In response to the Veterans Administration’s decision this week to cancel plans to provide transition surgery to transgender veterans until “appropriated funding is available,” the Palm Center released a study showing that the cost of providing transition-related health care would be $20.6 million, approximately one one-hundredth of one percent of the VA’s $183.2 billion budget. The Palm Center provided the study to VA administrators in December, 2014 to help inform their decision as to whether or not to offer transition surgery, but did not publicly release the study until today.

The $20.6 million estimate includes the cost of providing hormones and counseling, which the VA already offers to transgender veterans. Thus, the annual cost of adding surgery to the range of medically-necessary care would be even less.

According to Palm Center Director Aaron Belkin, “We don’t pit one veteran against another and demonize some as less deserving as others. No one would ever ask, for example, ‘why is the VA treating people for heart disease when combat vets are having trouble receiving care?’ Absent some extraordinary expense, we don’t make veterans fight among each other about who deserves medically necessary care. We take care of all of them.” Belkin added that the VA’s emphasis on appropriated funding makes no sense. “The VA offers many of the surgeries that transgender veterans need, such as hysterectomies, to non-transgender veterans, so it is unfounded to claim that Congressional approval is required to provide specific procedures,” he said. “If the VA didn’t have to wait for Congress to appropriate funds for hormones and counseling that it provides to transgender veterans, then surely there’s no need for a surgery-specific appropriation.”

As of November 2016, the US military has offered all transition-related health care, including counseling, hormones and surgery, to transgender service members. A 2015 study in the New England Journal of Medicine study estimated that the military’s annual cost for providing transition-related health care would be $5.6 million, approximately one one-hundredth of one percent of its annual healthcare budget. The RAND Corporation estimated the annual cost would be between $2.4 million and $8.4 million.