's gender identity; and
  9  
 10  Whereas, Delaying treatment for GID can cause and/or aggravate additional serious and
 11  expensive health problems, such as stress-related physical illnesses, depression, and
 12  substance abuse problems, which further endanger patients' health and strain the health
 13  care system; therefore be it
 14  
 15  RESOLVED, That the AMA support public and private health insurance coverage for
 16  treatment of gender identity disorder (Directive to Take Action); and be it further
 17  
 18  RESOLVED, That the AMA oppose categorical exclusions of coverage for treatment of
 19  gender identity disorder when prescribed by a physician (Directive to Take Action).

Fiscal Note: No significant fiscal impact.

References

  1. ↑ AMA Policy H-65.983, H-65.992, and H-180.980
  2. ↑ Diagnostic and Statistical Manual of Mental Disorders (4th ed.. Text revision) (2000) (“DSM-IV-TR”), 576-82, American Psychiatric Association; International Classification of Diseases (10th Revision) (“ICD-10”), F64, World Health Organization. The ICD further defines transsexualism as “[a] desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex.” ICD-10, F64.0.
  3. ↑ DSM-IV-TR, 575-79
  4. ↑ Id. at 578-79.
  5. ↑ World Professional Association for Transgender Health: http://www.wpath.org. Formerly known as The Harry Benjamin International Gender Dysphoria Association.
  6. ↑ The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, Sixth Version (February, 2001). Available at http://wpath.org/Documents2/socv6.pdf.
  7. ↑ 7.0 7.1 Brown G R: A review of clinical approaches to gender dysphoria. J Clin Psychiatry. 51(2):57-64, 1990. Newfield E, Hart S, Dibble S, Kohler L. Female-to-maletransgender quality of life. Qual Life Res. 15(9):1447-57, 2006. Best L, and Stein K.(1998) “Surgical gender reassignment for male to female transsexual people.” Wessex Institute DEC report 88; Blanchard R, et al. “Gender dysphoria, gender reorientation, and the clinical management of transsexualism.” J Consulting and Clinical Psychology. 53(3):295-304. 1985; Cole C, et al. “Treatment of gender dysphoria (transsexualism).” Texas Medicine. 90(5):68-72. 1994; Gordon E. “Transsexual healing: Medicaid funding of sex reassignment surgery.” Archives of Sexual Behavior. 20(1):61-74. 1991; Hunt D, and Hampton J. “Follow-up of 17 biologic male transsexuals after sex-reassignment surgery.” Am J Psychiatry. 137(4):432-428. 1980; Kockett G, and Fahrner E. “Transsexuals who have not undergone surgery: A follow-up study.” Arch of Sexual Behav. 16(6):511-522. 1987; Pfafflin F and Junge A. “Sex Reassignment. Thirty Years of International Follow-Up Studies after Sex Reassignment Surgery: A Comprehensive Review, 1961-1991.” IJT Electronic Books, available at http://www.symposion.com/ijt/pfaefflin/1000.htm; Selvaggi G, et al. “Gender Identity Disorder: General Overview and Surgical Treatment for Vaginoplasty in Male-to-Female Transsexuals.” Plast Reconstr Surg. 2005 Nov;116(6):135e-145e; Smith Y, et al. “Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals.” Psychol Med. 2005 Jan; 35(1):89-99; Tangpricha V, et al. “Endocrinologic treatment of gender identity disorders. ” Endocr Pract. 9(1):12-21. 2003; Tsoi W. “Follow-up study of transsexuals after sex reassignment surgery.” Singapore Med J. 34:515-517. 1993; van Kesteren P, et al. “Mortality and morbidity in transsexual subjects treated with cross-sex hormones.” Clin Endocrinol (Oxf). 1997 Sep;47(3):337-42; World Professionals Association for Transgender Health Standards of Care for the Treatment of Gender Identity Disorders v.6 (2001).
  8. ↑ The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, at 18.
  9. ↑ Id.
  10. ↑ AMA Policy H-120.988

Relevant AMA policy

H-65.983 Nondiscrimination Policy

The AMA opposes the use of the practice of medicine to suppress political dissent wherever it may occur. (Res. 127, A-83; Reaffirmed: CLRPD Rep. 1, I-93; Reaffirmed: CEJA Rep. 2, A-05)

H-65.992 Continued Support of Human Rights and Freedom

Our AMA continues (1) to support the dignity of the individual, human rights and the sanctity of human life, and (2) to oppose any discrimination based on an individual's sex, sexual orientation, race, religion, disability, ethnic origin, national origin or age and any other such reprehensible policies. (Sub. Res. 107, A-85; Modified by CLRPD Rep. 2, I- 95; Reaffirmation A-00; Reaffirmation A-05)

H-180.980 Sexual Orientation as Health Insurance Criteria

The AMA opposes the denial of health insurance on the basis of sexual orientation. (Res. 178, A-88; Reaffirmed: Sub. Res. 101, I-97)

H-120.988 Patient Access to Treatments Prescribed by Their Physicians

The AMA confirms its strong support for the autonomous clinical decision-making authority of a physician and that a physician may lawfully use an FDA approved drug product or medical device for an unlabeled indication when such use is based upon Resolution: 122 (A-08) sound scientific evidence and sound medical opinion; and affirms the position that, when the prescription of a drug or use of a device represents safe and effective therapy, third party payers, including Medicare, should consider the intervention as reasonable and necessary medical care, irrespective of labeling, should fulfill their obligation to their beneficiaries by covering such therapy, and be required to cover appropriate “off-label” uses of drugs on their formulary. (Res. 30, A-88; Reaffirmed: BOT Rep. 53, A-94; Reaffirmed and Modified by CSA Rep. 3, A-97; Reaffirmed and Modified by Res. 528, A- 99; Reaffirmed: CMS Rep. 8, A-02; Reaffirmed: CMS Rep. 6, A-03; Modified: Res. 517, A-04)

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