Trans Ontarians: Update the Sex on your OHIP Card and Prepare to Die* for your Cause
by Christin Scarlett Milloy
Published: Tuesday, 2012.09.04
This article has nothing to do with the question of government funding for SRS. While that is a very important issue to be sure, there are still other considerations which are of equal importance for trans and genderqueer persons looking to change their ID in Ontario.
Now that Ontario will very shortly be forced to begin issuing dignified, appropriate birth certificates with proper sex/gender identification flag to trans persons of all shape and description (or at least, to those whose identities presently conform to the binary), we collectively trans and genderqueer Ontarians will soon have greatly expanded options when it comes to controlling the identification documents our governments force us to live with.
This is indeed a great victory, one worthy of story and song. Problem is, great victories often lead to new battles when the war is not yet completely won.
Whether you might be classified as one of those post-ops, pre-ops, non-ops, cyclops or triceratops… If you were born in Ontario, because your birth certificate is the “gateway” ID to changing the rest of them, you will soon be able to have all your ID marked with whichever binary state most closely represents your identity. We’ll still have to work toward the right to non-classification and the ultimate deconstruction of the gender binary altogether, but more on that at some later date.
Once you get your new birth certificate (circa Q4 2012), you will be able to change your Passport, update your SIN registration, your hunting and fishing license… any ID you want, and also your OHIP card.
As an Ontarian person, you are legally entitled to the same standard of care, with access to the same set of medical treatments, as any cisgender person. This is not in question, and your medical practitioners being sentient, intelligent human beings, will of course acknowledge this human right (or goodness gracious, you need new HCPs). So, it stands to reason that continuing to access care from your doctor(s) using your new and gender-improved OHIP card should be no problemo. But oh no. Muchos problemos.
Let me explain.
OHIP isn’t really designed as an ID card, per se. In fact, our OHIP card is not legally valid as ID for any purpose other than accessing health care (ever tried for booze or smokes with one? It’s hit and miss). This might have something to do with minimizing OHIP fraud, as is commonly believed. However, I think it is more likely because government imposition of a compulsory photo ID card is a recipe for disaster, one which the ACLU says “will pose serious threats to our civil liberties and civil rights” and which even elements of our own federal government agree leads inevitably to dire consequences.
In other words, the province of Ontario wanted to sidestep the additional expense and problems associated with responsibility for issuing a compulsory ID.
Rather, your OHIP card signifies your “membership” in the mandatory single-payer “Ontario Health Insurance Plan.” Your OHIP card isn’t so much about your right to access free health care as it is about your doctor’s right to charge Ontario for selling you health care (under certain conditions, for a specific price). When you get treatment, it’s not really free – there’s a pricetag on every tongue depressor, and when you leave the clinic, your doctor bills it to your OHIP number.
Think of your check-up as a shopping spree, your Doctor is the store clerk, and your OHIP card is like a credit card Mommy and Daddy pay the bill for. Now the Doctor knows that you will never see the bill, since it goes directly to Ontario. The problem is that some enterprising (read: fraudulent) doctors figured out this is a great way to make extra money by charging the government extra dollars for treatments that were never performed.
Enter the misguided heroes of our story: government computer programmers. See, OHIP has an anti-fraud department. Part of their job is to make it so that the computer system can detect and refuse charges that are probably bullshit.
If a clinic tries to charge for three full leg casts at the same time on the same OHIP number, this is probably fraud because generally speaking humans have a maximum of two legs to break at any one time. Similarly, if a single clinic tries to charge OHIP for a leg cast for every single patient who walks in their door, this is probably fraud because generally speaking not every clinic patient has a broken leg. Also, 15 year olds aren’t likely to need treatment for chronic arthritis, a 6 month old child isn’t going to need orthotic insoles, and so on. I’m totally generalizing here, but this is how it works: the computers are set up to look for that sort of thing.
This is done to prevent Ontario tax-payers from getting even more ripped off than they already are by our mismanaged health care system, but I digress. The point is, preventing fraud is important to OHIP and it’s easy to understand why.
Fast forward: let us imagine a future clinic visit with your new OHIP card. Taking responsible care of your trans body means that every now and then it may be necessary to see your doctor for a manly pap smear, or perhaps it is time for a ladylike prostate exam. There is no shame in respecting the body you live in, after all.
Trouble is, OHIP’s computers are not equipped with ethical subroutines which respect trans bodies. The computer “knows” that women do not need a prostate exam, and men do not need a pap smear. So when your doctor charges for it, the computer calls bullshit. Trans equals fraud. I’ve been told this causes problems for intersex people as well.
Suddenly need an emergency hysterectomy? Or maybe you’ve decided it’s time for that orchiectomy we’ve been discussing… Let me check with billing. Your OHIP card was declined. The government says your body does not compute with projected budgetary expenditures.
Here are a few things that might happen to you.
- If the situation is serious, you could die waiting for the hospital bureaucrats to work out that your sex parts need the same health care as everyone else’s. It’s unlikely this would happen, but not impossible, especially if you find yourself somewhere rural, or if they think you’re using someone else’s OHIP card because maybe they’re just totally fucking stupid.
- You might be turned away by clinics or doctors who don’t consider your business worth the extra trouble to clear your charges through the pyramid of nonsense.
- Your doctor’s office might be willing to put up with the added trouble, but it could be a huge hassle for you every time you try to go for care, waiting for them to work through it (possibly outing you to a waiting room full of gawking influenza patients, and who needs that). So you might not bother keeping up with your check-ups. And so then you get cancer, and nobody notices until it’s too late.
So what should we do?
If I’ve terrified you with this article, I apologize. Please note, first and foremost: if you turn up at the emergency room, they are legally obligated to give you life-saving treatment, no matter what.
The most important thing to remember here is that this is not your problem. This is an issue between OHIP and your doctor, because of the way their billing system works, and it’s happening because Ontario has to fix a bug in their computer system.
Another important thing to remember is, your trans health care is legitimate. Because your needs are real, they are not fraudulent, no matter what the damn computer says. OHIP exists for all Ontarians, and that includes trans Ontarians. If you need treatment, the law says you are entitled to receive it, and OHIP is required to pay your doctor for it.
I was born with male physiology. But I am a woman. No matter what I have done, or might ever do to my body, I will always have a trans body. If they are going to insist on classifying me in a government record, and force me to present it on a card, that record and that card are damn well going to represent me for who I really am; as much a woman as any woman. And trans men, as men. That is our right, which even the province of Ontario has now recognized.
If you do not feel safe and comfortable updating your OHIP card in light of the potential fraud-confusion issue, I respect your decision. Only you can decide how best to reconcile your identity with shitty government bureaucracy. For my part, I am getting my OHIP card changed at the first possible opportunity.
Furthermore, I will be providing instructions on this site for anyone who wants help getting their own record changed when the time comes later this year.
The more of us there are, the quicker they will have to fix their systems to respect trans bodies.
Stick to your guns, people. We’re winning this war.
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