S.F. health care to cover sex reassignment surgery

SAN FRANCISCO A panel has voted to cover the cost and provide sexual reassignment surgery for transgendered people as part of San Francisco's universal health care plan.

The city's Health Commission approved on Tuesday the creation a comprehensive program for treating transgender people experiencing mental distress because of the mismatch between their bodies and their gender identities. San Francisco already provides transgender residents with hormones, counseling and routine health services, but has stopped short of offering surgical interventions, Public Health Director Barbara Garcia said Thursday after the vote was announced.

The idea for a new program that included surgeries came out of conversations between public health officials and transgender rights advocates who wanted mastectomies, genital reconstructions and other surgeries that are recommended for some transgender people covered under San Francisco's 5-year-old universal health care plan.

• San Francisco plans to provide transgender surgeries

At the urging of the San Francisco Board of Supervisors and the San Francisco-based Transgender Law Center, the commission agreed this week to drop sex reassignment surgery from the list of procedures specifically excluded from the Healthy San Francisco plan.

But Garcia described the move as "a symbolic process" for now because the city currently does not have the expertise, capacity or protocols in place to provide the surgeries through its clinics and public hospital.

"The community felt the exclusion on Healthy San Francisco was discriminatory and we wanted to change that as the first step," she said.

Currently, Healthy San Francisco provides medical care for uninsured residents below a certain income level, regardless of citizenship, immigration, employment or health status. Participants must have an income at or below 500 percent of the Federal Poverty Level, which means $54,480 for one person and $111,720 for a family of four. The program is paid for by federal funds, city business fees and participant co-payments.

Instead of expanding the existing plan, the Health Commission approved the establishment of a separate program that covers all aspects of transgender health, including gender transition. Garcia hopes to have it running by late next year, but said her department first needs to study how many people it would serve, how much it would cost, who would perform the surgeries and where they would be performed.

"Sex reassignment surgery is not the end all. It's one service that some transgender people want and some don't," she said. "We can probably manage this over the next three years without much of a budget increase because we already have these (other) services covered."

San Francisco in 2001 became the first city in the country to cover sex reassignment surgeries for government employees. Last year, Portland, Ore. did the same. The number of major U.S. companies covering the cost of gender reassignment surgery for transgender workers also doubled last year, reflecting a decades-long push by transgender activists to get insurance companies to treat such surgeries as medically necessary instead of elective procedures.

"There's been a consensus the last three to five years that transition related surgeries are in fact a medical necessity for people who have been properly diagnosed with gender dysphoria," Theresa Sparks, head of the Human Rights Commission, said to CBS station KPIX in San Francisco.

Kathryn Steuerman, a member of a transgender health advocacy group in San Francisco, said the city's latest move would help residents avoid going into debt to finance operations related to gender transition, as she did.

"I am filled with hope and gratitude that we are achieving this level of support for the well-being of the transgender community," Steuerman said.

[threaldrumbum]

This sounds like adolescent angst that caries on into adulthood. Most people aren't happy with their bodies, but this is beyond ridiculous. That money would be better spent serving the education system of the city.

[magnumdr]

This should never be covered by any insurance. If it is then why can't plastic surgery be covered also. The policy holders should never have to pay for this type of coverage with their insurance payments. It is like buying a new car, no insurance company would pay for that even if you were in love with the car!

[hypnotoad72]

Insurance companies do what gives them profit. Why else do they deny newborns coverage, citing "preexisting conditions"? (search it on the web...) They don't buy their customers things, so I don't quite see your connection to that notion...

But I agree - there is little difference to sex change operations and plastic surgery...

[goodbyeplanetearth]

Gender Reassignment surgery is not a form of cosmetic surgery. If a transgender person wished to have plastic surgery, insurance would not cover that. Gender Dysphoria is a legitimate medical condition recognized by medical and psychiatric communities worldwide. The only viable treatment for individuals suffering from this unfortunate affliction is hormone replacement therapy and in many cases gender reassignment surgery. Not all transgender people desire to have surgery. Each individuals medical needs are determined by an assessment carried out by mental health and medical pofessionals to determine the correct coarse of action in treating the patient.

Left untreated, transgender people frequently suffer tremendous psychological pain that often results in suicide. Over 41% of transgender people will have attempted suicide in their lifetime. There is no other approved method of treating this condition. The additional cost of transgender related medical care is insignificant given the rarity of this condition. To compare the necessary medical treatment required of those who suffer from this very painful medical condition to "buying a new car" is a gross misinterpretation of reality. To my knowledge, not being able to afford a new car is not a medical condition and therefore should not be covered by insurance. This is a logical fallacy, and while it may bring you some sort of comfort to believe that your logic is correct, unfortunately there is no evidence backing your assertion that either of these issues are comparable.