By Bill Siksay

What are the limits of medicare coverage? Does prejudice against an identifiable minority affect decisions about who gets covered? Does “medically necessity” not apply to minority communities?

These questions are raised when members of the transsexual and transgender community are denied medical coverage for sex reassignment surgery (SRS) and related therapies, including hormone therapy, hair removal, and breast augmentation.

Transsexual and transgender folks have a different experience of gender than many Canadians. Some trans folks experience their gender opposite to their physical sexual characteristics, a feeling of being in the wrong body. To correct this, they look to SRS. Others experience their gender in ways that are different to the accepted binary theory of gender that says you are either male or female. These folks find their gender on a continuum between or beyond male and female. Some trans folks feel no need to change their physical sex, and may live out their lives as neither traditionally male or female.

Members of the trans community face discrimination as any conversation with them will definitively establish. Trans Canadians experience increased violence because of their gender identity and its expression. Job discrimination is far too common. Often trans folks are passed over when trying to rent an apartment. Obtaining appropriate identity documents can be a frustrating hurdle, exacerbated by misunderstanding. Many trans youth are thrown out of their family homes, ending up homeless and on the street. And getting appropriate health care is sometimes impossible.

We need explicit legal protection for trans Canadians. That means adding gender identity and expression to the list of grounds on which discrimination is prohibited in the Canadian Human Rights Act. It also means adding gender identity and expression to the hate crimes and sentencing provisions of the Criminal Code of Canada, so hate crimes against trans people can be considered by police, prosecutors, and judges.

Protections are in place allowing successful human-rights complaints to be made by trans folks using the “sex” and “disability” categories of existing law. Specifically adding gender identity and expression to the law would make it absolutely clear that such discrimination is wrong in a society that seeks equality and fairness. Changing the law will also raise awareness about the life experience and situation of trans Canadians.

Medical coverage varies across Canada. Some provinces fully cover SRS. Some provinces don’t. Some offer only partial coverage. Some provinces cover related therapies. Some don’t. This is unacceptable. The Canada Health Act was meant to ensure that individuals are not burdened with the cost of medically necessary procedures. It is also supposed to ensure medical treatment is accessible and comprehensive. Forcing individuals to pay out of their own pockets for medically necessary treatment is wrong. Canadians decided some time ago to share the expense of medical care so we all get the care we need and don’t go bankrupt obtaining it.

SRS is not a frill. It’s not cosmetic. It’s not elective. It’s a necessary procedure that some trans people pursue in consultation with their doctors. It’s necessary medical treatment which helps some trans people lead healthy, happy, productive lives.

The federal government does not make decisions about which specific services are covered by medicare. Those decisions are up to provincial governments. But the federal government does fund medicare and set the standards which govern it. Those standards must recognize the medical necessities of trans Canadians’ medical requirements that must be funded collectively through our tax dollars. Decisions must be based in fact, not determined by prejudice.

For all these reasons, I’ve tabled a private member’s bill, Bill C-389, in the House of Commons to add gender identity and expression to the Canadian Human Rights Act, ensuring full protection for transsexual and transgender Canadians. My bill is likely to be debated and voted on this fall. And I’ve put a motion before the House to call on the federal government to ensure appropriate health care is accessible across Canada to transsexual and transgender people. Anything less than explicit, full, and comprehensive protection of trans Canadians diminishes Canada’s commitment to equality and diversity. And the failure to fully cover SRS within medicare diminishes the fundamental Canadian vision of public health care.

Bill Siksay is the member of Parliament for Burnaby-Douglas and the federal New Democrat critic for gay, lesbian, bisexual, transgender, and transsexual issues.