I'll begin by indicating that by GRS, I mean Genital Reconstruction Surgery. It is also know as Gender Reassignment Surgery, Sexual Reassignment Surgery (SRS), Gender Affirmation Surgery and, I'm sure, many other names and acronyms that are, to varying degrees, correct and/or incorrect depending on who is doing the surgery, who it is being done on and who is casting judgement upon it. When I was growing up, it was known as a sex change operation.
Oh, and as a disclaimer, I will be undergoing this procedure in less than three weeks, so it is something I have become a lay expert on in the process of procuring it.
So what are the politics aside from a sematic dispute over what to call it?
In relation to other surgeries, GRS is not particularly costly. I am paying $18,040 CDN for the procedure which, in U.S. dollars after exchange fees and whatnot, is in the neighborhood of $18,700. As my spouse has indicated, this would have bought us a new car. To pay for my procedure, I am earning a third master's degree in Educational Information and Technology and borrowing as much as I can. It's the best loan rate I can get. The same procedure can run over 30K here in Phoenix or somewhat less depending upon the surgeon and/or country (Thaliand being somewhat less expensive, but also requiring a longer journey).
So what about insurance? I'm a public school teacher and while my benefits are not the best, they are reasonably good all things considered. However, there is no coverage for anything related to trans care and, as we know, insurance companies can boradly define things as they will. But certainly GRS is not an option for them. A couple of companies cover the surgery and a couple of surgeons accept the coverage. It is limiting, but if I had that option, I would accept the limits.
The HRC requires companies wishing to be considered 100% compliant to provide :
As part of HRC's commitment to ending transgender discrimination full credit will only be given to employers offering all benefits-eligible employees (and their dependents) at least one health insurance plan that
•Covers medically necessary treatments without exclusions or limitations specific to transgender individuals or to transition-related care, and
•Conforms to current medical standards of care such as those defined by the World Professional Association for Transgender Health's Standards of Care in determining eligibility and treatment coverage for transition-related services.
This means that an employer must provide at least one plan that is available to all their employees that provides for complete transgender coverage, from therapy, to hormones/blockers, to medically necessary surgical procedures and aftercare etc. This plan must also include dependents of the employee so that a transitioning 'dependent', including a child, is covered. These effectively eliminate discrimination against transgender employees and/or dependents. Many businesses have already taken steps to remove discrimination from at least one of their health insurance plans for employees and their dependents: Employers of varying size and across industry sectors have successfully introduced coverage inclusive of services related to transgender transition, either at no cost or at a negligible cost.
I hope that this will change things in the future. But we are still a long way off from this being covered as it should rather than excluded unless otherwise indicated.
Because the fact is that it is boilerplate excluded on most policies and there is little political motivation for anyone to challenge this discriminatory exclusion, it will take legislation.
I have seen that some trans people are upset with the fact that the repeal of DADT did not include trans people. I am less upset by this than by the basic denial of medical care for our condition by insurance companies that needs to be corrected.
Beyond the costs of the procedure and the problems with insurance, there are some issues with GRS that should be considered.
An equally important issue is identity. For myself, this is not an problem. I am a native Californian and changing my birth certificate is relatively easy for me given my native state's more liberal laws. I live in Arizona which actually has made it quite easy to change my name and documentation to match my gender.
But there are a few states such as Idaho and Ohio that will not change or amend a birth certificate, meaning that for those trans people unfortunate enough to have been born in one of those states, they will never be able to amend their birth certificate to show their correct sex. This is problematic for a host of reasons including the ability to have a legal marriage in states that do not allow for everyone to get married. There is no good reason to allow individual states to make area specific laws in this regard.
There should be a federal record of birth that can be amended without prejudice. This would solve a host of problems and not just for trans people (such as making sure no one can question one's citizenship).
I am extremely fortunate that I am able to have this procedure and that I will have relatively few problems beyond it (I say relatively few in relation to others in similar circumstances...I still have those student loans to pay off). The AMA and APA both agree that this is a necessary medical procedure and yet some still dispute this, calling it elective or a form of self-mutilation or worse. Things have gotten better, but they are not nearly where they need to be for the many trans people out there who will suffer due to lack of funds or coverage or protections.