Our guest bloggers are Andrew Cray, Research Associate, and Jeff Krehely, Vice President for the LGBT Research and Communications Project at the Center for American Progress.

Senate candidates Scott Brown (R) and Elizabeth Warren (D) both responded negatively to Kosilek's court victory.

Last Tuesday, U.S. District Court Judge Mark Wolf ruled that Michelle Kosilek, an inmate in the Massachusetts Department of Correction system, is entitled to receive sex reassignment surgery. This decision follows a 10-year litigation process that Wolf described as “a prolonged violation of Kosilek’s Eighth Amendment right to adequate medical care.” Wolf is a 1985 Reagan appointee to the federal bench.

Despite the fact that the Supreme Court decided over three decades ago that inmates are Constitutionally entitled to care deemed necessary by prison medical officials, there still seems to be question about whether care provided to transgender prisoners is a “good use of taxpayer dollars” (in the words of Massachusetts Democratic Senate candidate Elizabeth Warren) or even whether it is an “outrageous abuse” of state funds (in the words of the sitting senator Warren is challenging, Republican Scott Brown).

But in fact, treating transgender people equally in providing medically necessary care is not only appropriate under the law, it is also the fiscally responsible thing to do.

Setting aside the generalized cost implications of providing transition-related services to transgender people, Massachusetts could have saved money by providing appropriate care in the first place. The State has spent over ten years in court arguing over whether the Department was required to cover transition-related care for Michelle Kosilek. In 2008 — four years ago — the Associated Press found that the Department had spent more than $52,000 on medical experts alone. That expenditure of taxpayer funds is itself double the estimated cost of surgery that Corrections physicians found was the only adequate treatment for Kosilek’s condition. Add in the litigation costs aside from medical experts, and another four years since the AP review, and the outcome is clear: Massachusetts officials chose to spend more money disputing the judgment of their own medical professionals than it would have by simply providing the care deemed appropriate by multiple expert medical organizations.

Furthermore, when transition-related care is provided to transgender people, data still suggests that nondiscrimination is fiscally sound policy. Like some commenting on the Kosilek decision, members of the City of San Francisco’s Health Service System Board expressed concern in the late 1990s that providing insurance coverage for transition-related care would encourage “abuse” of the system — transgender people may flock to City employment or marry city employees so that they could access inclusive benefits. However, in 2006, the City reported that none of this came to pass, and the actual costs associated with coverage were significantly less than projected – less than 1% of the initial estimates.

Permitting transgender people to access care related to transition also improves their health — meaning that fair treatment could actually cut costs. The California Department of Insurance, conducting an impact assessment of regulations implementing the state’s transgender nondiscrimination protections in insurance, found a drop in depression and anxiety among patients who had coverage for gender transition services. This improvement in mental health was so significant that the Department concluded that the “reduction in utilization of mental health services could be a source of cost savings.”

Cutting mental health care costs, improving inmate health, preventing excessive litigation expenses, and complying with the Eighth Amendment — all of these results point to the conclusion that providing medically necessary transition-related care to transgender inmates is the fiscally responsible thing for all states to do. The true “outrage” in this case is not that Massachusetts must treat Michelle Kosilek — it’s that our elected officials (and those who seek public office) still let bias and stigma, and not medical science or even arithmetic, guide their positions on issues of critical importance to transgender people.

A day after taunting his opponent with the endorsement he was scheduled to receive from a Massachusetts boxing legend, Sen. Scott Brown (R-MA) had to KO the event.

Micky Ward, the subject of the 2010 biopic The Fighter, was all set to endorse Brown until he learned that that the freshman Republican opposes LGBT rights and labor unions. Mark Wahlberg played Ward in the multiple-Academy-Award-winning film.

The Lowell Sun reported Friday that Ward initially told the paper day that he was set to endorse Scott Brown’s re-election, but changed his mind shortly after:

Roughly a half-hour after Ward confirmed he was backing Brown, ‘The Fighter’ called back. He said he had given his endorsement a little more thought. “I can’t support Scott Brown,” Ward said. “I just can’t do it.”

Within 30 minutes, Ward either did some Googling or someone close to him reminded him about where Brown stood on some hot-button political topics. “I found out Scott (Brown) is anti-union and I’m a Teamster guy,” said Ward. “I found out he’s also against gay marriage and I say if you love someone you should have the same rights no matter who you are.”

Brown has consistently opposed marriage equality and has a lengthy history of working against the LGBT community. He voted against the AFL-CIO’s positions 79 percent of the time in 2011.

Fifth in a series examining how anti-LGBT Senate candidates have worked to hurt the cause of equality.

After winning a special election in 2010 to fill the remainder of the late Sen. Ted Kennedy’s (D-MA) Senate term, Sen. Scott Brown (R-MA) is seeking a full term this November. Unlike his challenger, pro-LGBT Democrat Elizabeth Warren, Brown has opposed the LGBT community on several major issues.

Over his time in the Massachusetts state legislature and a Senator:

1. Brown actively worked to repeal marriage equality in Massachusetts and in the District of Columbia. Announcing “I believe that marriage is between a man and a woman,” Brown ran for the Massachusetts state senate in 2004 promising to back a state constitutional amendment to take away the civil marriage rights for same-sex couples that had been granted by the state’s Supreme Judicial Court. He refused to explain his opposition to marriage equality, saying only “It’s just a personal belief, based on my religious upbringing. It’s just my feeling.” In the state senate, he repeatedly voted for anti-LGBT marriage constitutional amendments. In the U.S. Senate, Brown voted to suspend same-sex marriages in DC pending a city-wide referendum. As recently as last year, Brown’s campaign site reaffirmed his belief that “marriage is between a man and a woman.”

2. Brown has opposed efforts to allow legally married same-sex couples in his own state to be recognized federally. Though he now claims that same-sex marriage in Massachusetts is “settled law” and says this issue should be decided on a state-by-state basis, he has opposed efforts to extend federal recognition to his own constituents’ legal unions. When the Obama administration announced it would no longer defend the unconstitutional Defense of Marriage Act (DOMA) in court, Brown complained, “We can’t have presidents deciding what laws are constitutional and what laws are not.” In 2011, a Brown aide told Bloomberg that the Senator still supports the DOMA, though a 2012 letter from Brown to a constituent carefully avoids expressing any position on the law.

3. Brown stood with Mitt Romney to preserve an anti-miscegenation law used to discriminate against LGBT couples. He was one of just three Senators to oppose repeal of a 1913 anti-interracial marriage law that then-Gov. Mitt Romney used to prevent out-of-state same-sex couples from marrying in Massachusetts.

4. Brown does not support a federal Employment Non-Discrimination Act.In the 111th and 112th Congresses, Brown refused to sign onto a bill to protect LGBT Americans from employment discrimination. Pam’s House Blend reported last September that Brown told a voter he opposed a federal non-discrimination law, saying “the states should take care of it, I believe in states’ rights.”

5. Brown obstructed Don’t Ask Don’t Tell repeal — which he supported — to ensure tax cuts for the rich. After initially opposing a repeal of the Don’t Ask Don’t Tell policy, Brown announced in December 2010 that he would support allowing gay and lesbian servicemembers to serve openly. But, he announced he would not support even an up-or-down vote on the measure in the Senate until after Congress agreed to extend the Bush tax cuts for the wealthy. Even after he got his way on tax cuts, Brown joined a filibuster of the first attempt at repeal before ultimately backing the final version.

6. Brown attacked same-sex parents as “not normal.” In 2001, he told the Boston Globe it was “not normal” for two women to have children. His comments — focused at then-State Sen. Cheryl Jacques and her domestic partner Jennifer Chrisler — also belittled Jacques’ “alleged family responsibilities.” While he later backed off of what he called a “wrong choice of a word that is probably going to crucify me,” Brown has to this day never directly apologized to Jacques and Chrisler.

7. Brown refused to be in the Massachusetts delegation’s “It Gets Better” anti-suicide video. Every member of the 12-person Massachusetts Congressional delegation joined in the effort except Brown. A member of his staff explained that Brown declined to send a message of support to LGBT youth because “His main focus right now is on creating jobs and getting our economy back on track.” Though the staffer claimed Brown has a “strong record” of opposing bullying, he has not co-sponsored any of the anti-bullying bills pending in the Senate.

8. Brown was the lone State Senator to stand with Mitt Romney in opposition to funding for gay and lesbian youth services. In 2006, then-Gov. Romney vetoed an increase in funding for the Governor’s Commission on Gay and Lesbian Youth. When the Massachusetts Senate overrode Romney’s veto by a 36 to 1 margin, Brown was the lone vote opposing the funding for at-risk LGBT youth.

9. Brown co-sponsored a bill to allow parental notification and opt-opt from any school discussion of “alternative sexual behavior.” He backed a proposed “Parents Rights” Bill to require parental consent for schools to mention “alternative sexual behavior” in the classroom.

Watch the “It Gets Better” video in which Brown refused to appear:

In an April op/ed in the Bay Windows, a New England LGBT newspaper, Brown mocked Warren’s support for pro-equality legislation, saying “I don’t come before you with a checklist of items promising that I will be an advocate for you on each and every one of them. My opponent has already started down that road, promising to support everyone’s pet project. That’s not the way I have ever operated.” Indeed, it is not.

Brown’s re-election to the U.S. Senate would be a huge threat to LGBT people and families.