San Francisco plans comprehensive health program for transgender residents

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The health commission in San Francisco, a city that adopted a universal health care program five years ago, voted last week to expand options for transgender residents.

San Francisco provides hormones, counseling and routine health services but has stopped short of offering surgical procedures, public health director Barbara Garcia said after the vote was announced.

The idea for a new program came out of conversations between public health officials and transgender rights advocates who wanted surgeries covered under San Francisco’s five-year-old universal health care plan. 

At the urging of the San Francisco Board of Supervisors and the San Francisco-based Transgender Law Center, the commission agreed 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.

Instead of expanding the existing plan, the San Francisco Health Commission approved the establishment of a separate program that covers all aspects of transgender health. 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 transition surgeries for government employees. Last year, Portland, Ore. did the same.

The number of major U.S. companies covering the cost of surgeries for transgender workers also doubled last year, reflecting a decades-long push by activists to get insurance companies to treat such surgeries as medically necessary instead of elective procedures. 

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.