In 2007, San Francisco became the first city in the nation to offer universal health care to its citizens through the Healthy SF program, which provides government subsidized health services to uninsured residents. Now, with a unanimous vote of the San Francisco Health Commission, the Healthy SF program will extend to transgender patients.
"Until now, Healthy SF excluded care for transgender issues, even when the procedures are medically necessary," said Kristina Wertz, director of policy and programs at the Transgender Law Center. "A transgender man may need a hysterectomy as part of his transgender operations and it wouldn't be covered, but a non-transgender woman could need the exact same procedure and it would be covered."
The Bay Area Reporter explained that Healthy SF previously offered some services to its transgender subscribers, such as hormone treatment and mental health services, but excluded for them many surgical procedures available to non-transgender individuals.
"That to me was just wrong," said San Francisco Supervisor Scott Wiener, who initially proposed the rule change before the city's Board of Supervisors earlier this year.
Wiener explained a transgender exemption wasn't written into the initial law when Healthy SF was first proposed. The policy was instead inserted by the city's Department of Public Heath during the early days of the program under the assumption that it would eventually be removed as Healthy SF moved forward.
Under the new system, Healthy SF will cover transgender procedures as long as they are both medically necessary and already covered for non-transgender patients.
"There is a historical bias against transgender people in health insurance plans," explained Wertz, "although that is starting to change with more plans opening up access."
A report by LGBT advocacy group Human Rights Campaign noted that in 2004, only one percent of Fortune 500 companies offered transgender-inclusive health insurance policies. By 2011, that number had grown to 25 percent.
The San Francisco already offers transgender-inclusive plans to city employees.
Even so, as Wiener explains, the transgender community still faces major challenges regarding access to both employment and health care.
San Francisco HEALTH Council member Kathryn Steuerman experienced these difficulties firsthand. "Although I was fortunate enough to obtain medical coverage through my employers over the years, the exclusion of transition-related care from these insurance policies left me with no choice other than to utilize credit in order to obtain the care I truly needed," Steuerman said in a statement. "As a result, I was forced to go into deep debt from which it has been very difficult to emerge.”
In addition to its changes to the Healthy SF program, the new legislation also calls for the creation of a group within the city's Department of Public Health focusing exclusively on health issues pertaining to the transgender community.
That program expected to get up and running in the coming months.