Gender Affirming Care for Transgender Adults
Covered by Tier 1 SondraCare™
by Sondra Wilson. Updated July 28, 2025.

As a transgender woman who began developing intersex traits in adolescence, I’ve lived the physical, emotional, and spiritual toll of being denied care. I was raised in a Christian household and taught that my identity was sinful—when in truth, it was biological, and deeply human. This proposal isn’t just policy—it’s personal.

🏥 Why Gender-Affirming Care Is Medically Necessary

Gender-affirming care—including hormone therapy, facial feminization surgery (FFS), and other procedures—is recognized by major medical organizations as essential for the health and well-being of transgender individuals.

  • The American Medical Association (AMA), American Psychiatric Association, and World Professional Association for Transgender Health (WPATH) affirm that gender-affirming care reduces depression, anxiety, and suicidality (AMA, 2021; WPATH, 2022).
  • Facial feminization surgery, often dismissed as “cosmetic,” has been shown to significantly improve mental health and social functioning (Ainsworth & Spiegel, 2010; Morrison et al., 2021).
  • Denial of care is associated with increased psychological distress, self-harm, and economic instability (James et al., 2016).

“Under CMS guidelines, medically necessary procedures are those that prevent or treat illness or injury, or improve functioning of a malformed body part (CMS, 2023). Facial feminization surgery meets these criteria for many transgender patients.”

  • “Isn’t this just cosmetic?” No. FFS corrects physical characteristics that provoke misgendering and harassment. It improves safety, social integration, and mental well-being (Ainsworth & Spiegel, 2010).

  • “Won’t this raise healthcare costs?” Quite the opposite. A study by Hughto et al. (2017) found that access to gender-affirming care reduces long-term healthcare costs by decreasing suicidality, substance use, and ER visits.

  • “Should the government pay for this?” Under the 9th Amendment and existing civil rights law, denying gender-affirming care is discriminatory (Lambda Legal, 2022). Furthermore, the "general welfare" and "excise taxes" clauses of the US Constitution provide legal justification for assisting trans folk in this way. Despite how often transgender people are in the news, they represent a very small percentage of the population.

Compassion is Key

I cannot speak for other transgender people, so I'm not even going to try. What I can say is that I have a great deal of compassion for them because I know the suffering firsthand. 

It is cruel and unusual punishment to prevent transgender people from accessing care that can eliminate or greatly lessen daily suffering. The following surgery, called "facial feminization surgery" ("FFS"), is the surgery I have never been able to afford because I have suffered setback after setback this lifetime. Everything from frequent harassment from people I've never met, being nearly beaten to death from complete strangers, sexually harassed by groups of people — the list goes on. Accessing FFS would be life-changing for me: instead of suffering harassment and loneliness, maybe I'd have a shot at happiness this lifetime. 

Note that I did not include the names of the surgeons for their personal safety, and I am broadcasting these images for First Amendment purposes.

 

⚖️ Legal and Ethical Foundations

Under the Medicaid and Medicare Act, medically necessary procedures must be covered without discrimination. The 9th Amendment of the U.S. Constitution protects unenumerated rights—including "the right to access medically necessary services", a right secured by the Medicare and Medicaid Act. Although we clearly cannot depend on the federal government to cover us, especially when politicians are stoking the flames of discrimination instead of speaking up for the most vulnerable.

Many insurers, guided by policies created by people who have never personally endured what it is like to suffer in this way, classify gender-affirming procedures as merely elective or cosmetic, leaving transgender adults in physical and emotional pain. Tier 1 SondraCare™ corrects this injustice by guaranteeing coverage for medically necessary gender-affirming care.

No gender-reassignment surgery will be covered for anyone under 18+. 

💬 A Personal Appeal

“I’ve heard many unqualified people speak on this issue. As a 43-year-old transgender woman who has suffered immensely, I assure you: not being able to receive care is excruciating—physically, mentally, and emotionally.”

— Sondra Wilson

This policy ensures that no Iowan is denied care because of outdated definitions or discriminatory practices. It affirms dignity, health, and the right to thrive.

📚 References

  • Ainsworth, T. A., & Spiegel, J. H. (2010). Quality of life of individuals with and without facial feminization surgery for gender transition. Plastic and Reconstructive Surgery, 125(5), 1610–1619.
  • AMA. (2021). AMA policy on transgender health. American Medical Association.
  • James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality.
  • Morrison, S. D., et al. (2021). Facial gender surgery: Systematic review of the literature and recommendations for best practices. Plastic and Reconstructive Surgery, 147(4), 803e–812e.
  • WPATH. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. World Professional Association for Transgender Health.