The Secret Obamacare Sex Change Plot (That Doesn’t Exist)

San Francisco, in a first for any U.S. city, is taking steps to cover the cost of gender realignment healthcare for trans citizens who do not have private health care insurance. This groundbreaking step is, however, being maligned by religious conservatives as a secret Obamacare plot.

San Francisco’s Health Commission voted unanimously on Tuesday to extend its existing health care program to cover the cost of gender realignment surgery. Currently, while hormone treatment, counseling and routine health care for trans people is covered by the city’s program, surgical intervention is not subsidized.

What is Gender Realignment Surgery?

Gender realignment surgery isn’t always necessary for transgender identifying people. However, for those who have been medically diagnosed as requiring gender change surgery in order to complete their transition, there are a number of surgeries which can aid trans people in living their lives presenting as their affirmed gender.

Surgeries that are classed under Sex Reassignment Surgeries, or the preferred and more accurate term Gender Realignment, are wide-ranging.

For affirmed trans men, they may include facial surgeries to give more prominent male features, chest surgery, a hysterectomy, phalloplasty and testicular implants.

Surgeries for affirmed trans women may include altering the facial features to reduce perceived male traits such as a square jaw, breast augmentation, a tracheal shave in order to reduce a pronounced “adam’s apple,” and genital change surgery.

Some trans people may elect to have no surgeries at all, finding that they can present as their gender identity, usually with the aid of hormone therapy, without surgical intervention.

Others may decide with their doctor that they require only “top” surgeries, that is to say surgeries that deal with the face, chest and upper regions of the body that are more readily visible. This enables trans individuals to present as their affirmed gender more easily.

Some trans people find they require a more extensive list of surgeries including genital change surgery. Consultation with a physician as to the amount of surgeries required is a personal process, and the care regimen is unique to each individual.

Gender Change Surgery Is Not About Vanity

It is crucial to understand that gender change surgeries, when they are required, are not simply cosmetic procedures and should not be maligned as vanity.

Gender realignment surgeries are a form of necessary medical treatment for gender dysphoria, that is to say a disparity between sex characteristics and gender, and as such they are vital to enabling trans people to live their lives in the body that matches their gender identity.

There is a problem, however. The high price of surgery can prevent trans people from completing their transition, or push them into some $35,000 of debt, therein causing potentially high levels of emotional distress and financial difficulties which increase the risk of homelessness.

As such, and after dialog with local trans groups and health care providers, San Francisco’s health commission this week decided to remove gender realignment surgeries from its list of specifically excluded procedures and instead create a designated inclusive program to meet the needs of trans citizens.

However, for the moment at least, this change remains symbolic.

Currently San Francisco lacks the capability to provide such surgeries. City officials will also have to make a careful study of how many people this change will serve and, indeed, how much it is expected to cost.

In the long term, however, this starts the process toward allowing trans people without private insurance to access the full range of medical care they may need.

A Victory for Transgender Health Care

In a statement, the Transgender Law Center points out this move to further serve the city’s trans community is consistent with prior actions and, also, medical opinion:

Healthy SF currently excludes transgender patients from accessing medically necessary transition-related care that is available to non-transgender patients. Transition-related care has been deemed medically necessary by the American Medical Association and numerous other professional health organizations. The removal of these exclusions follows a growing trend in government, educational institutions, and corporate America toward inclusion of health coverage for the medical needs of transgender people. The cities of San Francisco and Berkeley have already removed such exclusions for city employees.

Masen Davis, Executive Director, said “Removing these exclusions will make a real difference in the lives of transgender San Franciscans, especially those who struggle to make ends meet. I am grateful for the leadership of our HEALTH Council members, Supervisor Weiner, and many others who have all worked together to make this happen.”

There’s always a fly in the ointment though, isn’t there?

San Francisco’s forward thinking has made the socially conservative commentators and groups come out in droves to display their ignorance.

“Taxpayers cannot afford this, as there are unintended costs and unintended consequences unrelated to the actual surgery, such as their longer-term hormone treatment, psychology needs and other longer term health issues,” Thomas Moyer, author of “A Conservative Survival Guide to San Francisco” told Fox News in what is perhaps the vaguest protest we may ever hear.

The most overblown reaction to-date comes from the National Review Online that this is in fact part of the secret Obamacare agenda:

Eventually with Obamacare, we will see the same thing happen on a national basis — a Free Sex Change Rule, if you will. Here’s why: Centralized health care is politicized health care. Thus, the Free Birth Control Rule was promulgated to reward an important Obama political constituency and help serve as a foundation for the planned reelection “War on Women” lie.  Moreover, it has become a powerful sword in the administration’s very real War on Religion that seeks to shrivel freedom of religion into a highly constrained “freedom of worship.”

Apparently, trans people being able to access medically-affirmed necessary treatment is in fact part of a huge government conspiracy to take away your religion and impose “San Francisco” values on America.

If those San Francisco values amount to giving our trans brothers and sisters, neighbors and friends the care they require in order to prevent emotional harm, and the very real danger of depression leading to suicide, then those are values to which I will happily subscribe.


Related Reading:

Transgender Rights Are A Feminist Issue

How Voter ID Laws Impact Transgender People

Transgender Athlete Breaking Barriers

Image credit: Thinkstock.


Emma Lloyd
Emma Lloyd5 years ago

I wish there was a secret Obama sex plot. Gender realignment surgery should be available to anyone who needs it.

Annmari Lundin
Annmari Lundin5 years ago

Good move S.F.! And boo-hoo to those hypocriticals claiming they've been violated.

Lynn Squance
Lynn Squance5 years ago


. . . inclined to strut their theological stuff. "

So these evangelicals felt they were being persecuted, became more defensive, and turned around and started doing the persecuting — demanding that their way, regardless whether others felt the same way or not, be the law of the land, the moral compass if you like. As such, it is an exclusive stand that has no room for Jew, Muslim, Buddhist, Atheist, Agnostic, Animism or whatever faith someone has chosen to follow. It also means the decisions or proclamations made out of that religion infringe on the rights of others. In my opinion, it is not true to the real Christianity, nor is it in keeping with the constitution. Here's the link:

Lynn Squance
Lynn Squance5 years ago

OMG! Here we go again (or is it still?)! The National Review On-line is continuing the myth of Mr Obama's war on religion, and hanging on that myth, contraception and sex re-alignment,among other things I'm sure.

I find that it is these fanatical evangelicals and the like (read Roman Catholic church here), who have declared a 'war on religion' --- any religion that is not their's! How many trans people have to die because they couldn't cope without having the re-alignment surgery? How many women like Savita Halappanavar have to die because doctor's won't do what is just and needed because the church says NO?

Justice, love, compassion, and mercy are all sadly lacking in the fanatical evangelicals and the RCC.

This quote, taken from the 2009 WSJ article "The Power of Prayer" is rather telling.

"Part of the evangelical identity, increasingly, was a pugnacious sense that they were being persecuted and should not be cowed into suppressing their faith. "I knew stating that there is no other Name by which an individual can be saved grate on some ears and prick some hearts," Franklin Graham wrote about his inaugural prayer in his book, "The Name." "However, as a minister of the gospel, I was not there to stroke the egos of men. My role was to acknowledge the all powerful One and please Him….I want to please my Father in heaven no matter the cost." The country's growing religious diversity left evangelical Protestants feeling more defensive and inclined to strut t

Danuta Watola
Danuta W5 years ago

Thank you for information

Allan Yorkowitz
.5 years ago

I am so confused by this article. Does the current Obamacare cover sexual realignment or not?

Jane H.
Jane H5 years ago

Thank you---it is a sacrifice, to some extent for a male trans person to become a woman, even if it feels better. Pay for women---in any job is less than a man earns, and there are other discriminations as well. Oprah Winfrey had a great show about trans folks--little children as young as 2 or 3 years old knew they were in the wrong body.

rene davis
irene davis5 years ago

thank you.

ali a.
ali a5 years ago


Genevieve L.
Genevieve L5 years ago

Yes!! Yes!! Now that it's free, I feel the overwhelming urge to go though painful and extensive surgeries and treatments! Finally, the secret sex-change for everyone is exposed!

But seriously... Do these people even believe themselves? Or is it just for the few medieval-minded illiterates red-states redneck rightwingers' benefit? I can understand people not being happy that their tax money is going to these treatments (even though they are really essential to the people who were unfortunate enough to be born in the "wrong" body), but a secret plot to get everybody to change sex? The sad thing is that it's not even the most ludicrous thing conservative right-wingers have said recently. In fact, not even close. Sigh.