Issue:  Vol. 48 / No. 11 / 15 March 2018

Healthy SF to remove trans exclusions


Scott Wiener (Photo: Rick Gerharter)
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Nearly two years after a complaint was filed charging that Healthy San Francisco, the city's health insurance program for uninsured residents, is discriminatory because it excludes services for transgender people, city officials are in the process of rectifying the situation and including such services in the program.

Supervisor Scott Wiener and transgender leaders met with the Bay Area Reporter Monday, July 16 and said that city officials are expected to soon sign off on the changes that would allow sexual reassignment services, treatment, and surgery to be covered for transgender patients just as they are now for non-trans patients.

Barbara Garcia, the director of the Department of Public Health, told the B.A.R. Monday that her agency is committed to the changes, but that it would take another year to year and a half before the administrative steps are implemented, due to contracting requirements.

"We're totally committed to it," Garcia said.

Wiener introduced a resolution at Tuesday's board meeting calling on the health department to "provide medically necessary transition-related care for transgender people and to remove exclusions under the San Francisco Health Care Security Ordinance," or Healthy SF.

Healthy SF is the city's locally designed and funded universal health care program that was launched in 2007. It currently provides hormone treatment and mental health services to transgender participants, but administratively excludes sex reassignment surgery and denies coverage for certain surgical procedures to transgender people when the same procedures are provided to non-transgender participants, "thus denying transgender residents equal access to necessary health care under this local plan," Wiener's resolution states.

For example, a Healthy San Francisco participant diagnosed with breast cancer could have breast reduction surgery covered under the plan, but a female-to-male transgender person could not have the same surgery covered.

Wiener said the costs would be negligible and pointed out that when the city began offering similar benefits to its transgender employees several years ago the actual cost was lower than the projections.

Cecilia Chung, a transgender woman who was former president of the Human Rights Commission and who was recently appointed by Mayor Ed Lee to the Health Commission, agreed.

"The benefits outweigh any costs," she said. "It's removing barriers to transgender patients."

She also said that such services would be determined between the doctor and patient.

"Most procedures are already being offered," Chung said. "We want the process to be smooth but realistic."

The city spent approximately $150 million on Healthy SF in fiscal year 2011-12, Wiener said.

Wiener's resolution noted the "insignificant" cost of removing the exclusions and that inclusion "in fact provides cost savings as well as significant benefits for the health, welfare, and safety of the transgender population," according to a California Department of Insurance study of actuarial data of five employers, including the city of San Francisco.

It's been a long road for transgender leaders, who started talking about the change nearly two years ago when the initial complaint was filed.

"Since then, we've been negotiating with Barbara Garcia, TLC, and the community group to move forward," said Human Rights Commission Executive Director Theresa Sparks, who is transgender. "San Francisco should be a center of excellence for transgender health."

Sparks and the other transgender advocates pointed to Wiener's involvement being a key to accelerating the changes to Healthy SF.

"Scott brought energy to the discussion," Sparks said.

Wiener; Sparks; Kristina Wertz, director of policy and programs for TLC; and Masen Davis, executive director of TLC, also noted that more private sector employers are now removing transgender health care exclusions. The Human Rights Campaign, a national LGBT rights organization, made providing such coverage part of its Corporate Equality Index and that, too, has led to an increase in private sector companies coming on board. Those firms run the gamut from Bank of America to Chevron Corp. to Intel.

As to the original complaint, Sparks said that her department, the health department, and TLC held several mediation sessions with the client and DPH agreed to provide the services under the city's general services provision, not Healthy SF.

"The complaint shed light on the exclusion," Wertz said Monday.

Some two years ago TLC and Lyon-Martin Health Services established the Health Council, a local group formed to advocate around transgender health care needs. Jackson Bowman, a transgender man, said this week that he welcomes the announcement from city leaders.

"Removing the exclusion in Healthy SF is important. There was a discriminatory element with the exclusions," Bowman said.

Bowman also pointed out the unique demographics of the transgender population, noting that many are chronically underemployed or in-between jobs. Bowman himself recently became unemployed, he said.

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