The city of San Francisco will now pay up to $50,000 for its transsexual employees to have sex changes. Although the ordinance has already been written and passed within San Francisco city limits, it has opened a wide debate on whether to implement such legislation in other large cities with comparably dense transgendered populations. Our own San Diego has one of the highest in the nation, unfortunately reflected in the high number of anti-transgender hate crimes occurring here. However, the question remains: Is the allocation of public funds for a worker’s sex change wise or economically sound? Yes, it is; transsexual state employees should have their sex changes state-funded.
Before discussing this issue, it’s necessary to do some basic word definition as well as education on the current state of transgendered individuals’ daily lives. Transgender is an umbrella term for all those who don’t fall into the two societally accepted categories of “”male”” or “”female.”” The term transgender includes those individuals who would label themselves transsexuals (pre-, post- and non-operative). The transgendered population faces daily discrimination for just existing, and this discrimination is seen most blatantly through hate crimes. According to the National Gay and Lesbian Task Force, although transgendered individuals make up only a small percentage of the LGBT population, they account for 20 percent of all anti-LGBT murders and about 40 percent of the total incidents of police-initiated violence against the LGBT community. According to the National Coalition on Anti-Violence Project, 10 percent of all transgendered individuals will be murdered in a hate crime and close to 60 percent will be victims of a hate crime.
Gender Identity Disorder is the medical disorder that transsexuals are most often diagnosed with. GID is defined as an individual being born with the external anatomy of a gender that they don’t identify with internally, and is recognized by the American Psychiatric Association as a disorder in need of medical procedure — in this case a sex change operation. GID would be the medical condition cited to justify the need for state-contracted insurance companies to pay for the patient’s sex change.
There is pre-existing California case law providing the legal groundwork for state-contracted insurance companies to pay for state workers’ sex changes. The most prominent case is that of G.B. v. Jerome Lackner in 1978. In this 1975 case the appellant consulted his physician, who diagnosed him as having GID or transsexualism (the two are synonymous). G.B.’s physician diagnosed the cure or remedy for GID as a sex change operation for the appellant. G.B. then filed with his local Medi-Cal field office to get coverage for obtaining such a sex change. After a series of denials, appeals and overturns, the case went to the California Court of Appeals, where the court overturned the previous decision by the director of the California Department of Health, setting as precedent that the state (specifically its state-contracted insurance company, Medi-Cal) be required to pay for the sex changes of its transsexual employees.
This case did many things besides set precedent. First of all, it had prominent doctors state under oath that sex changes were necessary for those diagnosed with GID (transsexuals). Dr. John Brown stated that G.B. “”must have the requested surgery to treat her disorder and prevent further suffering, enable her to participate in normal living, and obtain steady employment.”” He went on to say that “”a preoperative transsexual, in my experience, is often unable to obtain employment due to employer’s biases, the requirements of a physical examination prior to employment, or psychological instability resulting from the frustration at being trapped in the body of a person of the opposite sex.””
The second thing the case of G.B. v. Jerome Lackner provided was a legal interpretation of the Medi-Cal insurance company contract. The wording of the extent of Medi-Cal coverage is incredibly wide and is said to provide (as written in Welfare and Institutions Code section 14059) “”diagnostic, preventive, corrective and curative services and supplies essential thereto, provided by qualified medical and related personnel for conditions that cause suffering, endanger life, result in illness or infirmity, interfere with capacity for normal activity including employment, or for conditions which may develop into some significant handicap.””
According to federal regulations, a state (which administers the joint state-federal Medicaid program) may not “”arbitrarily deny or reduce the amount, duration or scope of such services to an otherwise eligible individual solely because of the diagnosis, type of illness, or condition.”” In recognition of this language and the above ruling, courts have generally accepted the claim for Medicaid coverage of transsexual surgery by persons who can substantiate their medical need for it (read: those who can be diagnosed by a doctor under oath to have GID).
The case of G.B. v. Jerome Lackner was a milestone for the transgendered pre-, post- and non-operative community. It set precedent for state-contracted insurance companies to pay for transsexual state employees’ sex changes. However, since this ruling, insurance companies have evaded this by having their contracts specifically exclude sex changes.
Case law and professional medical opinion are on the side of transsexual state workers in regards to the argument at hand. Transsexuals suffer from GID, and the APA and doctors under oath have stated that sex changes are the most effective remedy to help these suffering individuals. Precedent, established in the verdict of G.B. v. Jerome Lackner, gives strong support at the legal level.
Unfortunately, state-contracted insurance companies have been able to avoid following these state-set guidelines. They have done this by simply having their attorneys reword their contracts with the state to specifically exclude sex-change operation candidates from obtaining insurance. The insurance companies have done similar things with cancer patients, either excluding them or making their premiums extremely high. However, San Francisco has found an insurance company that doesn’t have such an exclusion in its contract.Thus, one can determine that it is just a question of public organization (i.e. the State) contracting out to such insurance companies.
