"If the commander-in-chief won't take care of our veterans, I will."
So said Christine McGinn, a New Hope-based plastic surgeon, in July, upon the news that President Trump was banning transgender individuals from serving in the military. Speaking with me on CNN, McGinn offered to perform gender-confirmation surgery free if the government would pay for the other costs. She has twice since made good on her promise — initially by performing the first vaginoplasty on an active-duty soldier, and then in performing castration without vaginoplasty as a staging procedure. This week, on the eve of her third related surgery, she was pleasantly surprised to learn that despite the president's position, the government would shoulder a portion of the costs for a U.S. soldier who had transitioned to female.
NBC News was the first to report that Vice Adm. Raquel Bono, head of the Defense Health Agency, which provides medical care to active-duty personnel, approved a waiver request for the surgery Monday, according to a Defense Department (DOD) document.
"This afternoon, an active-duty military member received a sex-reassignment surgery. Military hospitals do not have the surgical expertise to perform this type of surgery, therefore it was conducted in a private hospital," the Pentagon said in a statement.
"Because this service member had already begun a sex-reassignment course of treatment, and the treating doctor deemed this surgery medically necessary, a waiver was approved by the director of the Defense Health Agency. The Supplemental Health Care Program will cover this surgery in accordance with the department's interim guidance on transgender service members."
In July, the president announced via Twitter a ban on transgender people serving in any capacity in the U.S. military.
"Our military must be focused on decisive and overwhelming victory, and cannot be burdened with tremendous medical costs and disruption that transgender in the military would entail," read the tweet.
That's when McGinn told me she would operate free. McGinn herself transitioned in 2000, the same year she was named senior flight surgeon at Willow Grove Naval Air Station, then the largest Reserve station in the country. It was also then that McGinn was nominated for flight surgeon of the year for the entire Navy.
After her offer was announced worldwide on CNN, McGinn said she had only 17 inquiries from military personnel, which she said only proves that the president inflated the impact of the issue.
"There was a memo put out in September saying that the DOD would stop funding any transgender surgeries in March of 2018, which is interesting, because they had never funded any such surgeries, so the memo was a means of just crossing their t's," she said. "But the system for dealing with transgender military members that was set up by Barack Obama was still in effect when Trump tweeted, so everyone didn't have specific instructions on how to deal with this ball that had been rolling at the time of his tweet."
In the case she just performed, McGinn said, the patient has already received confirmation that the government would reimburse both for anesthesia and for the hospital, which McGinn declined to identify.
"The patient that we performed surgery on today lived in Massachusetts, and she called her representative who put pressure on DOD. So it was [Rep.] Joe Kennedy and [Sen.] Elizabeth Warren who were making phone calls and got this through," she said.
McGinn says that the cost of ending the service of very well-trained, highly specialized military personnel who are transgender is "exponentially larger than just taking care of them." She cites a 2016 RAND Corp. study, commissioned by the DOD, which concluded that letting transgender people serve openly in the military would cost between $2.4 and $8.4 million a year, which she describes as an "exceedingly small proportion" of health-care expenditures. McGinn also said there was a lot of "misconception" about the downtime required for those transitioning.
"Some people opt to have no surgeries, but in general, most of my patients are back to work in six weeks, sometimes two weeks," she told me. "I think that this is getting inflated to make it a little more political."
As for the landmark operation she performed this week, she said there are three different fees involved with surgery: hers, the hospital's, and for the anesthesia. Thus far, those who have been taking her up on her offer have been paying for the hospital and anesthesia out of their own pockets.
"So they were fronting the money and then applying through the chain of command to have reimbursement for it, and this particular case got a memo from DOD in the eleventh hour, the night before the surgery, saying that they would indeed pay for the surgery," McGinn said.
"It's exactly the opposite of what Trump tweeted, and it's not going to bankrupt the military," she added. "It's a very small number of people. The first one was performed in September and she's already back in active duty. So it's really not the story that he was suggesting in the tweet."