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Changing Sex in San Francisco

But insurance won't spring for bigger breasts

THURSDAY, May 3 (HealthScout) -- If you want to change from a Mr. to a Ms., or vice versa, San Francisco leaders are willing to help to the tune of $50,000.

But transsexuals should read the fine print. Only municipal employees are eligible, breast implants aren't covered, and the city won't pay to shrink anyone's Adam's apple.

"This is not about cosmetic procedures," says city spokesman Marcus Arana, who was born a woman and now lives as a man. "It's about the very basics of what is necessary to go from one gender to another."

By a vote of 9-2, San Francisco's Board of Supervisors on Monday agreed to provide health insurance coverage for sex-change operations. Mayor Willie Brown must approve before the change becomes law, and he has until May 11 either to sign or veto the move.

The policy also has its critics who say it might set a precedent for having insurance companies pay for all sorts of elective procedures and may raise rates for everyone.

The city -- which is also its own county -- has about 27,000 employees, plus 9,000 retirees and dependents, says Arana, who works for the San Francisco Human Rights Commission. Only 14 have been identified as openly transsexual.

San Francisco, which has a population of 745,000, will apparently become the first city in the nation to adopt such a policy for employees. However, the Canadian province of British Columbia does pay for the procedures in some cases, Arana says. Other provinces have also paid for the operations.

The city is simply eliminating discrimination against transsexuals, who are denied many kinds of equally necessary surgeries that are given routinely to other people, Arana says.

For example, Arana says, insurance pays for the removal of uteruses in women who have cancer or are at high risk for getting it. "But not if it's a Jenny moving to become a Johnny."

Medical insurance plans also balk at treating transsexuals with psychotherapy, Arana says. "If you're given a diagnosis of transsexuality, it's like this magic bullet, and suddenly you're not allowed to access any of the things that are offered free of charge to people who are not transsexual."

Some city employees do not pay health premiums, but for those who do, they will shell out an extra $1.70 a month to pay for the new sex change services, Arana says. The overall rates per month are increasing by a total of $18 to pay for the sex change operations and other new services, such as fertility treatments.

The city insurance system won't pay more than $50,000 for a single person's lifetime sex-change benefits. That could spell trouble for people who want to switch from female to male -- the complex surgery costs as much as $77,000, Arana says.

The much simpler male-to-female surgery runs up to $35,000.

While San Francisco is one of the country's most liberal cities, the sex-change policy has critics, and they're worried about setting a precedent for elective medical operations. In a recent San Francisco Chronicle commentary, gay activist Arthur Evans wrote: "Shouldn't the city also pay for reconstructive face surgery, penis enlargement, etc.? Where do you draw the line, and on what basis?"

City spokesman Arana, who is considering a sex-change operation to physically become a man, expects the new policy will set an example for other cities and the health insurance industry.

In the end, employers will make the final call about what's covered, says Richard Coorsh, spokesman for the Health Insurance Association of America trade group. "The customer," he says, "is always right."

What To Do

In the ever-expanding world of sexual diversity, there are transsexuals, transvestites and transgenders. Who's who? Check out this glossary from the University of Calgary.

Should sex-change operations be encouraged? U.S. News & World Report columnist John Leo doesn't think so. Read his thoughts here.

Or, you might want to read previous HealthScout articles on health care costs.

SOURCES: Interviews with Marcus Arana, discrimination investigator, San Francisco Human Rights Commission; and Richard Coorsh, spokesman, Health Insurance Association of America, Washington D.C.; April 29, 2001 San Francisco Chronicle
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