Braxton Taylor
The Biden administration is poised to leave office without fulfilling one of its earliest promises: providing surgery to transgender veterans.
In June 2021, Veterans Affairs Secretary Denis McDonough delivered a high-profile speech in which he announced his department would work to cover gender-affirmation surgery for transgender veterans.
It was part of a flurry of moves the Biden administration undertook in its first few months to signal support to the LGBTQ+ community, including lifting a ban on transgender service members.
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McDonough and the Department of Veterans Affairs were always clear that his announcement was the start of a possibly lengthy process to change the agency’s health benefits package. But as weeks turned into months and then years, no formal policy on the surgeries ever materialized, with McDonough repeatedly saying he had outstanding questions that needed answers before moving forward.
In the background, politics around the issue shifted, as Republicans made attacks on LGBTQ+ rights a key part of their political strategy.
Now, with just a week left in the Biden administration, time has run out, leaving transgender veterans in the lurch as they prepare for an incoming Trump administration that is expected to be hostile to LGBTQ+ rights.
“We literally just waited and waited and waited,” said Lindsay Church, a Navy veteran who is the executive director of Minority Veterans of America and identifies as nonbinary. “So we are disappointed, and many are heartbroken, but we hit a wall years ago. And we became a political football to an administration that didn’t want to touch it anymore. And it was a real implication to people’s lives.”
Asked last week about why McDonough never followed through on his announcement or the status of the deeper analysis he asked for, the VA defended its “methodical” approach but declined to comment in detail, citing an ongoing lawsuit over the issue.
“Transgender vets deserve world-class health care and benefits, and gender-affirming care should be available to any vet who needs it,” VA spokesperson Terrence Hayes said in an emailed statement. “We have moved methodically in our consideration of this important potential change in coverage relating to surgery — because it must be implemented in a manner that’s been thoroughly considered and ensures that the services made available to vets meet VA’s rigorous standards for consistent, high-quality health care nationwide.”
The VA covers some gender-affirming care, including hormone therapy and pre- and post-operative care. But coverage of surgeries is explicitly banned in regulation.
McDonough’s announcement, made during a speech in Florida to mark LGBTQ+ Pride Month and the fifth anniversary of the shooting at the gay nightclub Pulse in Orlando, was supposed to herald the beginning of the end of that ban.
“We’re making these changes not only because they are the right thing to do, but because they can save lives,” McDonough said in his 2021 speech.
As with most updates to its medical benefits package, the VA planned to use the formal federal rulemaking process to allow for coverage of gender-affirmation surgery. While that meant it would be a while before any surgeries were offered, officials said they had to use that process since existing regulation bans surgeries.
At the time of McDonough’s announcement, the VA said the process, which includes a cost-benefit analysis, would take about two years.
But, at the two-year anniversary of his announcement, McDonough said he still had questions that needed to be answered before moving forward, without specifying what those questions were.
Then, in February 2024, McDonough added that he wouldn’t move forward with the policy until an analysis was completed on how the PACT Act, which became law a year after McDonough’s announcement on gender-affirming surgery, would affect the number of transgender veterans seeking care at the VA. While focused on veterans exposed to environmental hazards during their military service, the PACT Act expanded VA eligibility to millions of veterans who could use the system for health needs beyond just toxic exposure.
McDonough did not rule out proceeding with the surgery policy after the PACT Act analysis was done, but that was the last time he spoke publicly about the issue.
The PACT Act review was supposed to be completed in July, according to a copy of the McDonough memo ordering the analysis that was included in a legal filing. The VA did not answer Military.com’s question about the status of the analysis.
After McDonough’s February comments, an advocacy group for transgender veterans sued to force the department to cover surgeries. That lawsuit is ongoing.
In a September filing asking for the lawsuit to be dismissed, Justice Department lawyers argued that McDonough’s decision to wait for the PACT Act analysis was “reasonable” and that the delay “was not premised on a contrary view as to the need or effectiveness of gender-affirming surgical interventions for certain veterans.”
Rather, the filing said, McDonough had a “narrow disagreement” with the plaintiffs “regarding how best and on what timeline to provide those services.”
Rebekka Eshler, an Army veteran and president of the Transgender American Veterans Association, the group that filed the lawsuit, said in a brief email that the organization is “obviously disappointed with how everything played out.”
“Especially with how the election turned out and the already kind of public stance the new administration has taken on transgender active-duty service members and veterans,” Eshler added.
As the VA waffled over the surgeries, the politics around LGBTQ+ issues shifted. At state legislatures around the country, Republicans introduced measures targeting gender-affirmation care. And after Republicans first took control of the House in 2023, they repeatedly tried to ban not just gender-affirmation surgery at the VA, but hormone therapy as well, though those bans have not become law.
As GOP criticism mounted, the Biden administration shrank from some of its earlier vocal support for LGBTQ+ issues. After getting yelled at by Republicans at public hearings, the Pentagon banned drag shows on military bases, claiming the performances violated existing policy without specifying how. And last month, President Joe Biden signed a defense policy bill that bans some gender-affirming health care for transgender children of service members.
Now, the Trump administration is poised to take office after a campaign that vowed to reverse transgender-friendly policies across the federal government. President-elect Donald Trump’s nominee to be VA secretary, Doug Collins, has blasted efforts to protect transgender rights as a “misguided bid to privilege the rights of a few over those of the vast majority of Americans.”
“On Day 1, I will sign an executive order instructing every federal agency to cease the promotion of sex or gender transition at any age,” Trump said at an August campaign event.
The sting of the Biden administration never implementing gender-affirmation surgeries at the VA is compounded by concern about what the next administration will do to the other gender-affirming care the VA does provide, said Church of Minority Veterans of America.
“One of the frustrations that I have about the entire pursuit of rulemaking on the front of gender-affirming surgery is that we spent so much time waiting for the secretary to move this forward when we should have been fighting for codification of what is in place now,” Church said. “None of it’s really protected by law.”
Related: VA Won’t Cover Gender-Affirmation Surgery for Transgender Veterans Until It Reviews PACT Act Effects
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