Attacks on Gender-Affirming Care Make Their Way to Adults
“Pushing back against these bans requires thoughtful inclusion of the transgender and nonbinary people who are directly impacted.”
Last year, state legislators proposed a record number of anti-LGBTQ+ bills. Many were concerted efforts to control the lives and bodies of transgender and nonbinary youth; from hindering their ability to play sports to restricting their access to affirming health care. Unfortunately, these attacks not only continue but are escalating. Now, legislators in four states are considering bills that would also restrict access to gender-affirming health care for adults.
Gender-affirming health care is an umbrella term for a wide range of developmentally appropriate psychosocial and medical interventions to affirm an individual’s gender. It can include counseling to help individuals develop strategies to navigate transphobia and discrimination, hormones to either delay or change the development of secondary sex characteristics, and/or surgical procedures. For the transgender and nonbinary people who need and want these evidence-based interventions, access can be vital as these services have been proven to reduce anxiety, depression, suicidal thoughts, as well as substance use.
Since 2020, legislators committed to undermining the health of transgender and nonbinary people have primarily focused on passing gender-affirming health care bans for youth under the age of 18; successfully passing legislation in eight states while facing temporary injunctions in only two. With those bans in place, four states are now testing the waters to see if they can expand those restrictions to transgender and nonbinary adults – in some cases, adults as old as 25.
Oklahoma and South Carolina proposed the most restrictive bills that would prevent health care providers from administering, or recommending, gender-affirming care to transgender and nonbinary adults under the age of 26. They would also prevent the use of public funds or Medicaid payments to provide gender-affirming care. Kansas and Mississippi proposed similar bills that would ban gender-affirming health care for transgender and nonbinary adults up to age 21, although Mississippi’s bill died in committee at the end of January.
The bills still under consideration in Oklahoma, South Carolina and Kansas are not seeking to raise the age of consent for all types of medical care – which is currently age 18 in all three states. Rather, they are targeted attempts to prevent transgender and nonbinary adults from accessing medical care clearly outlined in existing, and recently updated, standards of care. Major medical organizations including the American Medical Association, American Psychological Association, Endocrine Society and American Psychiatric Association have openly opposed such bans on gender-affirming care. They continue to assert that providers should not be criminalized for providing evidenced-based care that is endorsed by numerous major medical groups and clearly outlined in current clinical guidelines.
Pushing back against these bans requires thoughtful inclusion of the transgender and nonbinary people who are directly impacted, as there are a wide range of potential policy solutions to prioritize. Depending on the status of access to gender-affirming care in your state, the anti-trans bills floating through your state legislature, and the input of transgender and nonbinary people, policy solutions could include: concerted efforts to block legislation that would ban gender-affirming care, pushing for legislation to protect providers who administer gender-affirming care, codifying state-level nondiscrimination protections, or ensuring health insurance plans offer the robust range of services transgender and nonbinary people need.
Some states are already putting in the work to fight back against anti-trans bills and can serve as potential policy models, for example:
- Vermont is currently considering legislation (H.89) to protect providers who administer reproductive or gender-affirming health care while making it a misdemeanor crime to obstruct, or threaten to obstruct, someone from receiving these services. This bill has so far successfully passed the state House of Representatives and heads to the state Senate.
- Massachusetts passed a law in 2022 (H.5090) to protect providers and those seeking reproductive and gender-affirming care by codifying through statute that access to reproductive and gender-affirming health care are rights secured under law and the constitution of Massachusetts. In addition, they extended protections to people seeking care from outside the commonwealth.
- Colorado now requires coverage for gender-affirming care in the individual and small group health insurance markets as part of their Essential Health Benefit (EHB) benchmark. Not only did they include hormone therapies and surgeries, but also facial harmonization and laser hair removal – which transgender and nonbinary people often identified as needed, but rarely covered, services. Specifying the types of services health insurance plans must cover is particularly important for ensuring access for transgender and nonbinary people of color, who are denied coverage for services more often than their white peers.
In addition to these state-based solutions, there are also federal actions the Biden administration could take to protect access to gender-affirming care. For example, the Department of Health & Human Services (HHS) could finalize their proposed rule to extend nondiscrimination protections to transgender and nonbinary people through Section 1557 of the Affordable Care Act. This regulatory change already went through the public comment period, which Community Catalyst responded to, and currently waits for final publication. HHS could also include gender-affirming health care in the federally mandated list of Essential Health Benefits – an action Community Catalyst endorsed during a comment period last month. There is also time this congressional session for advocates to start educating members in the House and Senate about the need to enshrine detailed and robust protections for transgender and nonbinary people through federal statute.
While we know that even proposing legislation to restrict the rights of transgender and nonbinary people can be detrimental to their mental health, we also know that affirming communities can dramatically improve their overall wellbeing and serve as a protective factor against the transphobia they face. By partnering with the transgender and nonbinary people directly impacted by these restrictive laws, there is an opportunity to both affirm that they are deserving of compassionate care and ensure they have the tools and resources they need to thrive.
**For more information about the restrictions on gender affirming care for youth, see our previous blog post published after Arkansas first introduced legislation in 2021**