How much will it cost the U.S. military to allow transgender service members to serve?

SPC Angela Burnham — Wed, 12 Aug 2015 00:11:57 -0400

How much will it cost us to let trans people serve openly? It's a valid question and I worked out some of the math down below. Some things to take into consideration before though, there are only around 15,000 trans people currently serving, we don't know how many veterans but it's probably around 75,000. Not all trans people get "the surgery" for various reasons, and the recovery time is typically 3 months. If half the current trans .mil population had sexual reassignment surgery, it would cost around $150,000,000 (assuming the cost for surgery remains around $20,000, which around North America is usually the case).

Now, the average length of enlisted service in the U.S. is around 7 years rounded up, and an average of 188,000 people join every year. Trans people make up .6% of the military population (rounded up), and therefore we could expect another 1,128 transgender recruits to join every year. Again, lets say half have SRS, the total estimated annual cost would be around $11,280,000. If we say 50,000 (66%) trans vets want the surgery (a very liberal estimate), that would be around $1,000,000,000. We might expect half the recently separated trans vets who didn't get it while in to get it through the VA while out.

Lets just assume for the sake of convenience that the same number of trans people that enter each year also leave (actually more people have been leaving than joining lately but w/e). So a quarter of those might want SRS (remember half would have already got it while in). That number is 282, and the cost would be $5,640,000 a year.

So to recap:
Initial wave of surgeries for active duty under Tricare - $150,000,000
Initial wave of surgeries for veterans/retired personnel - $1,000,000,000
Annual cost of surgeries for active duty under Tricare - $11,280,000
Annual cost of surgeries for veterans/retired personnel - $5,640,000

Sounds like allot of money, but how much will it increase our budget? In 2012, the DoD spent $52,000,000,000 on healthcare for service members. The Department of Veteran Affairs spends 42% of it's budget on healthcare, and it's budget was $168,800,000,000, with $70,896,000,000 spent directly on healthcare.

If we spend $150,000,000 more dollars in the initial wave of providing service members with SRS, it would reflect an overall budget increase of .3% (rounded up). The annual cost spent providing new recruits with SRS would be $11,280,000, which would reflect an overall annual budget increase of around .022% (rounded up).

If we spend $1,000,000,000 on the initial wave of surgeries for veterans (again a very very liberal estimate), it would reflect an overall budget increase of 1.4%. If we spend around $5,640,000 annually on surgeries for new veterans, it would reflect an increase of .008% (rounded up).

One more fun figure:
The total initial cost between both the DoD and DVA would be around $1,150,000,000. Out of the total amount of national debt, $18,342,202,555,158, this would reflect an overall increase of .0063% (rounded up).

My personal opinion is slanted on whether or not trans people should serve openly (I'm trans myself, left the service 4 days ago). So with the above numbers in mind, I'd love to hear from you. Do you support allowing transgender people to serve openly?

Response by SPC Angela Burnham made Aug 12 at 2015 12:23 AM

SPC Angela Burnham — Wed, 12 Aug 2015 00:23:56 -0400

Sources:
http://www.palmcenter.org/files/Transgender%20Military%20Service%20Report_0.pdf
http://www.va.gov/vetdata/Expenditures.asp
https://www.cbo.gov/publication/44993
http://www.usdebtclock.org/

Response by Cpl Private RallyPoint Member made Aug 12 at 2015 12:34 AM

Cpl Private RallyPoint Member — Wed, 12 Aug 2015 00:34:54 -0400

That sounds like an awful lot of money to support an extreme minority of people while the DoD is cutting in all areas including troop numbers. IIRC some of us have been saying that TG's would join for no other reason than to get the surgery. Personally, I see this as a huge waste of defense dollars.

Response by SFC Private RallyPoint Member made Aug 12 at 2015 2:08 AM

SFC Private RallyPoint Member — Wed, 12 Aug 2015 02:08:18 -0400

SPC Angela Burnham,

Thank you for posting sources, I'll get into them when I have some time.

I personally don't believe the Army is responsible for providing surgery. When you enlist you come "as is", i.e. the Army agrees to enlist you with proper disclosure of all preexisting medical conditions and a thorough medical exam. When you ETS the Army is liable for any damages incurred to your health due to your time in service. Transgender recruits are opting to enlist and serve which I find admirable and brave, but why is the Army responsible to discharge them in any shape or form other than that in which they enlisted? I'm not even sure budgetary considerations enter into the conversation.

You mentioned that "SRS is an appropriate method of reducing the effects of gender dysphoria", which I take to mean that the Soldier enlisted with a preexisting condition (gender dysphoria) which was not discovered or properly disclosed during the enlistment process. Doesn't that make the recruit ineligible for service? Is it grounds for fraudulent enlistment? I'm just throwing ideas out there. The LGBT community still has an uphill battle in all facets of our society, and I do not envy your struggle.

Response by 1SG Private RallyPoint Member made Aug 12 at 2015 2:30 AM

1SG Private RallyPoint Member — Wed, 12 Aug 2015 02:30:17 -0400

SPC Angela Burnham, there are not 15,500 Transgender persons serving in the US Armed Forces. I pulled the study that has been cited as showing that figure and debunked it on another thread for it's obviously flawed methodology. Short version is the sampled population were from LGBT Community Centers, and they filled out a survey that among other things asked them if they were current or prior service military and if they were discharged due to DADT. They then projected onto the general population based on survey responses and viola! Three whole aircraft carrier crew are transgender! Or three Army brigades. Or half of the entire US Coast Guard. On its face, this is preposterous. I would estimate the number as closer to 1000.
Having said that, I think that covering this surgery under Tricare would be a grievous mistake costing a fortune per Soldier with no benefit to the readiness of the armed forces. I can't think of a more compelling case than that for not doing it.
If people identifying as another gender want to serve, fine. Make the change on your own dime. I am supportive of you finding your own way and making a change like that is hugely important to you personally. But that is not why the military medical system exists.
I wish them well as I do any of my comrades in arms.

Response by SPC George Rudenko made Aug 12 at 2015 3:51 AM

SPC George Rudenko — Wed, 12 Aug 2015 03:51:53 -0400

We;ve spent a trillion on a fighter that still doesn't work. Enough said. lol

Response by MAJ Private RallyPoint Member made Aug 12 at 2015 9:18 AM

MAJ Private RallyPoint Member — Wed, 12 Aug 2015 09:18:41 -0400

In the grand scheme of things, $1.2B is chump change compared to what the military has spent buying oceanfront property in Afghanistan. That being said, I'm interested in hearing your thoughts as a transgender person on some of the costs that have nothing to do with money:

1. Man(person?)hours it takes to create policy to address transgender specific issues when we need all available minds to solve how the military should properly downsize

2. Confusion in the ranks on how to treat the now openly transgender person (when to switch APFT scales, EO complaints filed if a person is offended by being addressed as the wrong gender, who to assign as a urinalysis observer etc.)

3. Is transgender-ism fluid? Is there a possibility that the military will be required to pay for reverse surgery and treatment if a person no longer wants to be the gender they switched to?

I'll be the first to plead complete ignorance about transgender issues. If you can shine some light on these, I'll use the knowledge gained when interacting with transgender people in future units.

Response by LCDR Private RallyPoint Member made Aug 12 at 2015 2:07 PM

LCDR Private RallyPoint Member — Wed, 12 Aug 2015 14:07:18 -0400

SPC Burnham-I'm not qualified to comment on what you're experiences have been, so all I can offer is that for better, or worse, these are costly questions in both dollars, and the far reaching effects on the services. It would be lacking in integrity for me to offer counterpoints without admitting that my opinion is also formed by my personal feelings. I've yet to be convinced that the process of questioning one's gender is wholly without external influences...neither have I been convinced that it is the best course for the individual to follow towards a complete life. However, I hope you have people in your life who can help you on that individual journey.

What I "may" be qualified to add is that the service, like any other profession, has to balance investments to returns. I believe the central concern most of us in disagreement are offering is that there may be some who would join, at a later date request this assistance, then leave the service after incurring extensive medical costs and absences from duty. No "trick" question...but a sincere thought, what are your opinions on the military requiring an extension of service commitment upon completion of this process should it ever be offered?

Response by COL Jean (John) F. B. made Aug 12 at 2015 4:21 PM

COL Jean (John) F. B. — Wed, 12 Aug 2015 16:21:32 -0400

SPC Angela Burnham - This should be considered "elective surgery" and disallowed. If a person enlisted as "male", that is what he should serve as. If he wants to change his body to resemble a female, he should bear the costs. If not having the surgery creates mental anguish that affects his ability to perform his duties, he should be discharged, not provided surgery. (Note - The same is true for female to male, since I was chastised once for only discussing "M2F" and not "F2M", as it was put to me.)

Response by MSgt Curtis Ellis made Aug 12 at 2015 9:30 PM

MSgt Curtis Ellis — Wed, 12 Aug 2015 21:30:42 -0400

I can't even begin to quote cost in any aspect of this, but I do have my 2 cent's worth. My thought process, when I say this, is from my experience and knowledge of AF Accessions and Physical Exams and Standards; slightly different from service to service, but basically the same. I think the current Trans personnel wishing to serve openly and/or have re-assignment accomplished electively should be able to do both, as long as that change does not adversely affect readiness, and, depending on the numbers at any given military installation and numbers in minimal specialties, the surgeries shouldn't be astronomical (no wave) with a waiting list that only so many can be done per quarter per year to manage numbers and the follow-up/management/maintenance care afterwards. This will ensure numbers for personnel readiness won't be an issue. It would have to be accomplished by military at a military facility only. As far as those wishing to come in, because they are assuming the title "Transgender" at entry with surgery completed, baring no complications, they can be accepted after X amount of time has passed since the surgery and with an additional medical review/evaluation to ensure military acceptability. For those who wish to join for the surgery, the answer would be no, and if they signed up anyway listing themselves as a male or a female, and then claimed Trans after entry, then those individual should be separated due to breach of contract. Now, that being said, I also won't claim to have any knowledge of the mental workings either, ie how/when they knew they were... But from most that I have heard from (family members included), this has been something they have known for quite a while. I'm not saying that approaching it this way is fair, but it is a good start for the military, as it's job is to wage war with bodies able to do that, and to reduce the number "broken at entry". Some selective/elective surgeries prior to enlistment also require a wait time and a specific evaluation before entry, and I see this as elective as it has no bearing on what the member can do physically as it pertains to the job. This would also alleviate any issues that may/would fall on to the military as responsible care as all bodies do not respond the same. This (process) is nothing new, and I foresee the military heading this way, or something similar, in the near future. Again, just my quick and brief two cents worth.

Response by 1stSgt Private RallyPoint Member made Aug 13 at 2015 1:01 AM

1stSgt Private RallyPoint Member — Thu, 13 Aug 2015 01:01:59 -0400

Money aside, I am still wondering how this will work for housing/berthing? Just because you want to be a female but you have a penis, I am assuming that most real females will not want you in thier berthing area. I can also see that female who thinks they a male having issues in the male berthing when it comes time for showers after being in the bush for 2 weeks. Now I might be out of my simple infantry mind but how will this work?

Response by CSM Michael Chavaree made Sep 17 at 2015 7:51 AM

CSM Michael Chavaree — Thu, 17 Sep 2015 07:51:30 -0400

We dont currently hire folks with the intent to surgerize them as part of the condition that they serve. There are several physical disable individuals that would honorably serve if they had surgery paid for by the military as a condition that they serve. The only surgeries I know of that are offered to ADSM are for injuries illnesses that primarily occured while serving, with the exception of eye surgery for vision improvement. How do you convince the American people to invest money in this effort? What benefit does it offer them or the DOD? The argument that if you dont get the surgery will increase the chance of suicide is a defensive argument and paints the picture of stereotypical mental instability based off not receiving a surgery vs. spending money on preventing and enforcing discrimination against folks, as that is the main cause of the suicide... Descrimination right? Or is it the depressing physical appearance and lack of acceptance of the actual individual?

Response by SGT Private RallyPoint Member made Sep 17 at 2015 12:18 PM

SGT Private RallyPoint Member — Thu, 17 Sep 2015 12:18:09 -0400

It is not the governments responsibility too foot the bill for elective surgery. I understand that it is not your choice as a transgendered person to feel how you do however it is not a mission essential surgery. It doesn't help readiness. The military is not a place for experiment, it's a place to come in and get work done and do our job which is protecting the citizens of our great country. With that being said I hold no discrimination towards the people of the LGBT community and wish all of my brothers and sisters in arms the best in all of their endeavors

Response by MSgt Aaron Brite made Sep 17 at 2015 5:53 PM

MSgt Aaron Brite — Thu, 17 Sep 2015 17:53:01 -0400

I think you may have overstated the costs to the military by assuming the surgery would be made available to ADSM and veterans with VA medical care. I am only speaking from my experience with the VA and military medical systems so keep that dalt block handy.
The simpler error is including all transgender veterans as eligible for VA care. This is not currently the case as VA care is contingent upon a service connected medical condition or injury or indigence. Even retirees may not be eligible until eligible to receive retirement benefits. This eligibility requirement will likely shrink your numbers considerably. If and indigent veteran seeks VA care/it is on a means tested.scale with full access being difficult to achieve.
On the AD side, medical necessity will be one hurdle TGSM will face as will the preexisting ck dition determination. The military is loath to treat preexisting conditions or conditions that do not affect the SM's ability to fulfill their duties. This will further reduce your numbers.
To achieve your stated treatment rates, the DoD will need to determine that the surgery is necessary for all TGSM and veterans under either a specific waiver or under general treatment guidelines.
I would say your research has started a very worthwhile conversation and I look forward to its refinement as you refine your numbers at to the number of TGSM and whether the mitarybans VA medical systems will be available under the general treatment guidelines.

Response by SSG(P) Private RallyPoint Member made Sep 18 at 2015 2:43 PM

SSG(P) Private RallyPoint Member — Fri, 18 Sep 2015 14:43:39 -0400

I love the fact that this question was asked though I'm able to get shot down possibly. Let's take money into perspective yes the average is 20000 dollars. Now remember this will probably be done by military doctors which brings the cost down. Now put in the perspective the fact is all 15000 (estimated) soldiers leave. My reserve says between 50-70000 dollars that's nine hundred million dollars as apposed to if you go with the surgery which with your 20000 dollars would be 3 hundred million. That's 1/3 of the price to train new soldiers. As for the comment below on it being elective that's a great idea. Until you think about this. People come in with glasses make them pay for those. Make them pay for lasik if they want that also. Charge for birth control. Being transgender is not a choice but the military banning good soldiers is a choice.

Response by MSgt Private RallyPoint Member made Dec 9 at 2015 12:30 PM

MSgt Private RallyPoint Member — Wed, 09 Dec 2015 12:30:42 -0500

Here is a question... would the military take (allow to enlist) a "cis-gendered" person that they knew in advance would need a $20K surgery (not to mention whatever hormone therapy costs)?

From what I remember when I was recruited the answer is "probably not". Most existing medical conditions were an automatic disqualifier. Need knee surgery? "Sorry, but no". You suffered depression 5 years ago? "Sorry, but no". You are currently taking medication for XYZ? "Sorry, no".

Response by MSG Mitch Dowler made Mar 15 at 2016 11:03 AM

MSG Mitch Dowler — Tue, 15 Mar 2016 11:03:17 -0400

Why would the military or government pay for sexual reassignment surgery? This is elective and not a need. Should women get breast augmentation surgery covered because they do not feel womanly enough? Someone's mental health confusion over their own plumbing is not a problem of the American Citizen tax payers.

Response by 1LT Private RallyPoint Member made Jul 3 at 2016 11:07 PM

1LT Private RallyPoint Member — Sun, 03 Jul 2016 23:07:33 -0400

SPC Angela Burnham - Oy . . . piling numbers in numbers has no basis in reality.

Please see RAND Corporation Executive Summary and Fully Detailed Final Report here . . .

http://www.rand.org/news/press/2016/06/30.html

Impact of Transgender Personnel on Readiness and Health Care Costs in the U.S. Military Likely to Be Small

The study estimates the number of transgender individuals currently serving in the active component of the U.S. military at between 1,320 and 6,630 out of a total of about 1.3 million service members. However, not all of these transgender service members would be expected to seek medical treatment related to their gender status or become nondeployable.

The study estimates that between 30 and 140 new hormone treatments could be initiated a year and 25 to 130 gender transition-related surgeries could be utilized a year among active component service members. Additional health care costs could range between $2.4 million and $8.4 million, representing an approximate 0.13-percent increase.

In terms of readiness, RAND estimates that 10 to 130 active component members each year could have reduced deployability as a result of gender transition-related treatments. This amount is negligible relative to the 102,500 nondeployable soldiers in the Army alone in 2015, 50,000 of them in the active component.

The RAND Corporation Fully Detailed Final Report is downloadable for free here . . .

http://www.rand.org/pubs/research_reports/RR1530.html

Impact of Transgender Personnel on Readiness and Health Care Costs in the U.S. Military Likely to...

The U.S. Department of Defense has been reviewing its policy that bans transgender personnel from serving openly. If transgender people were allowed to serve openly, the number would likely be a small fraction of the total force and have minimal impact on readiness and health care costs.

Response by Capt Jeff S. made Jul 5 at 2016 6:20 PM

Capt Jeff S. — Tue, 05 Jul 2016 18:20:58 -0400

Stumbled across this article: http://truthuncensored.net/disgraceful-us-military-now-allowing-soldiers-to-cross-dress/ in my news feed on Facebook and pictured above is a screen cap of the public's response to it. [Note: I did not edit the above screen cap and cut out the positive responses.]

Granted this is not a scientific survey of public opinion and people that think alike tend to friend each other on Facebook. These responses came from a public group having to do with Border Control and it gives you some indication of how people in America are reacting to this change within our military... Note that the purpose of the Facebook page was border control so these people were not on that page with intent to discuss gays and gay bash. While the OP is not related to border control, nonetheless it elicited a response and people let go with their feelings on the subject and suffice it to say they aren't happy to see these changes. Aside from places like Key West and San Francisco, you will probably find most people in America share similar sentiments about both the changes that Obama has made to our military [which clearly isn't making them feel safer] and their tax dollars being wasted on operations for TG's.

Disgraceful: U.S. Military Now Allowing Soldiers To Cross-Dress

The military has undergone some controversial changes under Obama's presidency. In December, Defense Secretary Ash Carter announced that women would b...

Response by SrA Michelle Black made Apr 21 at 2017 2:08 PM

SrA Michelle Black — Fri, 21 Apr 2017 14:08:06 -0400

Always nice to switch to percentages when you can reflect millions of dollars as a tiny little fraction....whatever...who even cares about the money? Mentally ill people are not fit for military service.

Response by PO2 Stephen McKean made Jul 27 at 2017 3:36 PM

PO2 Stephen McKean — Thu, 27 Jul 2017 15:36:04 -0400

That money could be used else where for service members, as in better rec facilities, funding for college courses, etc. The transition surgery is not mission imperitive and thus should be treated as stated before, an elective surgery.

Response by SGT Lisa Fields made Mar 7 at 2019 4:49 AM

SGT Lisa Fields — Thu, 07 Mar 2019 04:49:58 -0500

The question has been answered. 3yrs 0.0003 percent of the Medical budget. Less then (non airforce) coffee cups.

Response by CSM Darieus ZaGara made Mar 19 at 2019 2:15 PM

CSM Darieus ZaGara — Tue, 19 Mar 2019 14:15:25 -0400

While I do not have a vote regarding who serves, as a taxpayer I would say that this should be treated as elective, as that is my view, therefore should not be paid for by the military. We could go back and forth all day as to whether it is elective. As a tax payer I do not believe this is partly my responsibility. If that is the case then everyone who wishes the surgery in the nation should have it covered by someone. I will say that if someone is authorized service and has previously had the suregery then all medical, including any complications should be covered, as the individual is who they are.

There are othe factors that broaden this topic that relate to competitive edges for promotion etc. such as PT scores which Cary a lot of weight in ones career. Under what category is it fare to compete, male or female, for obvious reasons. We are dealing with this very issue today in HS sports and competing for collegiate scholarships. Anyway, as I stated this could go on all day. In the end the military will adapt and overcome all and any issues associated with any changes as it always has. Thank you for your service.

Response by 1SG Private RallyPoint Member made Mar 19 at 2019 2:54 PM

1SG Private RallyPoint Member — Tue, 19 Mar 2019 14:54:15 -0400

AMA Journal of ethics article estimated that there are 134,000 Armed Forces veterans in the United States with gender dysphoria. The article also
estimated that 0.6 percent of the US population—roughly 1.4 million people—self-identify as transgender, not .6 percent of the military.
Your numbers of currently serving is grossly different.
Veterans Health Administration (VHA) Health Benefits, VHA Directive 2013-033 specifically prohibits gender-affirming surgery within Veterans Affairs (VA) facilities or using VA funding. Likewise, TRICARE has similar restrictions on covering the surgery, and only covers conditions present at birth.
Serving openly, and the costs of surgery are not one and the same.