Access to gender-affirming care is taking center stage in state governments across the U.S., with some states passing restrictions and others protections. The debates and lawsuits have raged throughout 2023 so far. This week’s developments included a Missouri judge blocking enforcement of a rule that would have barred treatments such as puberty blockers and hormone therapy for children and adults. In Montana, a transgender lawmaker was kicked off the House floor for her comments on restrictions. The federal government sued over a care ban in Tennessee. And governors in Minnesota and Washington became the latest to sign laws preserving access.
As transgender people have increasingly gained acceptance and visibility, conservative lawmakers have zeroed in on restricting their rights: keeping transgender children off girls’ sports teams and out of certain bathrooms, and blocking them from receiving gender-affirming medical care.
In response, a growing number of Democratic-controlled states have moved to protect such rights, especially access to gender-affirming care.
In developments this week, one governor is telling lawmakers they’ll have to return for a special session if they fail to pass some restrictions, two others signed protections into law and a transgender lawmaker was barred from a Statehouse floor amid a standoff with colleagues.
THE BIG PICTURE
The push by conservatives has mushroomed over the last few years and become, alongside abortion, a major theme running through legislative sessions across the country in 2023.
Six states have laws or policies in effect barring minors from receiving puberty blockers or hormone therapy. Similar provisions have been adopted but paused by courts in three more. They’ve been signed into law but haven’t yet taken effect in at least eight more.
THE CENTER OF DEBATE
In Missouri, the gender-affirming care battle is playing out in the Legislature and in court.
Earlier this month Republican Attorney General Andrew Bailey used an emergency rule to impose restrictions on both children and adults before they can receive such care. Just before it was to take effect this week, a judge halted enforcement until at least Monday and said she could push the date back further while legal challenges are considered.
Gov. Make Parson, also a Republican, said he would call a special legislative session if lawmakers fail to pass bills that would restrict transgender rights by May 12.
The GOP-controlled Legislature is on board but not in agreement over exceptions such as whether treatment for people already receiving puberty blockers or hormones would be allowed to continue.
BANNED FROM THE HOUSE FLOOR
Montana House Republicans barred a Democratic transgender colleague from the floor of the chamber for the rest of the legislative session as punishment.
Zooey Zephyr had told Republicans there would be “blood on your hands” — an expression frequently used in politics — if they approved a ban on gender-affirming care for minors. The bill passed, though it has not yet been signed into law.
Zephyr’s situation, which echoed the ouster of two Tennessee lawmakers from that state’s Legislature for a protest over gun policy this year, has turned her into a political cause for liberals nationwide.
She spent the first day of her exile this week battling to use a bench in a Statehouse hallway.
Also in Montana, Gov. Greg Gianforte signed legislation Friday banning gender-affirming care for minors.
The measure establishes penalties for health professionals who provide such care and allows for lawsuits if a patient suffers harm. Physicians could not hold malpractice insurance against such claims. The law also prohibits public employees and property from being involved in gender-affirming treatment.
During hours of emotional hearings, opponents testified that hormone treatments and in some cases surgery are supported by numerous medical associations and can be life-saving for someone with gender dysphoria, the clinically significant distress or impairment caused by feeling that one’s gender identity does not match one’s biological sex.
Gianforte said the bill “protects Montana children from permanent, life-altering medical procedures until they are adults, mature enough to make such serious decisions.”
THE FEDERAL GOVERNMENT WEIGHS IN
The U.S. Department of Justice on Wednesday filed a lawsuit challenging Tennessee’s law, scheduled to take effect July 1, banning transgender youth from receiving gender-affirming care.
The federal government said “no person should be denied access to necessary medical care just because of their transgender status.”
Assistant U.S. Attorney General Kristen Clarke sent a letter last month to all state attorneys general warning them that federal law protects transgender youth against discrimination.
ACCESS PROTECTED
Governors’ signatures in Minnesota and Washington on Thursday made them the latest of at least nine states with laws protecting access to gender-affirming care. Vermont lawmakers passed bills with similar provisions this week, though they haven’t been signed.
The measures aim to shield patients, health care providers and other actors from punishment or investigations into whether they violated gender-affirming care and abortion bans in states that have them.
So far, officials have not been trying to reach across state lines to enforce bans.
DIFFERENT DIRECTIONS IN KANSAS
The Republican-controlled legislature in Kansas fell one vote short this week of overriding Democratic Gov. Laura Kelly’s veto of a ban on gender-affirming care for minors.
But lawmakers overrode other vetoes of restrictions on rights for transgender people. One blocks them from using restrooms that correspond with their gender identities at schools, prisons, domestic violence shelters and rape crisis centers.
At least eight other states have bathroom restrictions, but most of them apply only at schools.
ROLING BACK A LIBERAL CITY’S BOYCOTT
San Francisco’s Board of Supervisors voted Tuesday to repeal a measure barring city staffers from making business trips to states with restrictions on abortion, voting and LGBTQ+ rights.
The 2016 policy also blocked the city government from doing business with companies headquartered in those states.
Officials said it was doing more harm than good. Instead of exerting pressure on those states, it was raising costs for San Francisco.
A final vote is expected on Tuesday. California is considering a repeal a similar measure at the state level.
RESTRICTING DRAG SHOWS
In tandem with the push to restrict transgender rights, conservatives in several states have also lately targeted drag shows as part of what critics say is a wave of anti-LGBTQ+ legislation.
Alabama became the latest to do so after legislation was filed Thursday that would add a provision to the state’s anti-obscenity laws.
The bill by Republican Rep. Arnold Mooney would prohibit “male or female impersonators, commonly known as drag queens or drag kings,” from performing in K-12 public schools, libraries and other public places where minors are present.
The measure is pending before the House State Government Committee.
Tennessee was the first state to place strict limits on drag shows. But last month a federal judge there temporarily blocked that measure after a group filed a lawsuit claiming it violates the First Amendment.