Missouri this month became the first state in the country to severely limit gender-based treatment for people of all ages, following a series of quiet nationwide moves that have gradually reduced access to medical care for transgender adults. became.
Last year, Florida joined six other states in banning Medicaid from covering any form of gender care for transgender people of all ages. These prohibitions are Estimated 38,000 beneficiaries According to the Williams Institute, a research center at UCLA’s law school, of the public insurance program.
And in at least five states, Republican legislators are proposing bills to end gender care not just for minors, but for young adults. Some are trying to ban users under the age of 21, others are trying to ban anyone under the age of 26.
Missouri’s radical new policy took a different approach. Citing consumer protection laws designed to regulate fraud, state attorney general Andrew Bailey has said doctors of all ages can’t be treated unless they comply with a number of important restrictions, including an 18-month psychological evaluation. Issued emergency regulations prohibiting the use of sexual therapy on patients. The rule also states that patients should not receive gender-based treatment until mental health issues have been “resolved.”
Onerous restrictions amount to a “virtual ban,” said Gillian Brunstetter, a communications strategist at the Missouri branch of the American Civil Liberties Union. announced Intention to make a legal objection to the rules.
“The political climate around trans health care has always been in this direction,” Branstetter said.
The rule excludes people who are currently undergoing treatment, so long as they and their doctors “promptly” comply with psychological evaluations and other restrictions.
Alo Royston, a 35-year-old transgender man in St. Louis, said he was shocked. by a new policy.He has been taking testosterone for his eight years and A refill prescribed by his doctor. If he becomes unable to receive treatment, he will be “devastated” and will have to travel out of state to receive treatment.
“What pisses me off the most is my functioning as a member of this society,” said Royston, a program manager for a U.S. defense contractor. “I have been working on a defense program to protect my country, and my country can’t protect me?
Missouri’s new policy takes effect April 27 and expires in February 2024, when the legislature reopens. (two bills Bills that would have banned minor care and would have barred Medicaid from covering all ages are not moving forward in this year’s session. )
Bailey’s order applies to all ages, but his public comments are focused on children and echo the rhetoric of Republican politicians across the country and in Missouri. As Attorney General, I will always fight to protect my children because transsexual intervention is experimental.
In February, his office launched an investigation of a youth gender clinic at Washington University in St. Louis after a former employee filed a whistleblower complaint. Complaint Patients there claimed to have been rushed to treatment and not given proper psychological testing. Said Adherence to accepted standards of care. )
Bailey’s spokeswoman Madeleine Thielen said when asked why adults were included in his orders: Care. “
Fourteen other states (Alabama, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, South Dakota, Tennessee, Utah, West Virginia, and North Dakota) have passed laws restricting gender care for minors. rice field.
Although there is some debate between medical professionals Several large medical groups in the United States have weighed in on which children benefit from gender-affirming care and when treatment should begin. American Academy of Pediatricsdenounced the legislative ban.
For transgender adults, many studies show transitional care. can improvement Psychological Happiness and quality of life.
In an interview earlier this year, Terry Schilling, president of the American Principles Project, a right-wing advocacy group that promotes restrictions on transgender rights, said focusing on minors is a short-term political calculation. A long-term goal for his organization, he said, is to eliminate transition care altogether.
“I think of this whole issue in the same vein as lobotomy and eugenics. It’s a bad medical epidemic,” he said.
Schilling said policies could include an outright ban on people of all ages, or legislation to make it easier for people to sue their health care providers if they regret the transition. He also raised the possibility of classifying transition care as a “consumer fraud.” This is the same approach that Bailey advocated. Because he claims it’s impossible to change gender.
over the years, seven states —Arizona, Florida, Missouri, Nebraska, South Carolina, Tennessee, and Texas—have enacted policies that prohibit Medicaid from covering certain types of gender-affirming care. It is partly funded by the state and has a lot of latitude in determining eligibility.)
Christie Mallory, legal director of the Williams Institute, said the Medicaid ban “is based on a precarious legal basis.” He ruled that he violated the Affordable Care Act and other federal regulations prohibiting sex discrimination.
But some lawmakers have introduced broader legislation that would ban gender-related care in government-owned or operated medical centers, or those that accept state funding.
For example, in Oklahoma, a bill introduced earlier this year by Sen. Refunds can be withheld.
In an interview in January, Dahm said his only goal was to keep taxpayers from spending their tax money on the transition process. “If adults want to make that decision and pay for themselves, they can,” he said. He also acknowledged that he may stop providing care to
Over the past few decades, physicians have removed more and more There are barriers such as psychological evaluation for adults to receive hormone therapy, leaving the decision-making to the patients themselves.
Erica Anderson, a clinical psychologist and former president of the American Association of Transgender Health Professionals, said:
Dr. Anderson, a transgender woman, express concern The increasing number of adolescents seeking gender-related care, especially those with complex psychiatric problems. She has also supported policies in certain European countries, including: Sweden and UKrecently restricted when children can receive certain treatments.
But last month, Dr. Anderson joined us. hundreds of clinicians Signed a letter highlighting that gender-affirming care is beneficial and important for many transgender children, and condemned its ban by U.S. law. Efforts to extend such restrictions to adults would do serious harm, she said.
“The ambiguity between youth and adult care is ominous,” she said.
Missouri’s rules have also received backlash from some conservatives in the state. Republican Secretary of State Jay Ashcroft, who recently announced his candidacy for governor, said: st louis public radio Although he supported a ban on children, he did not believe states should restrict adult care.
Referring to adult sexism, Ashcroft said, “I don’t think people should do that.” “But there is a difference between what I think and what I think the government should be involved in.”
Maggie Astor contributed to the report.
