Michelangelo Arles was taken aback when he received a message from MyChart saying that his appointment had been canceled. Curious about the sudden change in his care, Michelangelo called Missouri-based SSM Health to hear that they “are no longer providing that service”—a mastectomy for a transgender person. SSM confirmed that they are still providing mastectomies for cisgender people. After speaking up about this apparent health care discrimination, they were told that SSM believes it is their right as a “Catholic organization” to deny health service to transgender people. He describes the situation as “sick and discriminatory,” in concern for trans people with low incomes who lack health options that are becoming increasingly important. This decision has impacted the local transgender, non-binary, and gender expansive communities severely. SSM Health has not responded to our requests for comment on their decision.
Michelangelo has concerns about his health care going forward because they have Dean Healthcare, and are worried about their ability to work with UW Hospitals since they have not previously. He also is concerned about his ability to get gender-affirming care through Dean going forward. Dean claims that SSM’s decision will not affect their coverage of gender-affirming surgeries, and that they will now be referring patients to UW Hospitals as an alternative for care.
Other patients like August and their family also face dilemmas about keeping Dean Health Care given their ties to SSM Health. “I can’t imagine how long the waiting list will be,” one of August’s parents, Cody, tells us, worried about an out-of-network referral for treatment. Regarding August’s doctor at the SSM Clinic, “We aren’t sure she’ll be allowed to prescribe the (puberty) blockers.” Their doctor says for now they can, but Cody is afraid for their child. They have the ability to switch insurers if necessary, but know that is a privilege many do not have. Dean was previously owned by SSM Health, but sold to Minnesota-based Medica in 2021. Despite this, Dean Medical Group maintains some ties with SSM Health. Medica refers to Dean Medical Group as a “joint venture” with SSM Health.
Intersection of Religion & Health Providers
Legally, certain businesses have been able to skirt health discrimination laws through religious exemptions. The Supreme Court decided in the 2014 case Burwell v. Hobby Lobby that the contraceptive mandate under the Affordable Care Act violated the corporation’s religious freedom rights. Earlier this year, the Supreme Court ruled in 303 Creative LLC v. Elenis, that it was within the web company’s first amendment rights to refuse service to same-sex couples. The Court’s recent turn to the right under President Trump has opened the floodgates to various lawsuits from firms like Wisconsin Institute for Law and Liberty, aka WILL, to sue schools on dubious grounds and try to repeal discrimination laws through the courts.
“It’s a corporate decision,” an SSM Health receptionist relays to me. Sisters of St. Mary’s operates under private Catholic ownership. Some folks have pointed out that there is a conflict of interest in having a corporation supposed to be focused on health care, but ultimately more concerned with internal Catholic doctrine. This doctrine appears to oppose all life-saving gender-affirming care including puberty blockers, hormones, and surgeries. So far, SSM is just limiting surgeries, but patients worry that’s just the beginning.
By contrast, SSM Health is owned privately after Mary Odilia Berger and her sisters fled religious persecution in Germany to St. Louis, Missouri in 1872. They now own 23 hospitals across Missouri, Oklahoma, Illinois, and Wisconsin. Folks in LGBTQ+ communities say they are now religiously persecuting them. SSM claims a history of social justice and empathy for the poor, but has yet to respond for any official comment regarding this situation. According to SSM: “…the Sisters of St. Agnes have embraced peace and justice issues, women’s rights…” with the notable exception LGBTQ+ patients. Casa Maria Catholic Worker out of Milwaukee reached out to SSM Health encouraging them to support trans people. In a recent report by The Cap Times, Dane County Executive Joe Parisi announced that Dane County is investigating SSM Health and Dean because their health contract is up for renewal next year.
Challenges and Misinformation
This comes as a media firestorm emerges from the American Right calling queer and trans people “groomers,” and spreading misinformation on the efficacy of gender-affirming care. The Madison diocese shared a document with me regarding “Moral Limits to Technological Manipulation of the Human Body.” Folks in the community think this sounds dehumanizing.
Within that doctrinal note from the U.S. Conference of Catholic Bishops, the conference claims that gender-affirming care is not effective in treating gender dysphoria despite overwhelming consensus otherwise. They claim that trans people do not suffer sufficient “burden” for health care to be appropriate. These statements reinforce misunderstandings about gender dysphoria and trans health care.
Trans people are overwhelmingly more satisfied with their lives after transitioning. The JAMA Surgery journal recently published a study demonstrating that gender-affirming mastectomies had results “overwhelmingly positive compared to other medical and nonmedical decisions.” Transition, however, looks different for everybody and does not always involve medical intervention. This myth of transition having a beginning and an end is just that, a myth. Trans+ people thrive in an environment with social, legal, and medical options, and that’s something that Wisconsin is just lacking. Wisconsin has legal limits against discriminating against LGB people but, decades later, has not passed one protecting the T of LGBT.
Wisconsin law requires a “sex-change surgery” to change a birth certificate. A name change must be published in a newspaper unless a judge is able to declare it confidential. The law forces trans people to advocate for our own basic privacy in court, and to obtain surgeries they may or may not desire or have access to. Last year, there was a right-wing firestorm regarding a tent to obtain a letter of readiness for gender-affirming surgery at last year’s MAGIC Pride Fest. Known hate-mongers like “Libs of Tiktok” spread lies about gender-affirming surgery being easy to obtain, despite the extreme gatekeeping trans people still face in finding access to health care.
According to the LGBTQ+ rights non-profit, Human Rights Campaign, as of 7/25/23, 32.2% of transgender youth live in states that have passed bans on gender-affirming care, and another 13.2 are at risk of losing gender-affirming care. Due to the Wisconsin GOP’s relentless, and so far failed, attempts at banning gender-affirming care in Wisconsin, this state is firmly in the “at risk” category for vulnerable trans youth.
The WI GOP also attempted to protect conversion therapy through the legislature after deciding in committee that licenses cannot be revoked for practicing the dangerous, discredited practice that survivors amount to torture. There is no evidence that youth under 18 are incapable of pursuing appropriate gender-affirming therapy. The American Medical Association passed a resolution on June 12 in support of “evidence-based care” saying “medical decisions should be made by patients, their relatives, and health care providers, not politicians.” Based on the recent Wisconsin legislature, it appears our representatives have not gotten the memo.
Medically Necessary Gender Affirming Care
Ollie Heide was in the car on the way to his pre-op appointment for gender-affirming surgery when he got a call that it was rescheduled—indefinitely. Four different medical professionals told him that this surgery was necessary. Ollie, a teenager with blue hair, now has to deal with months more of physical and emotional turmoil as a result of this decision. His family reached out to SSM and the Madison diocese for a medical reason for this decision and got back little. It’s “an absolute political move” he said, noting that he gets called slurs on a regular basis at high school.
Binding is difficult for him, especially with hypermobility that makes it even more uncomfortable for his joints. This gender-affirming surgery would have relieved his pain and discomfort. Ollie notes that this move was clouded in secrecy. “It’s obvious you know you’re doing something wrong when it’s a secret like that.” He also made it very clear that his doctors were supportive and helpful. They are trying to provide care, but the hospital is preventing them. “Just listen to doctors about medical care.” In the end, SSM told him it was an “equipment issue,” which Ollie chalks up to a desperate lie.
Ollie has been through three years of therapy leading up to this decision. He says his insurance companies misgendered (knowingly used the wrong pronouns) him regarding his care. He was required by his insurance to be on testosterone for one year before even scheduling a consultation for surgery. This requirement has since been removed from WPATH policy, but not before Ollie’s coverage was denied and he had to jump through numerous hoops, including a review from multiple additional doctors. His family planned their summer around this surgery, making sure to give Ollie the care and time he needs to recover. Now, his top surgery is rescheduled for October at a different hospital in the middle of the school year. Now he will be forced to take a month out of school for this medically necessary surgery.
The Future of Trans Health Care
It appears that trans patients are being referred to UW-Health surgeons after being denied treatment. In the last couple of years, Indiana, Missouri, and Iowa have banned life-saving gender-affirming care for those under 18 despite the medical evidence to the contrary. Sarah Benzel, UW-Health’s Media Relations Manager communicated: “UW-Health will continue to serve our transgender, gender-expansive, and nonbinary patient communities.” Based on my own previous experience with them, the UW Gender Clinic confirmed that this new influx of patients from out of state has driven up wait times for transgender services.
Two workers at the UW System spoke to us on the condition of anonymity out of fear for their jobs. They say that UW directed them to not discuss SSM Health’s decision publicly. One told us that, while they were collecting feedback on the situation, they were told to not respond or encourage feedback. Another said that they can reply but cannot seek feedback actively. UW System and UW-Madison have not yet returned our request for comment. It is not clear if the Wisconsin Department of Employee Trust Funds (aka ETF) that manages employee health care will continue their contract with Dean. Given the lack of response from the state, this contract seems likely.
Going forward, the community is scrambling for answers regarding health care, rights, and religion. We face challenges related to misinformation, legal barriers, and limitations to health care access. We are talking about the word “genocide” and wondering if that’s what our opponents want. We talk about allies needing to do more to listen and help us. The LGBTQ+ community is built on solidarity. We rely on each other for our rights, our events, and our social lives. The future of gender-affirming care in Wisconsin is unclear, but the future of the transgender community in supporting each other in navigating these changes and finding solutions is looking as strong as ever.
Tessa Jade Price is a transgender woman who enjoys writing, web design, and community organizing. Tessa grew up in Joliet, Illinois, and as a politically minded punk youth, moved to Madison in 2011 to study politics. After graduating, she worked in tech support and web design for seven years. Tessa came out publicly as trans in 2020 and, in 2021, started working with Trans Advocacy Madison to advocate for the needs of transgender, non-binary, and gender-expansive people in the Madison area. Tessa writes about queer, trans, and diversity issues and lives with her big, fluffy cat, Rigo. She is passionate about helping others and using media and politics to help platform queer and trans perspectives.