If I am not mistaken, I believe Obamacare does cover sex change surgery. It's necessary coverage, whether you want it or not. Meaning you're going to pay for it, whether you want it or not.
Contacted for comment, HHS clarified this indeed is not a mandate on insurers to provide specific procedures in the sex-change process, but a ban on insurance companies from “categorically excluding from coverage all gender transition related services.â€
http://thefederalist.com/2015/09/14/will-new-obamacare-rule-force-insurers-to-fund-sex-changes-2/