In announcing he would ban transgender people from the military, President Donald Trump cited “the tremendous medical costs and disruption that transgender in the military would entail.” Whether the cost is “tremendous” is opinion, but a government-funded report found that allowing transgender people to openly serve in the military would likely have a “marginal impact” on health care costs and military readiness.
The report, released last year by the RAND Corp., estimated the additional cost at “between $2.4 million and $8.4 million annually, representing a 0.04- to 0.13-percent increase in active-component health care expenditures.” It also found that “less than 0.1 percent of the total force would seek transition-related care that could disrupt their ability to deploy.”
The RAND report was commissioned by the Defense Department after then-Secretary Ash Carter announced in July 2015 that the military would study “the policy and readiness implications of welcoming transgender persons to serve openly.”
Nearly a year later, Carter announced a new policy that immediately allowed transgender service members “to openly serve in the U.S. armed forces” without fear of discharge. The policy also set a date of July 1, 2017, for allowing transgender individuals to join the armed forces. The delay was designed to develop training plans, revise regulations and forms, and implement guidance.
On June 30, the Defense Department under Trump delayed the start date for accepting transgender service members until Jan. 1, 2018. In a June 30 memo obtained by the Associated Press, Defense Secretary James Mattis told service chiefs and secretaries that he would “use this additional time to evaluate more carefully the impact of such accessions on readiness and lethality.”
Associated Press, July 1: Mattis said the review by the services must be completed by Dec. 1, and he noted that his approval of a delay “does not presuppose the outcome of the review.” He said the additional time will ensure he has “the benefit of the views of the military leadership and of the senior civilian officials who are now arriving in the department.”
However, in a series of tweets, Trump abruptly announced the policy change before the end of the six-month review period.
After consultation with my Generals and military experts, please be advised that the United States Government will not accept or allow……
— Donald J. Trump (@realDonaldTrump) July 26, 2017
….Transgender individuals to serve in any capacity in the U.S. Military. Our military must be focused on decisive and overwhelming…..
— Donald J. Trump (@realDonaldTrump) July 26, 2017
….victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail. Thank you
— Donald J. Trump (@realDonaldTrump) July 26, 2017
Let’s look at what we know about the number of transgender individuals currently serving in the military and their potential impact on health care costs and military readiness.
In making his announcement that the military would accept transgender service members, Carter said that “there isn’t definitive data on the number of transgender service members.” But he cited RAND’s study of existing estimates “and their best estimate was that about 2,500 people out of approximately 1.3 million active-duty service members, and about 1,500 out of 825,000 reserve service members are transgender.” Those were mid-range estimates with the upper end of the ranges being 6,630 for active duty and 4,160 for the reserves.
So we are talking about a small subset of active and reserve service members. The number of service members that would seek gender transition–related medical treatment is even smaller.
Private health insurance data show that “0.022 to 0.0396 annual claimants per 1,000 individuals” seek transition-related health care each year. Based on that, RAND estimated that anywhere from 29 to 129 active-duty service members would seek such medical treatment each year among the force of 1.3 million members.
Although Trump described the cost as “tremendous,” RAND estimated that providing transition-related health care would increase the military’s health care costs for active-duty members “by between $2.4 million and $8.4 million annually.” That represents an increase of no more than 0.13 percent of the $6.27 billion spent on the health of active-duty members in fiscal 2014.
As for military readiness, the RAND report said: “Similarly, when assessing the readiness impact of a policy change, we found that less than 0.0015 percent of the total available labor-years would be affected, based on estimated gender transition–related health care utilization rates. This is because even at upper-bound estimates, less than 0.1 percent of the total force would seek transition-related care that could disrupt their ability to deploy.”
The report was less definitive regarding the impact of transgender individuals on “unit cohesion.” RAND said its review of data from the civilian population, foreign militaries, and previous integration experiences of gays, lesbians and women “suggest a minimal impact on unit cohesion.” But it acknowledged that its conclusion “may not hold for transgender service members.”
Update, July 28: In a July 27 memo, Marine Gen. Joseph Dunford, chairman of the Joint Chiefs of Staff, notified commanders in the various branches of the armed forces that the Pentagon would not change its policy on transgender service members until the White House provides formal guidance, according to the Los Angeles Times. “In the meantime, we will continue to treat all of our personnel with respect,” Dunford said in his memo. Defense Department spokeswoman Dana W. White reiterated that message in a separate statement issued the same day that said the department will ensure “all service members are treated with respect.”
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