Submitted by Representative Mary Miller (R-IL)

142. Question:
The Biden administration released shocking guidance entitled, “Gender Affirming
Care and Young People,” which encourages children to take dangerous chemicals
and have sex-change operations that permanently end their ability to ever have
children. Is it child abuse to perform a sex-change operation on a 12-year-old girl?
Response: Medical care is between a patient, their family and their health care
provider. The Department is focused on ensuring that care is not stigmatized or
denied based on a youth’s gender identity as consistent with the law. As stated in
our fact sheet: “Gender affirming care is a supportive form of healthcare. It
consists of an array of services that may include medical, surgical, mental health
and non-medical services for transgender and nonbinary people. Gender-affirming
care is patient-centered and treats individuals holistically, aligning their outward,
physical traits with their gender identity.”

143. Question:
Should doctors be allowed to perform sex change operations on children without
their parents’ consent?

Response : HHS is not in the practice of medicine and would recommend

consulting with medical associations regarding standards of care. Generally
speaking, care is between a patient, their family and their health care provider. As
stated in our fact sheet: “Gender affirming care is a supportive form of healthcare.
It consists of an array of services that may include medical, surgical, mental health
and non-medical services for transgender and nonbinary people. Gender-affirming
care is patient-centered and treats individuals holistically, aligning their outward,
physical traits with their gender identity.”

144. Question:
Your guidance says puberty blockers are reversible, please explain to the
Committee how this process is reversed.

Response: The Department advises the Committee to speak with health care
providers or medical associations regarding standards of care.
145. Question:
Do you believe that taxpayers should pay for chemical castration and sex-change
operations?
146. Question:

The HHS website has a list of the new procedures that will now be covered by
Medicare and Medicaid. The list includes “facial bone remodeling for facial
feminization, breast/chest construction, and laser hair removal.” Would you be
willing to change your guidance so that taxpayers are not forced to pay for sex-
change operations?

147. Question:
Last year, you announced the Biden administration will now interpret Section 1557
of the
Affordable Care Act to force doctors to perform sex-change operations. Do you
believe doctors should be forced to perform sex change operations on minor
children without their parents’ consent?

Response to Question 145 through Question 147: The Department follows the
law, and is working to ensure that all patients, everywhere can access care free
from discrimination, stigma and barriers. The Biden-Harris Administration
supports the upcoming release of the World Professional Association for
Transgender Health (WPATH) Standards of Care Version 8 and believes that all
children and adults should be afforded life-saving, medically necessary care.
Payers, both public and private, should cover treatments which medical experts
have determined to be medically necessary.

148. Question:
Do you think it is ever appropriate for a child to receive a permanent sex change
operation without parental consent?

OCR Responses to Question 147 and Question 148: HHS is not in the practice
of medicine and would recommend consulting with medical associations regarding
standards of care. Generally speaking, care is between a patient, their family and
their health care provider. The Biden-Harris Administration supports the upcoming
release of the World Professional Association for Transgender Health (WPATH)
Standards of Care Version 8 and believes that all children and adults should be
afforded life-saving, medically necessary care. Payers, both public and private,
should cover treatments which medical experts have determined to be medically
necessary.
HHS issued guidance to make clear that discrimination on the basis of gender
identity is not allowed under the law. A link to that guidance is provided here for
your awareness: https://www.hhs.gov/sites/default/files/hhs-ocr-notice-and-
guidance-gender-affirming-care.pdf.