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California and the West

San Francisco Benefits May Cover Sex Changes

Services: The new health care plan is expected to be approved next month. 'This isn't about cosmetic surgery or about people who . . . like to cross dress,' an official says.


SAN FRANCISCO — Supervisor Mark Leno has championed the rights of transgendered people for years, a cause he sees as this liberal city's remaining civil rights battle.

The fight may be ending: San Francisco is poised to become the first city in the country to provide benefits covering a host of medical needs for city employees seeking to change their sexual identities.

"This isn't about cosmetic surgery or about people who periodically like to cross dress," Leno said. "It's about people who have a disconnect between their psychological and physical identities regarding gender."

Under a new health care plan expected to be approved by Mayor Willie Brown and the city's Board of Supervisors next month, San Francisco would provide employee coverage for sex-change operations and related care. Officials estimate the transgender program could cost the city $1.75 million a year if 35 people take advantage of benefits.

Even in a city that prides itself on tolerant policies, the proposed benefits package has raised concern among some residents.

"I think there's far better things to be done with taxpayer dollars--like finding homes for the homeless," said John Clifford, a bank employee. "I'm not knocking the transgendered, but I think it's pretty much a choice issue. But there's no choice in being homeless."

Garth Moulton, a dot-com employee, disagreed.

"Look at what these people already have to go through--their life must already be hell," Moulton said. "How would you like to be walking around the street saying 'I look like a man but really feel like a woman.' We ought to give these people the benefit of the doubt."

Claire Skiffington, a city employee who is undergoing treatment to become a woman, applauded the new plan. The 55-year-old worker for the Department of Public Health has struggled to pay the $20,000 cost of estrogen therapy, previously not covered by insurance.

"This will make a difference," Skiffington said. "If you don't have the financial means to pay for your own treatment, then what is already an emotionally charged issue becomes nearly an impossible situation to reconcile."

Four years ago, San Francisco passed its landmark Equal Benefits Ordinance, which requires companies doing business with the city to provide gay employees and their domestic partners with the same benefits as married workers.

"But the city was being hypocritical because it wasn't offering equal benefits for our own transgendered employees," Leno said. "This new law will correct that."

Larry Brinkin, a compliance officer for the San Francisco Human Rights Commission, said the city hopes to set a national standard for its compassionate treatment of the transgendered, who he said are abused everywhere, from restaurants and employment offices to shelters for the homeless and police lockups. City officials say West Hollywood, Santa Cruz and Portland, Ore., have expressed interest in the program.

"This is truly a wonderful thing," Brinkin said. "Finally, we're on the way to become the sole city in the nation that does not discriminate against its transgendered employees."

City officials estimate there are 12 to 15 transgendered employees in a municipal work force of 29,000. They say San Francisco may be home to as many as 15,000 transgendered residents.

Transgender surgery can cost $35,000 to $80,000, city officials estimate. The new benefit plan would set a $50,000-per-employee cap and also would cover related services such as psychological counseling and care related to hormone therapy.

Leno said the new benefits plan was a priority for the city's transgender civil rights task force, which was established last year. The 17-member task force found numerous examples of discrimination against transgendered people, who struggle to secure jobs and housing. Leno said studies have shown they also face a murder rate 15 times higher than the general population.

"This is a horribly difficult life," Brinkin said. "More than 70% of the transgendered are unemployed. They face ridicule and worse from every corner of society. They're treated as freaks by their medical providers."

The city's Health Service System Board voted 6-1 earlier this month in favor of the new benefits plan, which would take effect in July. City officials say there has been surprisingly little opposition.

Leno said his office has received several e-mails and telephone calls from voters who ridiculed the plan.

"Many people are asking 'What's next? Is the city going to pay for nose jobs for its workers?' " Leno said.

"But they don't understand. They think this is some sort of elective surgery. So we figure we're educating people by doing this."

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