Portland Mayor: Let My People Obtain Gender Reassignment Surgery!

Portland may soon become the second city in the U.S. to include gender reassignment benefits in their employees’ health plans. And it’s all because of Sam Adams. (Okay, yes, like the beer.)

Mayor Sam Adams

Adams, the Mayor of Portland, is inspired by San Francisco’s decision years past to include the same benefits in their municipal health coverage. He has said he feels this is “the right thing to do,” and he certainly has reason to say so: the American Medical Association declared many moons ago that transgender health care is medically necessary, and that coverage shouldn’t be denied by insurance providers for that care. But the declaration hasn’t done much. Aside from these two cities, no other municipalities have adopted a policy inclusive of sex changes.

Opponents of including gender reassignment benefits in San Francisco often focused on the high cost of surgery, and how it would impact the cost of their health care. Gender reassignment surgery can cost anywhere from $7,000 to $50,000 dollars, and the inclusion of hormone therapy and other associated medical care makes it even higher. In San Francisco this led to restrictions on the coverage, but didn’t put a damper on their historical 2001 decision:

“Even though we’re not happy with the limitations, we think the fact that the benefits are being offered is wonderful,” said Larry Brinkin, senior contract compliance officer for the San Francisco Human Rights Commission, an agency that has pushed for the expanded coverage.

“This action will help lead to the elimination of discrimination against transgender people and hopefully will be a model for employers across the United States,” Brinkin said.

And Brinkin was right, or at least ended up being right ten years later. But in Portland the cost appears to be NBD: it only presents a .08% increase to their spending. That doesn’t mean the measure doesn’t have it’s opponents – it does. And they’re trying to distort numbers to win. But the plan also has vocal support, not only from the mayor but from city council commissioner Amanda Fritz:

“As a former nurse, I believe medical decisions should be made between the doctor [and the patient], and the insurance company shouldn’t be getting in the middle of who can have what kind of procedures. I think this is a step in the right direction.”

A sampling of headlines on this issue:

Portland Mayor Wants City to Pay for Gender Reassignment Surgery (KEZI TV)

Mayor: Portland Should Pay for Sex Surgery (KTVL)

Mayor Wants Insurance to Pay For Sex Change (KATU)

A poll on Oregon’s FOX affiliate website is so far so good — go vote!

The Portland city council will vote on the plan on June 8. Cross your fingers! The only remaining question really is, “why is this taking so long?” Major corporations like Google and Nike offer these benefits – why not municipalities?

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Carmen spent six years at Autostraddle, ultimately serving as Straddleverse Director, Feminism Editor and Social Media Co-Director. She is now the Consulting Digital Editor at Ms. and writes regularly for DAME, the Women’s Media Center, the National Women’s History Museum and other prominent feminist platforms; her work has also been published in print and online by outlets like BuzzFeed, Bitch, Bust, CityLab, ElixHER, Feministing, Feminist Formations, GirlBoss, GrokNation, MEL, Mic and SIGNS, and she is a co-founder of Argot Magazine. You can find Carmen on Twitter, Instagram and Tumblr or in the drive-thru line at the nearest In-N-Out.

Carmen has written 919 articles for us.


  1. I’m really interested to hear what people who might be affected by this legislation have to say about it.

  2. I may have to move out there and see if any of the offices need their own personal baker!

  3. Portland seems to be getting more and more awesome. As a Californian deserting to go to Oregon (which is strange for me) all this news is encouraging. I may have to relocate permanently.

  4. Portland: where even an 18 year old can enjoy a Sam Adams.

    Scandals are fun. He’s actually a pretty fantastic mayor.

    Needless to say, we’re all pretty thrilled about this.

  5. I was JUST saying how Portland is the new gay capital of the United States. Thank you for backing me up, Autostraddle.

    Also, I like the ratio of comments from this to the 100 hot lesbians post. 60:6.

  6. People get really pissed off when public employee health plans include what is considered elective surgery. I don’t see how something like this will get much support.

    I will freely admit I know extremely little about transgenderism; my guess is that transgender individuals suffer mental health issues being in the wrong body and surgery alleviates that. I understand that much and any mental health issues obviously need to be addressed. But the gender reassignment surgery is still elective as is any surgery that’s only purpose is to change your appearance. I’m sure some people will argue they are depressed because they have small boobs and want a boob job (which we can agree is silly, but the argument will be there.) Transgender individuals can invoke other methods (I know FtM’s bind, for example). I just think using taxpayer money to cover any sort of elective surgery is problematic. People found out public employees in my city got a cosmetic rider and went apeshit. (I actually was covered under my parent’s coverage and got laser hair removal for free. Hah.) The actual cost of covering elective surgery is a tiny, tiny, tiny piece of an overall budget. But it’s the idea that there’s little oversight and sloppy finances that really bothers people. They also get mad when elected officials order lots of takeout, as if they even makes a dent in the budget. I’m not trying to be a Negative Nancy. Just calling it like I see it. I would be surprised if this passes, but I don’t know much about Portland!

    • Calling medically necessary surgery “elective” is what is really problematic.

      Severe body dysphoria is a hell of a lot different than being depressed over body image issues.

      • I said that argument was silly, but that people will use it. What I was saying was that you’ll have a very difficult time trying to convince the general public that sex reassignment surgery is not elective and they should pay for it. I remember a couple times in the past few years where word got out some municipality paid for a sex reassignment surgery and everyone lost their shit so the municipality changed their healthcare plan. Personally, I think since the number of people who would need such a surgery is very low, they should just let those individuals (well, everyone, to be fair) the opportunity opt into a plan that covers it and give the others the basic plan. Then at least the argument for waste on extra cost is weaker.

    • “But the gender reassignment surgery is still elective as is any surgery that’s only purpose is to change your appearance.”

      I look at it this way — if a cis woman gets in an accident and, idk, loses a boob or something, shouldn’t the surgery to fix it be covered under her health insurance? It would be pretty absurd/cruel to say ‘oh no, we’re not covering your boob surgery, that’s just COSMETIC.’ I don’t see why the same shouldn’t go for trans people.

      • And I see that you clarified your statement above, rendering my comment unnecessary. NEVERMIND. /awkward

        • I agree that gender reassignment surgery should be covered. The thing I’d be very interested in knowing is how insurance companies view it. Do they consider it elective or medically necessary? Is it only covered under plans that have cosmetic riders? And what about the psychology community? I tried to do some searching to see if gender reassignment surgery is considered by mainstream medical experts necessary or elective and I couldn’t find anything. I think the ability of something like this to pass could hinge on those factors.

          People can easily get rhinoplasties by claiming a deviated septum makes it difficult to breathe, for example, so it may be a bit of transphobia that fuels the outrage over paying for sex changes. But also, I think there’s probably a lot of ignorance as to why it’s needed and what being transgender actually means. Poll the general public and I guarantee the vast majority will label it “elective” with no caveats. I think they probably think being transgender is like cross-dressing for fun. It will be interesting to see how this issue develops and what, if any, arguments are used to sway the result.

          • >And what about the psychology community? I tried to do some searching to see if gender reassignment surgery is considered by mainstream medical experts necessary or elective and I couldn’t find anything.

            It’s considered medically necessary. If you want precedent, the 1979 New York Supreme Court case of Victoria L. Davidson vs. Aetna Life & Casualty Insurance Co is probably where you’re going to best find it – the court ruled in favour of Ms. Davidson, finding the surgery “[could not] be considered to be of a strictly cosmetic nature”.

          • It was also (legally) considered medically necessary in a ruling last year involving the ability to write off certain transition-related medical expenses involved in transition as deductible expenses (O’Donnabhain v. IRS).

            It was ruled that SRS (and FTM top surgery) was a medically necessary expense. Unfortunately, it still left it somewhat unclear as to whether procedures like laser/electrolysis, breast augmentation and FFS (which, for trans women, are often even more important than SRS) are deductible, but it made a clear ruling about the medical necessity of SRS for those who need it.

  7. I applaud Mayor Adams is proposing this, however there is a more fundamental issue: how many trans people are actually hired by the city much less ones that could potentially benefit from this? Yes, SRS and other possible medical benefits are important, but it doesn’t erase the issue that a huge percentage of the trans population wouldn’t even be able to get employment in city jobs regardless of the anti-discrimination laws on the books (which are incredibly leaky, difficult to prove and still don’t cover a wide range of employees). Moreover, this doesn’t impact people who, for instance, work in schools (Portland is covered by a wide variety of school districts) nor people who are contract workers for the city. It’s a first, very basic rudimentary step… better than nothing but more symbolic than anything.

  8. I think the bigger question for P town is how many people are getting jobs. period. Also, of all the places I have lived Portland seems to higher a pretty diverse group. At least in the government sector. I think if we constantly poo poo any effort as too little, nothing will get done. Where do you start? We should all be so lucky to work for Nike or Google.

  9. My point is that real, genuine job discrimination protections which include contract workers, part-time employees, and temp employees (which is the reality of many of the jobs people are getting these days) and truly clarify discriminatory situations which trans people face (because the legislation which is currently used is virtually useless in the vast majority of discriminatory environments) as well as real job development initiatives for chronically unemployed trans people (and it’s huge in our community… even in recent surveys I believe it’s still undercounted) means a lot more than a few mythical people getting their SRS covered by insurance. This is putting the cart way before the horse, well intentioned though it is. The TEEI job development program in SF which targets chronically un and underemployed trans people is far more important development than permitting mostly non-existent trans city employees to get surgeries. Btw, in terms of hormones and blockers, Kaiser Permanente, which is one of the Portland city health care providers, already covers that.

  10. a lot more insurance companies cover trans related stuff than people realize. i have blue cross blue shield and it covers my testosterone and also paid for/is paying for my surgeries. i was pre-approved right away for my hysto and they are also paying for my bottom surgery

    • Really? I have Blue Cross Blue Shield and they’ve covered my testosterone but I never thought they’d cover any surgeries. How can I get more information about this?

  11. My current insurance (aetna student plan) won’t cover trans*-related issues unfortunately. At least testosterone is not very expensive and I can pay for it out of pocket, but if I were to get any surgery, I’m fucked.

    And honestly, the trans* population is so small and the benefits of gender affirmation surgery are so positive (for those who desire it, of course) that it SHOULD be covered by insurance. Dysphoria is so very consuming – often to the point of not being able to cope with whats going on in your life – alleviating it should be medical priority so a trans* person who is very dysphoric can live a more fulfilling life.

  12. This Mayor Has Got It Rite,
    Mayor Sam Adams,
    Would YOU Pleeeeease come to Phoenix and represent our community. We as a community pay our taxes and our healthcare premiums like everyone else. This facet of a Transgendered persons phycological and physical Transition is a medical diagnosis and should be inclusive in healthcare plans across our country. For those that have not Thanked You please allow me to do so. Please advocate this change across this country and our healthcare system. I can only wish I resided in Portland and my labors and my dollars were supporting this much needed change for me. Keep this man in Office… Shannon

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