San Fran. Poised to Pay for Sex Changes

San Francisco is prepared to make history by becoming the only city to pay for employees’ sex changes — a move some say is long overdue in ending discriminatory practices against transsexuals.

“It really is a civil rights issue,” said Marcus Arana, a transgender San Francisco Human Rights Commission discrimination investigator. “We have an insurance issued that will pay for a hysterectomy in Mary but not in Marcus, and will pay for hormone therapy in Mary but not in Marcus.”

After a five-year fight in the city’s Health Service System, the gender-switching benefits earned approval last week from a city committee and will go before the full Board of Supervisors on Monday.

San Francisco apparently would be the only governmental body in the nation to make sex-change benefits available. The state of Minnesota offered such benefits, but the program was phased out in 1998. The issue was discussed in Oregon, but a commission decided against it in 1999.

Public Support, E-Mailed Opposition

Several supporters have publicly endorsed the measure, and no one has spoken against it. Opposition has come only in e-mails and phone calls from people living outside San Francisco, mainly Texas, said Board Supervisor Mark Leno, founder of the Transgender Civil Rights Implementation Task Force.

The term transgender covers a broad range of categories including cross-dressers, transvestites, transsexuals and people born with characteristics of both sexes.

“We have transgender people living and working among us,” Leno said. “They deserve the same dignity and respect as every other citizen. One way is to make sure the city provides equal benefits for equal work.”

On average, male-to-female surgery costs about $37,000, while female-to-male surgery runs about $77,000.

The coverage extends to hormone treatment and medical matters such as mastectomies or breast cancer. It will not cover cosmetic procedures and can only be used after a doctor deems treatment medically necessary. Employees first must go through an extensive medical review process that takes up to six months.

Payouts Capped

Even if the benefits are approved, they will not be equal, Arana said. Transsexuals would have to be employed a year by the city before they’re eligible for the coverage, which also has a lifetime $50,000 cap and a 15 percent or 50 percent deductible, depending on whether the physician is in the city’s health network.

“We hope to eliminate that down to 10 percent,” said Theresa Sparks, a transgender member of the city’s Human Rights Commission.

Sparks underwent surgery to become a woman last year in Thailand because she couldn’t afford it in the United States. She’s paid about $30,000 since she began making her transition in 1997, but will still be able to enjoy the city’s benefits, which would kick in July 1.

Sparks said she hopes San Francisco’s adoption of transgender benefits sends a message to other municipalities that all employees need to be treated equally. She also hopes insurance companies will begin extending similar benefits to private employers.

“It’s a symbolic benefit. The city is recognizing this is a medical condition and there are medical procedures that can correct it,” Sparks said. “How can the city enforce nondiscrimination ordinances if they, themselves, are discriminating?”

About 14 of the city’s 37,000 workers are transgender. All employees’ health costs would increase about $1.70 a month under proposed changes which also include coverage for hearing aids and acupuncture.

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