President Donald Trump announced a ban last week on transgender persons serving in the military, citing the “tremendous medical costs.”

The political left and right have sought to discredit or substantiate the president’s claim with various cost estimates.

Verdict: Unsubstantiated

Since 2016, the military has covered the medical cost of gender reassignment surgery and other transition-related care.

The Daily Caller News Foundation analyzed four studies that quantify these medical costs, but limited source data and different methodologies have resulted in dramatically different estimates that should be regarded with caution.

Fact Check:

The military pays the full cost of health care for active duty service members, and after President Barack Obama’s administration announced policy changes in 2016 allowing transgender persons to serve openly, the military began to cover the cost of gender reassignment surgery, hormone therapy and any other care deemed “medically necessary.”

Before announcing the policy change, the Obama administration asked RAND Corporation, a left-leaning think tank, to study the costs associated with allowing transgender individuals to serve openly. RAND produced a study that found the policy change would cost $2.4 to $8.4 million a year, an “exceedingly small” amount relative to the $6.3 billion already spent annually on health care for active duty personnel.

After Trump claimed the transgender policy would result in “tremendous medical costs,” a host of politicians and media outlets attempted to discredit the claim by citing the RAND study. At the same time, Republican Missouri Rep. Vicky Hartzler, who supports the president’s ban, claimed the policy would cost far more – $1.3 billion over 10 years – based on estimates produced by her office.

A 2017 study by the Family Research Council (FRC), a group that opposes transgenderism, estimated even higher 10-year costs of up to $3.7 billion. At the other end of the spectrum, Aaron Belkin, a pro-LGBT sociologist and advocate, published results in 2015 more in line with the RAND study, estimating the annual cost at $5.6 million.

TheDCNF analyzed each of the four studies to assess their credibility and better understand why the estimates vary so drastically.

Researchers lack rigorous data on the number of transgender persons who undergo gender reassignment surgery or hormone therapy each year. In addition, medical costs vary, and transgender persons may elect to receive various degrees of care. For these reasons, the RAND study repeatedly warns that its findings “should be interpreted with caution.”

Hartzler’s office estimates the surgical cost at $132,000 per person using a pricing list from the Philadelphia Center for Transgender Surgery. The analysis assumes a transgender service member would receive the full catalog of surgical options including facelifts, liposuction and other procedures.This price tag should be considered the upper bound, and the FRC study assumes a somewhat lower surgical cost of between roughly $89,000 and $110,000. The surgical prices come from one source, so while the figures are helpful for approximation, they are by no means authoritative.

Transition-related medical care also includes counseling, hormone therapy and other costs. Belkin estimated dramatically lower average costs of about $30,000 per person using insurance claims data from the University of California, which offers health plans that cover transgender procedures. Claims ranged as high as roughly $87,000.

Unlike the other studies, the FRC analysis considers the cost of time lost. RAND estimates transgender service members could be non-deployable for up to 135 days after surgery, so FRC estimates around $504 million in costs for recovery time.

Health care providers often require transgender persons to spend a year in their desired gender before undergoing surgery. According to military policy, a transgender person can identify as the opposite sex during off-duty hours or take “extended leave.” FRC assumes that every transitioning service member would request a one-year leave of absence at a 10-year cost of $1.8 billion.

Total costs to the military also depend upon how many transgender persons would seek treatment. Belkin relies upon claims data compiled by the Williams Institute, a pro-LGBT advocacy group, to estimate that only 188 active duty service members a year would require transition-related care. This figure is consistent with the RAND estimate of up to 129 individuals annually, and Belkin found the numbers comparable to the rate of transition-related care in the Australian military.

In stark contrast, the FRC study estimates around 6,900 transgender persons in the military would seek gender reassignment surgery. It relies upon the National Transgender Discrimination Survey which reported that the overwhelming majority of transgender individuals either want or have undergone transition-related surgery. For example, it calculated that 23 percent of biological males surveyed have undergone the reconstructive procedure known as vaginoplasty, while an additional 64 percent wanted to someday have the procedure. RAND cautions against relying too heavily on the survey because it’s not based on a random sample.

Hartzler’s office estimated about 30 percent of all transgender service members would request surgery. The much lower estimate comes from a single physician who cares for transgender individuals.

Beyond service members, the families of troops also receive health care through the military health system. None of the four studies estimate how many dependents would utilize transition-related care. In addition, researchers debate whether paying the full medical costs would create a “magnet” effect, where transgender persons sign up for military service in part to receive the health care benefits.

The parameters, assumptions and source data used in each of the four studies dramatically alters cost calculations, so any estimate should be treated with caution. Due to this variability, Trump’s claim about “tremendous medical costs” is unsubstantiated.

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