Abortion services aren’t the only health care services under direct attack by the GOP. In Florida, the Republican-controlled health care agency recently used junk science from a concentrated disinformation campaign to declare that gender-affirming care for minors is “experimental and investigational.” The determination opens the door for the state to not cover these services under Medicaid, potentially go after the medical licenses of practitioners who provide gender-affirming care in the state, and even possibly force transgender people to de-transition.
The policy is part of a wider Republican offensive on transgender Americans. In March, NBC News reported that a record 238 anti-trans bills had been filed this year in state legislatures across the country.
And in late June, following the Supreme Court’s overturning of Roe v. Wade, Alabama asked a federal appeals judge to allow it to enforce a ban on health care for trans youth. As the state’s Republican attorney general argued in the brief, the high court’s recent rulings on abortion and concealed carry prove that “no one — adult or child — has a right to transitioning treatments that is deeply rooted in our nation’s history and tradition… The state can thus regulate or prohibit those interventions for children, even if an adult wants the drugs for his child.”
The Florida development, which occurred a few weeks earlier, illustrates how conservatives are working to short-circuit laws banning health care discrimination based on gender identity.
Early last month, the Florida Agency for Healthcare Administration (AHCA), which regulates the state’s Medicaid program and health facilities, declared: “Several services for the treatment of gender dysphoria — i.e., sex reassignment surgery, cross-sex hormones, and puberty blockers — are not consistent with generally accepted professional medical standards and are experimental and investigational with the potential for harmful long term affects.”
This determination flies in the face of scientific consensus. The American Academy of Child & Adolescent Psychiatry, the American Academy of Pediatrics, and the American Medical Association are just a few of the many medical associations that deem gender-affirming care crucial for transgender youth.
The AHCA based its rejection of gender-affirming care on information obtained from isolated fringe studies. According to the Human Rights Campaign, the country’s largest LGBTQ+ advocacy group, the state agency’s findings “dismisses a recent explainer by the U.S. Department of Health and Human Services (HHS) on the medical need for gender-affirming care” and “rejects the science, medicine, and evidence-based approach of the HHS, instead dangerously cherry-picking select research to assert their claims.”
Policies like this that make social and medical transitioning difficult or impossible for young people could have disastrous effects on trans youth, who are already at very high risk of suicide. A 2021 peer-reviewed study by The Trevor Project, a nonprofit that supports LGBTQ+ teens, published in the Journal of Adolescent Health, found that gender-affirming hormone therapy led to significantly lower rates of depression, suicidal thoughts, and suicide attempts among transgender and nonbinary youth.
What’s worse, these legislative efforts are already having a psychological impact.
“The record wave of anti-LGBTQ bills across the country, and the ugly rhetoric surrounding them, are taking a toll on LGBTQ youth’s mental health,” Dr. Jonah DeChants, research scientist with The Trevor Project, told The Lever.
According to DeChants, Trevor Project research has found that 85 percent of transgender and nonbinary youth said recent debates about anti-trans laws have negatively impacted their mental health, and 93 percent of such young people said they worry about transgender people being denied access to gender-affirming care due to state or local laws.
How Florida Is Targeting Trans People
The Affordable Care Act (ACA), Democrats’ signature 2010 health care law, created a set of essential health benefits that plans must cover and stated that people with pre-existing conditions can’t be denied coverage. And while the federal law specifically prohibits the discrimination of care based on gender identity, it empowers states to determine whether certain treatments are experimental and therefore not covered if the state so chooses.
In response, Republicans and conservative think tanks are now helping invent junk science that says that gender-affirming care is not proven to work, thus allowing states to not cover the care under Medicaid and ban such services.
In the case of Florida, where Republicans control the state legislature and the governorship, the AHCA based its conclusions about gender-affirming care on several studies that defy the medical consensus on gender-affirming care.
For example, one study the state agency used to argue that many young people de-transition didn’t actually look at transitioning youth, but instead focused on conversion therapy, an unethical and harmful practice that seeks to “convert” gay people to heterosexuality.
The state’s findings also noted that “studies do not show that the use of puberty blockers improves mental health.” But in fact, an abundance of studies conclude the use of puberty blockers, which essentially pause puberty so trans youth and families can decide the best path forward, does improve mental health outcomes. These improvements include a reduction in suicidal ideation, self-harm, and psychological distress.
Such anti-trans “science” is expanding. On June 13, the Heritage Foundation, a conservative think tank, released a study titled “Puberty Blockers, Cross-Sex Hormones, and Youth Suicide,” which claimed: “By 2020, there are about 1.6 more suicides per 100,000 people ages 12 to 23 in states that have a policy allowing minors to access health care without parental consent than in states without such a policy.”
Yet the study, which was not peer-reviewed, doesn’t look at gender-affirming care, as it claims. Instead, its authors deceptively examined suicide rates among young people in states that allow access to any kind of health care without parental consent. The states with higher suicide rates include Alaska, Oklahoma, and Montana, all of which have very little access to gender-affirming care for trans youth. These same states have loose gun regulations and higher gun ownership, and both have been shown to lead to an increase in suicides.
A Coordinated Attack On Trans Rights
Florida’s new policy is part of a larger coordinated attack against the trans community.
In Alabama, the state’s attorney general is using the end of Roe v. Wade and a ruling invalidating gun control laws to try to implement a recent bill passed by the Republican-controlled state legislature that would make it a felony to prescribe puberty blockers or use hormone therapy to anyone under 19 years old. Those who are found guilty could face up to a 10-year prison sentence.
In Texas, Governor Greg Abbott has directed the Department of Family and Protective Services to investigate gender-affirming care as child abuse, a non-binding directive but one that the agency has been following. While a recent injunction has been put into place to stop the directive, the judicial decision only covers families who were directly involved in the case, not the families of all trans youth in the state.
What’s more, 15 states already restrict life-saving gender-affirming care in some way.
The common refrain in defense of these attacks is that they are about protecting children. Many anti-trans activists argue that trans kids can wait until adulthood to decide what’s best for them.
But for many people, gender-affirming care cannot wait.
In January, a study from the Stanford University School of Medicine found that participants who began hormone treatments in late adolescence were nearly two times less likely to experience severe psychological distress than those who began hormone treatments during adulthood. What’s more, participants who began such treatments in early adolescence were roughly six times less likely to have had suicidal thoughts in the previous year than those who began treatments as adults.
Meanwhile, The Trevor Project has found that ready access to gender-affirming care and support can be transformative for young people.
As DeChants noted, “We also found that LGBTQ youth who lived in an accepting community, had access to LGBTQ-affirming spaces, and/or felt high social support from family and friends reported significantly lower rates of attempting suicide in the past year.”