A review published in the New England Journal of Medicine Tuesday said that if the military choose to include gender transition services in soldiers' health care plans, the cost would be "too low to matter."
Debate over what the cost would be to provide the services, which could include gender-affirming surgery and hormonal therapy, began after Defense Secretary Ash Carter in July ordered a review of what he called the military's "outdated, confusing, inconsistent" policies banning transgender people from serving openly in the armed services.
The Associated Press, which first reported Carter's order, and said a "key concern" was "whether the military would conduct or pay for the medical costs of surgeries and other treatment associated with any gender transition."
The NEJM review, conducted by Dr. Aaron Belkin, a key player in the repeal of "Don't Ask Don't Tell," looked at data from large employers whose health care covered transition-related services. Belkin applied these costs to the estimated number of transgender troops currently eligible for medical benefits – about 12,800 people. This amounts to an estimate of $5.6 million annually, or 22 cents per member per month.
"I am convinced that [the cost that the military will incur by providing transition-related care] is too low to warrant consideration in the current policy debate," Belkin, who is the director of Palm Center – a think tank focusing on issues related to gender, sexuality, and the military – wrote in his report on his findings.
During last week's prime time GOP presidential debate, this issue of cost was raised by former Arkansas Governor Mike Huckabee. "The military is not a social experiment. The purpose of the military is kill people and break things," he said. "The purpose is to protect America. I'm not sure how paying for transgender surgery for soldiers, sailors, airmen and Marines makes our country safer."
In the report, Belkin said evidence shows that "government agencies, courts, and scientists agree that for many, transition-related care ... is medically necessary, and state regulators have found medical exclusions to be indefensible and in some cases unlawfully discriminatory."
The review says there would be increases in the budget if these transitional services should apply to family members of personnel or if the military becomes a magnet employer due to its provision of these services.
"It is always possible that people will try to join the military to gain health care," Belkin told BuzzFeed News. "It's something military recruiters often use anyway, so it's not necessarily a bad thing."
Belkin argued that enabling transgender personnel to serve openly and providing transition-related care could even help save the military costs, as transition-related care has been proven to "mitigate suicidality that, left untreated, impose costs on the military" due to potential medical and psychological consequences of requiring someone to "live a closeted life." It would probably even improve job performance, Belkin added.