Anti-transgender Bills Are Affecting Healthcare Around the U.S.

Multiple states are introducing bills that restrict or prohibit health care related to transgender individuals. According to the Williams Institute, approximately 1.6 million Americans identify as transgender. While the Supreme Court ruled in 2020 that it was sex discrimination and against federal law to fire gay and lesbian employees, there is a long way to go to ensure equality.

In 2020, 19 states introduced bills that target the rights of transgender people. So far, in 2021, 33 states have introduced a variety of bills targeting transgender individuals. Many of these bills target access to healthcare.

Hundreds gather in Love Park in Philadelphia in response to the Trump administrations memo defining gender as an unchangable biological characteristic

During a pandemic, receiving adequate healthcare unrelated to COVID-19 has been challenging. Several states have introduced bills in 2021 that would make accessing healthcare for transgender youth extremely difficult.

Recap of Healthcare Bills Affecting Transgender Individuals

Alabama introduced two bills Senate Bill 10 and House Bill 1. Both would make it a felony for doctors to treat transgender youth with hormone blockers to delay or prevent puberty and hormone replacement therapy (HRT), the prescription of estrogen or testosterone. Both bills allow for schools to provide gender-related information about students directly to parents. Both bills have been read for a third time with three health amendments added and are 50% of the way to becoming law.

Arkansas passed House Bill 1570 – the Safe Adolescents From Experimentation (SAFE) Act on March 29, 2021. This bill prohibits doctors from treating transgender youth with gender-affirming care, such as HRT, prescribing puberty blockers, and performing gender-affirming surgery to trans youth under 18. Governor Hutchinson vetoed the bill a few days later, but the state legislature overturned the veto. The first bill of the year to target transgender youth accessing health care comes into law in July.

Arizona has proposed a similar bill to Alabama and Arkansas to penalize doctors with prison time for providing gender-affirming care. The main portion of Senate Bill 1511 covers dangerous crimes against children, proposing more substantial punishment for sexual assault, murder and child abuse. However, it also could punish doctors with over ten years in prison for prescribing puberty blockers or HRT to those under 18. SB1511 was read for a second time in the Senate.

Florida’s House of Representatives proposed HB935, which is similar to many of the other bills introduced in other states. One exception is that Florida’s bill could only charge medical professionals with a misdemeanor in the first degree if they perform surgery or prescribe HRT and puberty blockers. This house bill is in committee, with the first reading expected shortly.

Georgia’s legislature introduced HB401, which prohibits medical professionals from providing gender-affirming care to minors. This bill does allow for treatment for those individuals who were born with ambiguous sex organs. Like bills introduced in Arkansas and Arizona, this Georgia bill could punish doctors with one to ten years in prison for prescribing HRT, puberty blockers or performing surgery.

In January, Iowa introduced HF193, which aims to deter doctors and other health care providers from providing gender-affirming care like prescription medication and surgery. As with some of the similar bills like the ones in Georgia and Florida, this bill would not charge healthcare provided with a felony but would seek to have healthcare providers disciplined for their actions. As well, HF193 allows a fine of $1,000 to be levied for each action. This bill does allow parents to make final decisions about their children, including whether minors can access counseling and treatment of mental health concerns if gender dysphoria or gender nonconformity is suspected. HF193 is currently in committee.

Indiana has proposed two bills – SB0224 and HB1505 – both of which focus on minors transitioning genders. Senate Bill 224 would prohibit the gender transitions for those under the age of 18 – while potentially charging health care professionals like doctors and nurses with felonies or misdemeanors, depending on their involvement.

Indiana HB1505 focuses on prohibiting health care professionals from performing gender-affirming surgery and prescribing puberty blockers and HRT. This bill would charge a healthcare provider with a misdemeanor or a felony, depending on their actions. HB1505 had its first reading in January and was referred to the Committee on Public Health. Should both bills be passed by Indiana’s Senate and House, these bills would become law July 1, 2021.

Kansas legislators introduced SB214 and HB2210 – both of which make it a crime for a doctor to perform gender-affirming surgery on minors or prescribing HRT and puberty blockers to those under 18 years old. Senate Bill 214 was referred to the Committee on Judiciary, while House Bill 2210 was referred to the Committee on Health and Human Services in February.

In February, Kentucky legislators filed HB336 – a bill designed to prohibit medical professionals from providing gender-affirming care to minors. As well, House Bill 336 would create protections for public employees who share opinions about gender identity. Further, this bill would allow parents to withhold consent to treat their child’s gender dysphoria. HB336 was referred to the Committee on Committees after being introduced.

Louisiana introduced SB104 on April 12. This bill would make it a crime to provide gender therapy, like counseling, nonsurgical procedures and surgery for gender dysphoria to minors. The bill was introduced by the Louisiana Senate, read a second time, and referred to the Committee on Health and Welfare.

Mississippi proposed SB2171 in January. This bill would prohibit gender transitioning and the accompanying procedures for minors. Senate Bill 2171 was referred to the Committees of Public Health, Accountability, Efficiency and Transparency but died in committee in February.

Missouri lawmakers filed HB33 and SB442, both of which focus on prohibiting medical providers from administrating gender-affirming health care for minors. House Bill 33 was read the first and second time before being referred to the Committee of Children and Families. Public hearings were scheduled and completed in March. Senate Bill 442 was referred to the Committee of Seniors, Families, Veterans and Military Affairs, which has begun to hold hearings. Should SB442 be made into a law, it would be effective August 28, 2021. HB33 is not currently on the House of Representatives calendar.

Montana has introduced five bills that specifically target transgender individuals. Three bills would prevent minors from accessing gender-affirming surgery, HRT and puberty blockers – HB113, HB427 and SB195. Montana House Bill 113 had a third reading and did not pass. Further, additional filing deadlines were missed. This bill is in limbo. House Bill 427 passed the third reading and had made it out of committee in March. Senate Bill 195 was introduced in February but has remained in committee since then. According to the Montana Legislature, this bill is probably dead.

The other two proposed bills in Montana are SB245 and SB280. SB245, which would allow medical providers and insurance companies to refuse to treat or cover transgender patients for being transgender, was indefinitely postponed and is most likely dead. While SB280, which would permit birth certificates to be re-issued with a gender change only after surgery was performed, passed the third reading in April, paving the way for it to become law shortly.

New Hampshire lawmakers have introduced HB86 – a medical ban that would criminalize and define all gender-affirming provided to minors as child abuse. In April, this bill was removed from Consent and marked inexpedient to legislate, meaning the bill failed.

In North Carolina, legislators proposed SB514, a bill that would prevent transgender youth under 21 from accessing HRT, puberty blockers, and other forms of gender-affirming healthcare. And would require state employees to publicly disclose transgender and queer children to their parents. This bill has passed the first reading. After watching other governors like Arkansas Governor Asa Hutchinson and South Dakota Governor Kristi Noem both veto recent anti-transgender bills, it is likely Democratic Governor Roy Cooper may also veto this bill.

Oklahoma lawmakers have introduced two pieces of legislation that would prevent those under 21 years old from accessing gender-affirming treatments. SB676 would make gender-affirming treatment illegal. This bill passed the first and second reading and was referred to the Health and Human Services Committee and the Appropriations Committee in February. SB583 would make it illegal for those under 18 years old to access gender-affirming medical treatment. This bill passed the first and second readings and was referred to Health and Human Services in February but it failed to advance.

South Carolina legislators filed H4047 – a bill designed to protect vulnerable children. This bill would prohibit medical procedures, including prescribing medications such as HRT and puberty blockers to minors to change their gender or delay puberty. This bill was read for the first time and referred to the Committee on Judiciary.

Tennessee lawmakers proposed HB0578 which would prohibit gender-affirming healthcare for those who have not yet entered puberty. Further, House Bill 0578 would require parents to provide three written recommendations from at least three doctors before allowing gender-affirming healthcare to begin in those minors who have entered puberty. This bill is currently sitting with the Health Committee and action has been deferred until the second calendar of 2022.

Similar to HB0578, Tennessee senators introduced SB0657 which is nearly identical to House Bill 0578 and would prohibit gender-affirming healthcare for those who have not yet entered puberty and those in puberty. This bill passed on second consideration as was referred to the Senate Judiciary Committee in February.

Texas lawmakers have proposed several anti-transgender bills – HB1399 – that would prevent those under 18 from accessing gender-affirming treatments, like surgery and medication like HRT and puberty blockers. In April, this bill is sitting in the committee on Public Health. SB1311 is similar to HB1399 and would prevent those under 18 from accessing gender-affirming treatments. Should this bill be made into law, it would take effect on September 1, 2021. Additionally, SB1646 would redefine child abuse and include supplying puberty blockers and HRT to minors as abuse.

Like Montana’s Senate Bill 245, Texas has introduced SB1424, which would give the right to object to medical treatment to healthcare providers, specifically gender-affirming treatment for transgender individuals and abortions for women. Also included in this bill is insurance companies’ right to deny coverage or care to those seeking gender-affirming treatment. This bill has been read for the first time and was referred to the Public Health Committee, which has scheduled public hearings.

In January, Utah lawmakers introduced HB0092 – a bill that would prohibit doctors from performing gender-affirming care, such as surgery and the prescription of HRT and puberty blockers on those under 18. In March, this bill was not adapted into law.

In February, West Virginia legislators introduced HB2171 – a bill that would prevent minors from accessing gender-affirming care like puberty blockers and HRT. This bill would also make it a felony for medical professionals to provide gender-affirming care. This bill was introduced to the House of Representatives and referred to the House Committee on Health and Human Resources.

Twenty-two different states have introduced bills that specifically target healthcare and gender-affirming treatment for transgender youth. While the punishment to healthcare providers ranges from a fine to up to 10 years in prison, this is increasingly concerning. All doctors take the Hippocratic oath – to first do no harm. These bills could harm the lives of transgender youth and their families living in these states. There is much more to come in regards to these bills.