The Alberta Government has announced that it will be reinstating health care funding for sex reassignment surgery (often called gender reassignment surgery, and abbreviated as GRS by the province and its clinicians), effective June 15th.
In the recent provincial election, Premier Alison Redford was returned to power by an electorate that appears to have been hoping her government would track back toward progressive politics. Albertans have been watching to see if her government would indeed follow through, and in what manner. An Angus Reid poll placed Ms. Redford as the second most popular Premier currently in power.
The province had cut funding in 2009 as a "cost savings measure" - however, the $700,000 savings (provided for approximately 16 people per year) wasn't even a sliver of the provincial health budget. Since then, the Province has been on shaky legal ground with the funding cut, since human rights tribunals have typically recognized the procedure as being medically necessary. It was for this reason that the Province of Ontario ultimately reinstated funding, and B.C. abandoned an attempt to defund the surgery. Judicial court rulings (eg.) in Canadian case law also indicated a likelihood that the medical necessity of GRS would be upheld.
The Trans Equality Society of Alberta responded to the announcement with a media release:
We are pleased that the current administration sees value in caring for all Albertan's needs, enabling them to live happy, fulfilled lives. The return of this coverage, whose removal only saved Albertan's $0.18 each annually, will give hope to those for whom GRS was previously out of reach. While there are many other issues facing Trans-identified Albertans, this is a huge step in the direction of respect and dignity for the Trans Community by the Alberta Government. Thank you for taking this important first step.
The American Psychiatric Association and American Medical Association both stress that sex reassignment surgery is a medical necessity, and a 2008 resolution by the AMA emphasized that insurance companies should cover the procedure.
Most Canadian provinces have some form of coverage for GRS, although some have problematic quirks of process or costs that can create barriers to obtaining the procedure, and some still do not fund sex reassignment procedures for trans men. In 2008, Nova Scotia's Liberal Party added working toward GRS funding inclusion to their political platform, although it has not yet been accomplished in that province.
Internationally, several nations have also added coverage to their public health insurance programs over the past couple of years, including Cuba, Brazil, and Chile. Argentina recently passed the most comprehensive policies on trans enfranchisement, which included GRS funding, new name change guidelines, anti-discrimination inclusion in their human rights code, and legal protections from hate crimes. A number of Australian provinces are under renewed pressure to provide funding after an incident of attempted self-performed surgery in an act of desperation. There have been (trigger warning) at least three other major self-mutilation incidents reported in international media in the past year, including one person in China who self-castrated and then jumped to their death because they couldn't deal with the pain. Although not all trans people decide that they require surgery, for those who do, it can be an absolute necessity.
Corporations have also been rapidly adding health plan coverage to their benefits programs, including Apple, Chevron, General Mills, Dow Chemical, Chubb, American Airlines, Kellogg, Sprint, Levi Strauss, Eli Lilly, Best Buy, Nordstrom, Volkswagen's U.S. division, the University of Pennsylvania, Whirlpool, Xerox, Raytheon and Office Depot (note: some of these may not apply in Canada). According to the Human Rights Campaign's Corporate Equality Index (CEI), over 200 major U.S. businesses now include trans-inclusive health care coverage featuring surgical transition-related care, including 50% of Fortune 500 companies - an increase of over 1500% in that group since 2002.
Alberta's 2009 announcement was followed by a mass filing of human rights complaints. Due to changes in grandfather-through decisions, some of those complaints were negated when funding was given, and others are still in process. Due to the backlash at the time of the announcement, the province had eventually conceded to provide funding for people already in transition prior to the cut, to a maximum of 20 per year. A number of others who had not qualified for the "Phase Out" program (usually because of the timing of their first medical appointment after starting transition) had been typically offered GRS funding as part of a settlement during negotiation stages of their human rights complaints, but have not spoken to media due to confidentiality requirements.
Although this victory is huge, some concerns about medical access remain. It can be difficult or near impossible to find trans-friendly (let alone trans-aware) medical practitioners in several regions of the province. This can make it hard to even find general practitioners willing to treat people for medical issues that are not trans-related.
For transition care, there is one clinic in Edmonton (therapy only, currently with an 18+ month waiting list) - in Calgary, there is also a once-a-month trans health clinic operated by a psychologist and a family doctor who've teamed up to try to help, but the need is one that is difficult to fill with a once-a-month model. The previous Stelmach government had shut out attempts by the trans community to speak about these matters, and advocates are hopeful that this can now change.
On Wednesday, the Federal government voted to allow a human rights bill proposing protections for transsexual and transgender Canadians to committee for review and possible changes, toward a final vote. The bill had passed in the previous Parliament, but died in the Senate upon the election call.
(Here is a full backgrounder on why GRS is medically necessary. It is also available as a trifold brochure)
(Crossposted to Dented Blue Mercedes and Rabble.ca)