The study didn't include estimates of costs for reservists, because of "their highly limited military health care eligibility". It also didn't include estimates for retirees or military family members, because they may also have "limited eligibility" for care via military treatment facilities.
"The implication is that even in the most extreme scenario that we were able to identify, we expect only a 0.13-per cent ($8.4 million out of $6.2 billion) increase in health care spending," Rand's authors concluded.
By contrast, total military spending on erectile dysfunction medicines amounts to $84 million annually, according to an analysis by the Military Times - 10 times the cost of annual transition-related medical care for active-duty transgender service members.
The military spends $41.6 million a year on Viagra alone, according to the Military Times ' analysis - roughly five times the estimated spending on transition-related medical care for transgender troops.
Looked at another way, the upper estimate for annual transgender medical costs in the military amounts to less than one-10th of the price of a new F-35 fighter jet. Or, 1000th of one per cent of the Defence Department's annual budget.
The price of providing medical care to transgender service members, in other words, is negligible, and hardly "tremendous" as the President put it.