More than a year after the Alberta government announced it would no longer provide funding for gender-reassignment surgery (GRS), Alberta Health and Wellness has quietly agreed to pay for up to 20 surgeries per year until 2015. The new guidelines, which have yet to be publicly announced, are part of the government’s plan to phase out funding for GRS.
The news comes as a welcome surprise to some members of the Alberta trans community who received government letters last week, informing them of the program and the criteria that must be met in order to qualify.
Diane Gall, a male-to-female transsexual in Medicine Hat, has been waiting since April 2009 to find out if the government will pay for her surgery.
“Oh my god, I can’t even express to you how relieved I was when I got this [letter], and I looked at those criteria, and I realized that I qualify,” she says.
Gall says she’s been in limbo since the cuts were announced last spring.
At the time, the Alberta government said the decision to cut funding for GRS was made to save the government $700,000 in the 2009/10 budget. Activists pointed out that it wasn’t a significant cost savings measure, amounting to only 19 cents per Albertan.
Several days after the initial announcement, then-health minister Ron Liepert said the government would cover operations for those who had already started their transition. This left many patients confused and wondering whether they would be “grandfathered” through. Wanting more clarification, Gall says she sent several emails and letters to the government, but never got a response. Eventually, she joined dozens of other transgender people in filing individual human rights complaints.
“Now we know what the minister meant,” says Gall. “But I know why a lot of people are surprised — because they believed that the government would simply say ‘Too bad, so sad.'”
The phase-out program isn’t good news for everyone, though. Gall says her excitement was “immediately tempered” when she realized that not everyone wanting surgery will qualify.
In order to be eligible for funding, patients must have met the following criteria prior to April 7, 2009. Patients must have been:
- a resident of Alberta with Alberta Health Care Insurance Plan coverage;
- aware of Alberta Health and Wellness’s GRS program;
- diagnosed with Gender Dysphoria or Gender Identity Disorder;
- and were in an irreversible physical state between sexes as a result of hormone therapy or had undergone initial surgeries with the expectation that the final surgery would be covered.
In addition, each patient must have completed the real-life test — a one-year trial period, during which patients live full-time in their preferred gender role under the supervision of a psychiatrist. Patients must have met all program criteria, including the real-life test, by March 31, 2011.
Psychiatrists with a special interest in Gender Identity Disorder are required to submit registration forms by July 31, 2010 for all of their patients who potentially qualify for the phase out of the GRS program.
Lorne Warneke, a doctor in Alberta authorized to provide gender-reassignment referrals, says the short timeframe is unfair.
“That’s a very difficult deadline for me to meet,” he says. “Everyone who wants to be included has to see me before [the end of] July 2010 — well, that’s only a few months away. That’s unfair to me, and it’s unfair to people who are trying to get in to see me.”
Warneke has other concerns too.
REINSTATE FULL GRS FUNDING, SAY ACTIVISTS
Gender-reassignment surgery is a medically necessary procedure and funding should be permanently reinstated, says Mercedes Allen, a trans activist in Calgary.
While Allen welcomes the funding for the phase-out program, she says it isn’t enough.
“Just because some people have been grandfathered through doesn’t mean anything’s really going to change,” she says. “There will always be transgender people and some of those will always need to go through a transition process, and many of them will need surgery.”
Allen, who was “grandfathered” through and had her final surgery in August, says the operation allows transsexuals to put closure to any discomfort they have with their bodies.
“The thing to remember is that who we are isn’t a choice,” says Allen. “We don’t wake up one morning and decide that we just want to do this. It’s something that we’re compelled to do.”
Kris Wells, a researcher with the Institute for Sexual Minority Studies and Services at the University of Alberta, agrees that the procedure is a medical necessity. He says it should be fully funded by Alberta Health Services as part of its health care mandate and that when it comes to health care, decisions should be made based on scientific and medical evidence, not at the whim of civil servants.
Wells says that by eliminating funding for surgeries, it will, in the long run, cost the government more money.
“Treating people who have Gender Identity Disorder is going to bring cost savings to the system rather than it being cost prohibitive… because if these individuals aren’t supported to find the health care services that they medically require, then it’s going to manifest itself in other areas,” says Wells. “Basically we’re talking about the impact of stigmatization that leads to a whole host of negative outcomes.”
Wells says the phase-out program presents a window of opportunity for the trans community and its allies to raise awareness of the issue and to pressure the government to fully reinstate the funding.
Allen agrees, and plans on doing just that.
“If [patients] have made irreversible changes with the knowledge that the surgery was paid for, to me, they should qualify,” he says. “My philosophy is you’ve got rules, but you’re also dealing with human beings — and human lives don’t always fit nicely into categories.”
The operation costs about $18,000 to transition from male to female and about $60,000 for females to males.
If patients were on a waiting list and weren’t able to get in to see Warneke before April 7, 2009, he says he’ll make a case that they should be covered, provided they’ve already transitioned and are living full-time in their preferred gender role.
According to Warneke, there are approximately 40 to 50 people he knows of who’ve made irreversible changes, but haven’t completed the real-life test yet. He estimates that 35 of his patients have fulfilled all the requirements and are eligible for funding.
Warneke says he’s still waiting for the government to make a public announcement.
“The government’s been very quiet about it, and I think it’s because… they don’t want to be perceived as having gone soft,” he says.
The new Alberta health minister, Gene Zwozdesky, did not respond to Xtra‘s request for an interview by the time of publication. A spokesperson for Alberta Health and Wellness says phase-out programs are common when eliminating a publicly funded service, and the government has no plans to reinstate full funding for GRS on an ongoing basis.
Warneke believes that if it hadn’t been for the strong lobbying of the trans community, whose members have been calling for funding to be fully restored, the government may not have followed through with the phase-out program. Warneke says he, too, wrote letters to Liepert, but got no reply. After writing letters to Zwozdesky, Warneke says he was finally invited to attend a meeting with Alberta Health and Wellness in November. Following the meeting, Warneke continued to badger the government for a phase-out program.
“I think if I had not badgered them, they would’ve just let this whole thing be glossed over without any action,” he says.
Others speculate that the phase-out program is the government’s response to the high number of human rights complaints filed by individuals in the trans community. They wonder if the government has received legal advice and if it is now trying to prevent these cases from going to court in order to avoid legal costs and the possibility of losing.
Gall, for example, wonders if her human rights complaint will be thrown out now that she qualifies for funding.
A spokesperson with Alberta Health and Wellness denied that this was the reason for the phase-out program.
Either way, Gall says it’s a bittersweet victory for her. On the one hand, she’s looking forward to her surgery.
“I don’t think that my life is going to change a huge amount,” she says, “but there’s still quite a lot of unresolved incongruity with the way my body works. So I’m looking forward to it being part of the final stages, and then I’m just a woman, and that’s that.”
On the other hand, she’s frustrated that not everyone will qualify.
“There are people who are going to be denied under these criteria. I was lucky, and that really saddens me because it’s simply a medical procedure — and that’s all — and it’s a necessary one. It’s like somebody saying ‘You know what? It’s really expensive to do coronary bypass surgeries, so we’re not going to fund that anymore.'”
Either way, Gall says, the fight isn’t over until funding for GRS is fully restored.
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Reinstate Gender Reassignment Surgery Funding in Alberta