City of Chicago to cover employees' gender reassignment surgeries

Transgender city employees and their dependents will soon get $100,000 in costs tied to their gender reassignment surgeries covered by taxpayer-subsidized city health insurance, under a groundbreaking mayoral order disclosed Wednesday.

After the landmark U.S. Supreme Court ruling that made same-sex marriage legal across the nation, one of five openly gay aldermen urged Chicago to turn its attention to the rights of transgender people and consider requiring “gender-neutral” washrooms in public places.

Emanuel didn’t go quite that far Wednesday. But he did take a giant step to recognize the rights of transgender Chicagoans.

While the mayor spent the day in Washington, D.C., his office put out a news release announcing that the city was poised to lift the “exclusion of gender reassignment services” from city health care benefits.

That means “male-to-female or female-to-male” surgeries tied to the painstaking process of changing gender would become “standard” for city employees and their dependents covered by taxpayer-subsidized city health care plans.

City Hall said it is “in the process of finalizing specific criteria” that must be met to receive coverage for the multiple procedures tied to changing sex and which specific procedures would be covered.

But a $100,000 “lifetime cap” on gender reassignment procedures is planned for each employee to avoid saddling the cash-strapped city with expenses it can’t handle.

No matter what the new benefit ends up costing the city, it’ll be a drop in the bucket of the Chicago’s skyrocketing tab for health care. Emanuel’s 2015 budget pegged those annual costs at $470 million.

Dr. Loren Schechter is a plastic surgeon who has been performing gender confirmation surgeries for more than 15 years.

Schechter said the $100,000 cap should cover most of the basic procedures tied to male-to-female surgeries, including breast augmentation, creation of a vagina and procedures related to what he called “facial feminization.”

But Schechter said the $100,000 cap would likely not be enough to cover lifetime hormone therapy, nor would it cover female-to-male conversions.

“Making a penis and testicles is much more complex and expensive. It’s often performed in several stages. The cost is probably at least $15,000 just for the implants. That’s minus the professional fees and hospitalization costs. There’s also the female-to-male mastectomy — removal of breasts,” he said.

“I don’t’ believe $100,000 is enough. I guess you can say it’s better than nothing. It certainly defrays a portion of cost. But I’m not aware of insurance companies that put limits” on these procedures.

The mayoral order is expected to be approved by the Benefits Committee on Tuesday and take effect on October 1.

It will be implemented first and unilaterally for non-union city employees while the city continues “working with labor partners” to do the same for the unionized workforce.

“Chicago is known for being a city that is welcoming to all and inclusive of every resident, and this new policy is in line with our efforts to support the rights and well-being of transgender individuals,” Emanuel was quoted as saying in the news release.

“With this change, Chicago will ensure that transgender city employees are able to receive the medical care that they need.”

Emanuel said he decided to push for the groundbreaking changes after the ACLU raised a red flag about the city’s decision to deny health insurance coverage to a transgender city employee. The city employee at the center of the controversy does not want to be identified or interviewed, the ACLU said.

“We commend the City of Chicago for recognizing that no one should be denied insurance coverage because of who they are,” John Knight, LGBT & HIV Project Director for the ACLU of Illinois was quoted as saying in the news release.

“More and more cities, states, private employers and the federal government have gotten rid of these outdated policy exclusions that make no sense, from either a medical or an economic standpoint. It’s wonderful news that Chicago employees will now have access to the gender affirming care they need.”

The mayor’s office billed the change as paving the way for Chicago to become the nation’s largest city to cover sex change surgery. San Francisco, Washington, D.C. and Philadelphia already provide the benefit.

In the private sector, Aon, Exelon, United Airlines, Hyatt Hotels, Groupon and AbbVie are among the Chicago companies that also provide such coverage.

Last year, an appeals board at the U.S. Department of Health and Human Services ruled that Medicare may no longer exclude gender-reassignment surgery from coverage.

Emanuel has been a champion of gay rights and a darling of the gay community as an aide to Presidents Bill Clinton and Barack Obama and as a member of Congress and as mayor.

As Obama’s chief of staff, he lobbied the president to issue an executive order protecting hospital visitation rights for same-sex couples.

The spotlight has shined even more brightly on issues surrounding transgender Americans after a television interview with and subsequent appearances by former Olympic decathlon champion Caitlyn Jenner.