Oregon became the fifth state to expand its Medicaid coverage to include the often staggering costs of transgender medical bills. It joins California, Massachusetts, Vermont and the District of Columbia, all of whom already offer coverage for gender dysphoria. Oregon's expanded coverage includes reassignment surgery, hormone therapy, and puberty suppression.

Oregon estimates that 175 people will use the coverage this year. But Republicans still oppose the measure. "To a large degree, I think the jury is still out on these procedures and whether or not they're legitimate," Republican state Sen. Jeff Kruse told NPR. Kruse added that gender reassignment surgery is "elective" and "dubious at best."

But Dr. Ariel Smith, director of Oregon's Health Evidence Review Commission, argued that the expanded coverage would provide much needed medical care. "People with gender dysphoria that did not receive treatment had a much higher rate of hospitalizations or ER visits or doctor visits for depression and anxiety," Smith said. When transgender individuals received the medical treatment they required, they had "an almost normal rate of depression and anxiety compared to the general population," Smith added. Their suicide rate also dropped dramatically.

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And because the politics of medicine has devolved to the business-speak of "cost savings" and "bottom lines" over medical necessity and compassion, Smith added that the expanded coverage might reduce overall spending. "Because," she said "hopefully, these folks will no longer be going to the ER or being hospitalized for their severe depression or suicide attempts." The program currently costs the state a measly $200,000.

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