Senator Joe Bolkcom (D-Iowa City) made his objections known to the idea that Medicaid should not provider coverage for sex reassignment surgery. He said he has grave concerns about that portion of the bill.

“(Transgender Iowans) are human beings,” Bolkcom said. “They deserve our respect just like every single senator in this room deserves respect. The language in this bill targets coverage for their essential and necessary medical treatments. It’s ignorant. It’s discrimination of the worst kind. It’s a clear violation of equal protection under the Iowa Constitution and I hope somebody on your side has the guts to explain to us this afternoon why this language is in the bill.”

Bolkcom argued such a procedure is not cosmetic.

“Medically necessary gender affirming surgery is intended to alter a person’s body to conform with the person’s gender identity in order to address the life altering and at times life threatening consequences of gender dysphoria,” he said.

If the person is left untreated, Bolkcom said undisputed medical evidence shows that destroys a person’s ability to function effectively in daily life.

“Why we would want to prevent somebody from getting the medical care they need to function effectively in daily life I have no understanding of,” Bolkcom said.

He then cited the 41-43 percent suicide rate for people who are transgender. The baseline rate for individuals is about five percent, he said.

“The language in this bill is cruel. I think it’s ignorant, it doesn’t understand the science and it discriminates against Iowans already marginalized,” Bolkcom said.

Bolkcom asked Sen. Mark Costello (R-Imogene), who managed the bill on the floor, to explain the logic behind the transgender language of the bill.

Costello said the language has been in administrative code for years and was always practiced that way. But a recent court case changed that.

“It’s a pretty expensive surgery,” Costello said. “I don’t know that I’d agree with you that it is always medically necessary, which is what Medicaid is about. I think a lot of people might have trouble paying for this type of surgery, thinking it’s not a proper use of our state moneys.”

Bolkcom responded.

“People that are prepared to end their lives, people that are not able to function in their lives deserve to have the medical care they think they need,” he said. “We spend a lot of time talking about mental health here. We’re spending several hundred million dollars on it. If this isn’t a mental health issue, for transgender Iowans to not be able to be who they are and get the medical care they need, what could be more important than that?”

He acknowledged the increased risk of suicide for transgender Iowans. Then he took issue with the idea that cost should be a consideration.

“We don’t ask when somebody has cancer ‘geez, what’s that going to cost,'” he said. “‘Well, that’s too much.’ I don’t like the idea Sen. Costello that suddenly for transgender Iowans we’ve got a cost test.”

Bolkcom said he’s been told it costs anywhere from $5,000-$30,000 out of pocket.

“At the end of the day this is a matter of life and death for people,” Bolkcom said. “Gender dysphoria is a serious medical condition that requires surgical treatment for those people that elect that and it’s, I believe, medically necessary for those transgender Iowans.”

Later during debate Bolkcom asked Costello if he supported Medicaid paying for organ transplants or people with brain injuries who need rehabilitation.