President Donald Trump's claim that the U.S. military "cannot be burdened with the tremendous medical costs" of transgender service members contradicts the findings of a recent report the Pentagon itself commissioned.
Care for transgender people in the military would add $8.4 million to the total medical costs of all active duty service members, according to an analysis last year by RAND Corp. That's a little more than 0.1 percent of what the military spends on medical care for all service members. To put that in perspective, it's about 0.0014 percent of Trump's total defense budget proposal.
The report was requested by the Department of Defense under President Obama. Trans people were only allowed to serve openly starting last year.
There is little concrete data on how many trans people serve in the military, and the Department of Defense didn't respond to a request for comment. Other recent attempts to figure out how many transgender people serve in the military have come to far larger estimates—raising the possibility that Trump's decision to bar transgender people from serving in the military at all could eliminate the nation's single largest employer of transgender Americans.
A 2014 study estimated that 15,500 trans people were currently serving in the U.S. military. The Williams Institute, a think tank at UCLA School of Law that researches gender identity, came to that figure using a 2011 survey of 6,546 transgender Americans. Around 20 percent of that survey's respondents said they had served in the armed forces. There are currently 1.3 million active-duty personnel in the U.S. military and an additional 800,000 in reserves.
Using various extrapolations based on population estimates and rates of service for men and women, the Williams researchers concluded that 8,800 people were in active duty and another 6,700 were in the National Guard and U.S. Army Reserve. Trans people, the Williams report suggested, might even join the military at a higher rate than other groups.
"It’s a consistent finding in studies that have been done across a variety of different data sources that trans people serve in the military at higher rates than the general population," said Jody L. Herman, a co-author of the Williams study. She cited academic interviews conducted with transgender servicemembers that underscored the appeal of the military's perceived hypermasculine environment.
But, as Herman added, "trans people want to serve in the military for the same reasons as everyone else wants to serve in the military."
Researchers from RAND used much lower numbers to estimate transgender-related health-care costs, putting the total ranks of active transgender service members between 1,300 and 6,600 and concluding that only about 130 might seek gender-related surgeries. But even if the number of transgender service members is closer to the Williams Institute's estimate, the cost for their medical care would be a negligible share of the military's total health budget.
The Veterans Health Administration pays for pre- and post-operative care for transgender service members but not for gender-confirmation surgery itself. The military began paying for that surgery last year through Tricare, the health plan for troops and their families. This month, Congress narrowly rejected p roposed legislation from Representative Vicky Hartzler, a Missouri Republican, that aimed to stop the military from providing transgender-related medical care.
Trump's declaration on Twitter doesn't stop it, either; it would take an executive order or some other official action to change the practice. " The tweet obviously is not policy," says Evan Young, president of the Transgender American Veterans Association and a retired Army major who served for 14 years and completed his transition after leaving the military. "It is the president tweeting whatever he feels like he wants to tweet."
Beyond the military, more health insurers are covering medical care related to gender transitions. Medicare, the federal health insurance program for people 65 and over, refused to cover gender-confirmation procedures until the exclusion was struck down in 2014; coverage is now determined on a case-by-case basis. Medicaid programs in 12 states and Washington, D.C., must explicitly include gender transition care, according to the Movement Advancement Project, a research group that promotes equality for gay, lesbian, bisexual, and transgender people. More private employers are expanding medical benefits to cover transition-related care as well.
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Some health economists have made the case that it's cost-effective, meaning the benefits to society outweigh the costs. If all insurers covered medically necessary services, including hormone replacement and surgery, it would add just 1.6¢ to the average monthly health insurance premium, according to an analysis published in the Journal of General Internal Medicine last year that modeled the potential costs and benefits of expanding such coverage.
Health care is not the only benefit that trans military personnel would lose if banned from service. There's also evidence that trans people are at a higher risk of poverty and unemployment than other Americans. As a group, trans workers aren't protected from job discrimination in many states. The same 2011 survey of trans Americans found unemployment rates at twice that of the population as a whole, and trans workers were nearly four times more likely to have a household income of less than $10,000.