Sex Reassignment Surgery under OHIP

By Siobhan Doria

Effective on June 3rd, 2008, Regulation 552 of the Health Insurance Act has been amended to reinstate sex reassignment surgery (SRS) as an insured service under the Ontario Health Insurance Plan (OHIP). To be eligible for the procedures one must complete a Gender Identity Clinic Program to ensure the mental readiness of the candidate. [1] Before addressing the question if SRS should be covered by OHIP, it is necessary to note what particular surgical body changes are insured; as well as provide a basic understanding to the discrimination and fear the transgender population face in society.

For male to female reassignment surgery the removal of male genitals, construction of vagina, labia, and clitoris is compensated. For female to male surgery the removal of breasts and chest reconstruction, the freeing of the clitoris and construction of testes, or removal of female genitals, construction of male genitals, as well as the removal of the uterus and ovaries upon recommendation as of part of transition. However, there are procedures that are not covered by OHIP: breast implants, facial surgeries, neck and vocal chord surgery, hair transplants and removal, and liposuction. With that being said, hormones supplements are similar to other prescriptions, in that, they are either paid for by the patient, a company health insurance program or, for those who qualify, a government program such as the Ontario Drug Benefit Program. [2]

Medical coverage varies across Canada. Some provinces fully cover SRS while some offer partial, and others provide coverage for related therapies. Those standards concerning which specific services are covered by medicare must recognize the necessities of transgender medical requirements. We need to ask who is in the best position to know a person's sex? These decisions must be based on fact not determined by preconceived notions of what it means to be transgender. They should be about distinguishing between what is and what isn’t life threatening or deemed “medically necessary.” [3]

Before formulating conclusions it is critical to understand the conceptualization of sex and gender. Gender in this article is referred to as the social meanings and value attached to being female or male in any given society. Its focus is identity which is expressed through the concepts of femininity and masculinity. In comparison, sex refers to the biological differences between females and males defined in terms of anatomy, which consists of two types of human being. [4]

Transsexualism is a term used to describe anyone who bends or challenges "traditional" gender roles: gay cross-dressers, straight cross-dressers, transsexuals, drag queens and kings. [5] Transsexualism shatters the beliefs of binaries and stimulates questions of the significance of gender identity in our lives. The majority of us believe that gender is male or female for the sole reason that we are comfortable living in our birth designated sex. But, where do those who are transgender fit in the artificial gender binary? Transexuals have made it possible to imagine that a person could feel themselves to be a particular gender “trapped” in the “wrong” sex, as well as ask ourselves what counts as a person and a coherent gender? [6] 

We live in a world that is black and white. There is male and female, masculine and feminine. With such a strong emphasis on sex divisions members of the transgender community face, job discrimination, the inability to rent apartments, violence, and the inability to alter government issued identification cards. [7] Obtaining appropriate identity documents can be a challenge which further diminishes the ability to gain appropriate health care. [8]

The Canada Health Act was designed to guarantee individuals freedom from the burden of medical costs concerning necessary procedures. It was created to ensure medical treatment is accessible and inclusive. Demanding individuals to pay for medically necessary treatment is unethical. Reassignment surgery is not a luxury or cosmetic. It is a necessary procedure that some transgender pursue to aid themselves in leading productive and satisfied lives.

I wonder, what are the limits of medicare coverage? Does prejudice against an identifiable minority affect who is covered? Is it fair that the Canadian tax payers pay for the health care of people who chose to smoke? Or liver transplants for alcoholics? People should be careful not to use what is $200,000 on a $40.2 billion health budget as an excuse to continue the cycle of transphobia.9 Our  beliefs and attitudes need to be motivated by compassion and understanding of gender issues, not by our concerns of government spending and the nature of the operation.

Everyone deserves the opportunity to prosper, to have dignity, and to be emancipated from socially constructed labels. As a heterosexual I cannot truthfully express the pain and feelings of discomforts transsexualism face. I can only subjectively ask, who can I become in such a world where the meanings and limits of the subject are set out in advance for me? By what norms am I constrained to? [9]

From the moment a doctor performs an ultrasound and declares us as either a boy or girl our lives are immediately shaped and planned, for the most part, we seem to follow our gender paths quite naturally. Unlike some we do not struggle to pretend to be a gender that that does not fit and feels unnatural. We are not in despair at not having a body that matches our mind. For society to demand that we adhere to a gender confronts the notion of hierarchy in gender and claims we each have one true sex. [10]