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Veterans Affairs Secretary On Gender Confirmation Surgery For Transgender Veterans


During a Pride Month event in Orlando last month, VA Secretary Denis McDonough announced that the Department of Veterans Affairs will provide gender confirmation surgery for transgender veterans. This lifts a long-standing ban on such surgeries. And Secretary McDonough joins us now to talk about it. Welcome.

DENIS MCDONOUGH: Thank you, Ari.

SHAPIRO: There has been a push to lift this ban for a long time, including during the Obama administration, when you were White House chief of staff. So having been part of the conversations then and now, tell us about what changed to make this happen.

MCDONOUGH: Oh, well, you know, Ari, the most important thing about this decision is it came to me as a uniform unanimous recommendation from the governing body that oversees what health services we provide at VA. And they unanimously recommended that we begin to provide this service based on the simple finding that those transgender veterans who suffer from gender dysphoria and who get treated in this way have a dramatically better outlook on mental health and - as against serious questions like suicide than those who do not. So I think they thought this was best clinical outcome.

SHAPIRO: Can you tell us about how President Biden's view on this might have evolved since he was vice president, when the VA directive was that the department, quote, "does not provide sex reassignment surgery"?

MCDONOUGH: You know, the president has been very clear since the moment he offered me the job here that I should be a fierce advocate for veterans. And when he said that, he said for all veterans. And that's the way he's run his administration. That's what he expects of me - to make sure that we're doing the best that we can, offering world-class health care and timely access to benefits for all veterans. Be they veterans of color or LGBTQ+ veterans, our job is to get them all the service and the care that they've earned.

SHAPIRO: There are an estimated 134,000 transgender veterans in the U.S. today and another 15,000 serving in the armed forces. So when can these people expect to be able to use this policy? When will it be implemented?

MCDONOUGH: Yeah. So we're in the midst now. We've begun the rulemaking process, Ari. That's important for a couple of reasons. One, we have to do this pursuant to statute. And two, we have to do it publicly, subject to public comment. So we'll want to hear the public's comment on this. And obviously, we'll address those concerns as they - and those comments as they come.

We anticipate that process will take us the next two years or so to be in a position to provide the care. And we estimate about 543 veterans annually will be eligible for the surgery. So we think these are both important numbers but manageable numbers inside our current budget envelope for example.

SHAPIRO: You mentioned the budget. The last push to reverse this ban in 2016 fell apart amid concerns about funding. Do you have an estimate of what the cost might be?

MCDONOUGH: You know, the cost projection is from - anywhere from just over a million dollars a year to somewhere closer to $30 million a year. We also assess it might get a little bigger than that because we assess that there may be as many as 3,000 veterans who would have this care if they could get it, those waiting for it. So if that's the case, it could get up to as much as $71 million all in by 2028.

So these are obviously big numbers. We take great care to spend the taxpayers' money wisely. But we also think that these are manageable numbers. And over time, if we make this investment, we'll save costs on things like mental health care treatment and other health care problems that would result of our transgender vets not having access to this care.

SHAPIRO: If I could ask you one question on a different subject before we conclude - the last U.S. troops are leaving Afghanistan after 20 years. And I wonder what your message is to veterans of the war in Afghanistan who, seeing this, might feel like their sacrifices were in vain?

MCDONOUGH: I would say this to our veterans - thank you. We went to Afghanistan, as the president said today, not to nation build but to bring justice to those who carried out 9/11, to bring justice to Osama bin Laden and to ensure that Afghanistan will never be used again as a training base to attack us. Our veterans who deployed there ensured that we met those objectives. And so we say thank you.

If there are veterans who are feeling like they are struggling as a result of what they're seeing on the ground, I say to them, please come to VA. We're here to help. We have services across a full range of questions that any of our vets may have. But the overwhelming thing I have to say to our veterans is thank you and on top of that, we're here to serve.

SHAPIRO: That is Secretary of Veterans Affairs Denis McDonough. Thank you very much.

MCDONOUGH: Thanks so much, Ari. Transcript provided by NPR, Copyright NPR.

Ari Shapiro has been one of the hosts of All Things Considered, NPR's award-winning afternoon newsmagazine, since 2015. During his first two years on the program, listenership to All Things Considered grew at an unprecedented rate, with more people tuning in during a typical quarter-hour than any other program on the radio.