California insurance commissioner: Breast amputation surgery for minor girls must be covered

Hand holding a paper sheet with transgender symbol and equal sign inside. | Getty

The California insurance commissioner is clarifying that insurance coverage on double mastectomies for gender dysphoric females is not "cosmetic" but "reconstructive," and classifying normal breast tissue as "abnormal structures of the body caused by congenital defects."

The move paves the way for more minor girls who identify as something other than their biological sex to undergo breast amputation. 

In a Dec. 30 letter from General Counsel and Deputy Commissioner Kenneth Scholl under the banner of Insurance Commissioner Ricardo Lara, the state agency clarified that existing law says health insurance providers may not deny "male chest reconstruction surgery for female-to-male patients" solely on the basis of age. The letter was in response to the San Diego-based TransFamily Support Services, which had inquired about the criteria. 

The department is instructing health insurance companies to "consider a patient’s specific clinical situation to determine actual medical necessity based on evidence-based standards of care."

The letter referenced specific sections of legal code that require insurance coverage of surgeries that "improve function" or "create a normal appearance, to the extent possible" and forbid discrimination "on the basis of an insured's or prospective insured's actual or perceived gender identity, or on the basis that the insured or prospective insured is a transgender person." 

Whereas the surgeries were once referred to as "cosmetic," the state agency now refers to them as "reconstructive" and also categorizes physically healthy breasts as "abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease."

Maria Keffler, co-founder of the recently-formed Partners for Ethical Care, said in an email to The Christian Post Monday that she finds this particular change in language an "unethical, predatory, and despicable attempt to even more viciously abuse children via gender ideology."

"By circumventing parental consent in order to medicalize children without any minimum age restriction, the California Department of Insurance, whose very letterhead claims to 'Protect, Prevent, and Preserve', does exactly the opposite," Keffler said. 

The letter cites as authoritative the standards of care from the World Professional Association for Transgender Health, she pointed out, but even WPATH currently states that the evidence base is not sufficient to predict the long-term outcomes of completing a gender role transition in early childhood. 

"WPATH also cites that 73-88% of children who suffer gender dysphoria will align with their birth sex if allowed to pass through puberty naturally. Scholl, the California Department of Insurance, and the gender industry are propagating, participating in, and profiting from unchecked savagery against our nation's children," Keffler asserted. 

Supporters of the move said the change is yet another win against a form of discrimination within the medical arena. 

"The state of California has always led the way on issues of equality, and this legal opinion takes a much-needed stand to protect the rights of California's LGBTQ residents, regardless of age," said California Assemblyman Evan Low, a Democrat from the Bay area and chair of the Legislative LGBTQ Caucus, in a statement last week. 

"Every patient, including those experiencing gender dysphoria, deserves to have their specific clinical situation taken into consideration. Discrimination does not have a place in California and should not have a place anywhere in health care."

Minor girls and young adult women in California who claim a different gender identity than their biological sex, whether trans or nonbinary or something else, have already been undergoing cosmetic double mastectomies in recent years. 

The Federalist reported in September 2018 that in a federally-funded National Institutes of Health grant to a major transgender medical center in Los Angeles, two 13-year-old girls and five 14-year-old girls had double mastectomies. Of the 68 girls and young women documented at the time, 33 were under the age of 18 and none were over the age of 25. 

Kara Dansky, chair of the Committee on Law and Legislation global Women's Human Rights Campaign and member of WHRC-USA steering committee, which was launched in August 2020, blasted the move as scandalous and an affront to women. 

"The medically unnecessary mutilation of female bodies at the altar of an ideology that tries to brainwash our teenagers into believing they are born wrong, is flat-out injury and harm," Dansky said in a CP interview Monday.

"The California insurance commissioner should be ashamed of himself for taking this stand against women and girls. How does he justify his allegation of 'out-dated medical criteria'? The female body has not changed. His arguments are unscientific, misogynistic, homophobic, dislodged from material reality, strictly political, and incompatible with the international Declaration on Women's Sex-Based Rights."

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