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There may not be a more a divisive issue in the ongoing culture war than the fight over gender-affirming care, which encompasses a range of behavioral, psychological, social and medical interventions, including hormone treatment and surgery, intended to support an individual’s gender identity.
Recent Gallup polling found that a little more than a third of American adults support banning gender-affirming care while just over six in 10 oppose such prohibitions. And indeed, the actions by states have played out along the red-and-blue divide you’d expect.
This year about 100 measures referencing gender-affirming care were considered in 21 states, according to the LexisNexis® State Net® legislative tracking system. The majority of that legislation was introduced by Democrats and aimed at providing protections for providers of gender-affirming care or otherwise supporting the practice.
Another roughly 100 measures referring to “gender transition” were considered in 28 states. The majority of those measures were introduced by Republicans and aimed at restricting or prohibiting gender transition procedures involving minors.
Twenty-two states—Alabama, Arizona, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia and Wyoming—have already imposed some type of ban on gender-affirming care, according to a recent, comprehensive analysis by MedPage Today, a medical-focused news site.
In actuality, 25 states have enacted gender-affirming care bans, as the outlet noted, but in three of those states—Arkansas, Florida and Montana—courts have blocked their implementation
This year at least 21 states considered measures referencing gender-affirming care, according to the LexisNexis State Net legislative tracking system. The majority of that legislation was introduced by Democrats and aimed at providing protections for providers of such care. At least 28 states considered measures referring to “gender transition.” The majority of those measures were introduced by Republicans and aimed at restricting or prohibiting gender transition procedures involving minors.
The progressives in California attempted to swing the pendulum far the other way this year.
The Legislature there recently passed a bill (AB 2442) that would have required the Medical Board of California, the Osteopathic Medical Board of California, the state Board of Registered Nursing, and the state Physician Assistant Board to expedite the licensure process for anyone who could show they intended to offer gender-affirming care.
All an applicant to those boards would have had to do to get their application to the front of the line is include a letter from an employer or contracting entity showing the applicant had accepted a job or entered into a contract to provide gender-affirming care or gender-affirming mental healthcare.
Supporters of AB 2442 saw the bill as a bulwark against the red-state bans.
“California has always been a beacon of hope for those seeking essential health care services, whether it’s reproductive health or gender-affirming care,” AB 2442’s author, Rick Chavez Zbur (D), said in a press release announcing the measure’s passage. “As MAGA-led legislatures across the country attack the transgender community and restrict the care they desperately need, this bill enables California to step up and meet the needs of those traveling here for the services banned in their states.”
The bill was backed by California heavyweights, including Planned Parenthood Affiliates of California and Equality California, a nonprofit that advocates for the civil rights of LGBTQ+ Californians.
“Currently, over two dozen states across the country restrict or outright ban access to medically necessary healthcare backed by decades of research and supported by every major medical association in the U.S.—leaving many families in these states facing agonizing decisions about whether to relocate or travel out of state to access the essential health services they need,” Equality California Executive Director Tony Hoang said in a press release. “We thank the California Legislature for its unwavering commitment to protecting transgender lives and ensuring that all people have the right to access the care they need.”
Even in deep blue California, however, AB 2442 faced resistance, underscoring the issue’s ability to rankle.
AB 2442 drew dissenting votes at every point along the legislative process (and some lawmakers of both parties declined to vote on the measure at all).
In May, the California Family Council, a religious nonprofit, cited a recent study that found “patients who have undergone gender affirmation surgery are associated with significantly higher risks of suicide, self-harm, and PTSD compared to general population control groups.”
“The evidence is overwhelming: transgender treatments are dangerous and worsen an already concerning problem,” said Greg Burt, vice president of the California Family Council, in a statement. “Individuals suffering with gender dysphoria need psychiatric support rather than ‘affirmation’ of their delusions. California legislators are fighting against science and common sense – a battle they cannot win. Continuing to pursue increased access to transgender treatment puts countless vulnerable children in danger. We need an immediate about-face from our legislators on this issue.”
Ultimately, the California Family Council got what it wanted, but from Gov. Gavin Newsom (D) rather than lawmakers. At the end of September, the governor vetoed the bill, saying in his veto message that while he commended the effort to address “healthcare gaps in the state,” he was “concerned about the aggregate effect of legislation that seeks to expedite licensure.”
“As the number of applicants who qualify for expedited licensure grows through legislation, the benefits of mandated prioritization may start to diminish, at the expense of potential negative impacts to other applicants,” his message said. “Additionally, the increase in staff needed to ensure expedited applications may lead to licensing fee increases.”
The back-and-forth over SB 2442 illustrates the tensions inherent to gender-affirming care, with opponents questioning the mental health implications of the medical interventions, especially when they’re applied to children, and proponents concerned about the number of jurisdictions that are cutting off access to such care.
With both sides continuing to pump out legislation addressing the issue, it is likely to remain a key battleground in America’s culture war for some time to come.
—By SNCJ Correspondent BRIAN JOSEPH
Visit our webpage to connect with a LexisNexis® State Net® representative and learn how the State Net legislative and regulatory tracking service can help you identify, track, analyze and report on relevant legislative and regulatory developments.