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The 4th U.S. Circuit Court of Appeals ruled Monday that transgender people are a protected class and that Medicaid bans on trans care are unconstitutional.
Furthermore, the court ruled that discriminating based on a diagnosis of gender dysphoria is discrimination based on gender identity and sex. The ruling is in response to lower court challenges against state laws and policies in North Carolina and West Virginia that prevent trans people on state plans or Medicaid from obtaining coverage for gender-affirming care; those lower courts found such exclusions unconstitutional.
In issuing the final ruling, the 4th Circuit declared that trans exclusions were “obviously discriminatory” and were “in violation of the equal protection clause” of the Constitution, upholding lower court rulings that barred the discriminatory exclusions.
The 4th Circuit ruling focused on two cases in states within its jurisdiction: North Carolina and West Virginia. In North Carolina, trans state employees who rely on the State Health Plan were unable to use it to obtain gender-affirming care for gender dysphoria diagnoses.
In West Virginia, a similar exclusion applied to those on the state’s Medicaid plan for surgeries related to a diagnosis of gender dysphoria. Both exclusions were overturned by lower courts, and both states appealed to the 4th Circuit.
Attorneys for the states had argued that the policies were not discriminatory because the exclusions for gender affirming care “apply to everyone, not just transgender people.” The majority of the court, however, struck down such a claim, pointing to several other cases where such arguments break down, such as same-sex marriage bans “applying to straight, gay, lesbian, and bisexual people equally,” even though straight people would be entirely unaffected by such bans.
Other cases cited included literacy tests, a tax on wearing kippot for Jewish people, and interracial marriage in Loving v. Virginia.
See this portion of the court analysis here:
4th Circuit rules against legal argument that trans treatment bans do not discriminate against trans people because ‘they apply to everyone.’
Of particular note in the majority opinion was a section on Geduldig v. Aiello that seemed laser-targeted toward an eventual U.S. Supreme Court decision on discriminatory policies targeting trans people. Geduldig v. Aiello, a 1974 ruling, determined that pregnancy discrimination is not inherently sex discrimination because it does not “classify on sex,” but rather, on pregnancy status.
Using similar arguments, the states claimed that gender affirming care exclusions did not classify or discriminate based on trans status or sex, but rather, on a diagnosis of gender dysphoria and treatments to alleviate that dysphoria.
The majority was unconvinced, ruling, “gender dysphoria is so intimately related to transgender status as to be virtually indistinguishable from it. The excluded treatments aim at addressing incongruity between sex assigned at birth and gender identity, the very heart of transgender status.” In doing so, the majority cited several cases, many from after Geduldig was decided.
Notably, Geduldig was cited in both the 6th and 11th Circuit decisions upholding gender affirming care bans in a handful of states.
The court also pointed to the potentially ridiculous conclusions that strict readings of what counts as proxy discrimination could lead to, such as if legislators attempted to use “XX chromosomes” and “XY chromosomes” to get around sex discrimination policies:
The 4th Circuit majority rebuts the state’s proxy discrimination argument.
Importantly, the court also rebutted recent arguments that Bostock applies only to “limited Title VII claims involving employers who fired” LGBTQ employees, and not to Title IX, which the Affordable Care Act’s anti-discrimination mandate references. The majority stated that this is not the case, and that there is “nothing in Bostock to suggest the holding was that narrow.”
Ultimately, the court ruled that the exclusions on trans care violate the Equal Protection Clause of the Constitution. The court also ruled that the West Virginia Medicaid Program violates the Medicaid Act and the anti-discrimination provisions of the Affordable Care Act.
Additionally, the court upheld the dismissal of anti-trans expert testimony for lacking relevant expertise. West Virginia and North Carolina must end trans care exclusions in line with earlier district court decisions.
The decision will likely have nationwide impacts on court cases in other districts. The case had become a major battleground for trans rights, with dozens of states filing amicus briefs in favor or against the protection of the equal process rights of trans people. Twenty-one Republican states filed an amicus brief in favor of denying trans people anti-discrimination protections in healthcare, and 17 Democratic states joined an amicus brief in support of the healthcare rights of trans individuals.
Many Republican states are defending anti-trans laws that discriminate against trans people by banning or limiting gender-affirming care. These laws could come under threat if the legal rationale used in this decision is adopted by other circuits. In the 4th Circuit’s jurisdiction, West Virginia and North Carolina already have gender-affirming care bans for trans youth in place, and South Carolina may consider a similar bill this week.
The decision could potentially be used as precedent to challenge all of those laws in the near future and to deter South Carolina’s bill from passing into law.
The decision is the latest in a web of legal battles concerning trans people. Earlier this month, the 4th Circuit also reversed a sports ban in West Virginia, ruling that Title IX protects trans student athletes. However, the Supreme Court recently narrowed a victory for trans healthcare from the 9th U.S. Circuit Court of Appeals and allowed Idaho to continue enforcing its ban on gender-affirming care for everyone except the two plaintiffs in the case.
Importantly, that decision was not about the constitutionality of gender-affirming care, but the limits of temporary injunctions in the early stages of a constitutional challenge to discriminatory state laws. It is likely that the Supreme Court will ultimately hear cases on this topic in the near future.
Celebrating the victory, Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan said in a posted statement, “The court’s decision sends a clear message that gender-affirming care is critical medical care for transgender people and that denying it is harmful and unlawful … We hope this decision makes it clear to policy makers across the country that health care decisions belong to patients, their families, and their doctors, not to politicians.”
On Thursday, Congress unveiled the much-anticipated spending bill to avert a government shutdown. The bill, which includes funding for major government departments such as Health and Human Services and Education, featured fierce negotiations over conservative “policy riders.”
These policy riders included bans on coverage for gender-affirming care, DEI bans, sports bans and more. Despite some indications that Democrats might compromise due to the sheer number of conservative policy riders, it appears those fears did not come to fruition. Democrats held firm in negotiations, and the most impactful anti-trans and anti-LGBTQ riders were nowhere to be found.
One policy rider proposed for the Food and Drug Administration would have defunded any hospital that “distributes, sells or otherwise uses drugs that disrupt the onset of puberty or sexual development for those under 18,” a measure targeting not only transgender youth but also those experiencing precocious puberty.
Another rider sought to bar any government funding toward “surgical procedures or hormone therapy for the purposes of gender-affirming care” in the Department of Health and Human Services. This move would have significantly impacted private and subsidized insurance in the Healthcare Marketplace. It also aimed to bar the enforcement of President Joe Biden’s executive order titled “Preventing and Combating Discrimination on the Basis of Gender Identity,” which broadened anti-discrimination protections for trans individuals.
In total, over 40 riders were proposed and negotiated in the spending bills. None of these were found in the final bill.
Ultimately, the final spending bill released contained only a single anti-LGBTQ rider: A ban on Pride flags being raised or displayed above foreign embassies. The policy, while certainly qualifying as anti-LGBTQ and a regression to Trump-era policies, notably does not bar personal displays of Pride flags by embassy workers.
In the past, some embassies have gotten around such bans by not “flying a flag over the embassy” but rather, painting portions of the embassy in rainbow colors or draping flags on the side of buildings.
News of the defeat of the most impactful anti-trans and anti-LGBTQ riders comes after a significant push from Equality Caucus Democrats and the Biden administration against the riders. “As you negotiate government funding for Fiscal Year 2024 (FY24), we write to strongly urge you to reject any attempts to include anti-LGBTQ+ provisions in any final FY24 funding agreement,” said a letter signed by 163 representatives on behalf of the Congressional Equality Caucus to the Biden administration.
However, Republicans also pushed hard for their inclusion. In a shutdown threat issued Feb. 21 from the House Freedom Caucus, Republicans indicated that bans on gender affirming care and trans participation in sports were necessary to prevent a potential shutdown.
Previously, U.S. Dan Crenshaw (R-Texas) stated that such bans are the “hill we will die on.” In a report published by Axios, one Republican lawmaker stated, “People are predicting a shutdown even if it’s just for a few days.” Others concurred, citing gender affirming care riders as one of the potential reasons for such a shutdown.
Many anti-LGBTQ leaders in the Republican Party reacted negatively to the bill. U.S. Rep. Matt Gaetz (R-Fla.) expressed anger at funding for the New Jersey Garden State Equality in Education Fund, calling it “force feeding the LGBT agenda in schools” and stating that it enables “gender mutilation surgeries in minors,” “biological men” in women’s bathrooms and trans participation in sports.
U.S. Rep. Marjorie Taylor Greene (R-Ga.) decried the lack of a DEI ban. U.S. Rep. Andrew Clyde (R-Ga.) stated that Republicans “surrendered” to Democrats on hormone therapy. The House Freedom Caucus published a lengthy list of healthcare and equality centers that the budget would fund, urging the GOP to vote “no” and to shut down the government.
In a press release published by House Appropriations Democrats, they stated that the bill rejected over a hundred poison-pill riders, many of which targeted LGBTQ people. For example, the Labor-HHS-Education portion of the bill blocked provisions around gender affirming care, sports bans and nondiscrimination.
Press release, House Appropriations Democrats on Labor-HHS-Education
The bill must pass by Friday evening to avert a government shutdown, though the impacts of such a shutdown would likely not be felt until Monday. If passed, the bill would keep the government funded through September, at which point all of the riders could resurface during the peak of the 2024 presidential election.
However, for the next several months, LGBTQ riders will not pose a significant threat in a year where trans and queer individuals have faced attacks at historic levels.
The pace of anti-transgender legislation has slowed in recent weeks, with several states, known for previously targeting transgender individuals, failing to pass any such laws. However, a different dynamic is emerging across the Gulf South, where three states are advancing bills that would cease the legal recognition of transgender individuals, potentially having significant repercussions for their trans residents. Louisiana, Mississippi, and Alabama are introducing bills to define sex in a manner that excludes transgender individuals, potentially affecting birth certificates, driver’s licenses, bathroom access, and more.
The bills, dubbed the “Women’s Bills of Rights” by their supporters, fall far short of actually protecting women’s rights. They fail to protect access to birth control or abortion, do not ensure equitable pay, neither allocate funds for nor promote women’s athletics, and lack any provisions designed to curb violence against women. Instead, they categorize sex based on reproductive capabilities and ends legal recognition of transgender individuals’ gender identities.
In Louisiana, House Bill 608 was introduced with a staggering 63 Republican co-sponsors, signaling a strong opposition to any efforts to lobby against the bill. While its primary focus seems to be on restricting bathroom access in schools, prisons, and shelters, a particular section of the bill indicates that “any provision of law enacted by the legislature or any rule adopted by a state agency or other entity subject to the Administrative Procedures Act when applicable to an individual’s sex shall apply those definitions provided in R.S. 9:58.” This provision could lead to the banning of changes to birth certificates and driver’s licenses, effectively ending all legal recognition for transgender individuals. The bill has not yet been scheduled for a hearing, but given the substantial support it has garnered, its progression through the legislative process is anticipated to be swift once it begins.
In Mississippi, Senate Bill 2753 and House Bill 1607 have successfully passed their respective chambers. House Bill 1607 defines sex based on reproductive capacity, and puzzlingly states that for transgender individuals, “equal” does not mean “same” or “identical.” Notably, the bill does not provide a definition for “equal,” a term also left undefined in similar legislation in other states. This ambiguity sparked debate over a comparable bill in Iowa, which is currently stalled in the legislature there in part because of disagreements over that line. As for Senate Bill 2753, it would ban bathroom access for transgender individuals in publicly owned facilities, such as rest stops and the Jackson airport.
In Alabama, House Bills 111 and 130 similarly target transgender individuals. House Bill 111 specifies sex based on reproductive capacity for all vital statistics purposes. Meanwhile, HB 130, although not directly defining sex, will reportedly be amended to add language that extends “Don’t Say Gay” legislation to Space Camp. This addition comes after conservative media expressed outrage over a transgender individual being employed at the state’s renowned Space Camp and could be used to target transgender employees in state facilities.
So far, only five states have passed similar legislation: Kansas, Montana, North Dakota, Tennessee, and Utah. In Kansas, a judge has recently ruled in favor of Attorney General Kris Kobach that drivers licenses and birth certificates must contain transgender people’s old assigned sex at birth, citing the law there. Meanwhile, although such a law does not exist in Florida, rule changes have resulted in a lack of ability for transgender people to change their drivers licenses; reportedly, Florida residents are unable to change their birth certificates as well. Additionally, Oklahoma and Nebraska have executive orders defining sex similarly.
Should these bills become law, an increasing number of states will not legally recognize transgender individuals. The implications of such legislation are profound: individuals who have long since updated their identity documents may face the reversion of those documents back to their assigned sex at birth. These state-issued identification documents could then be employed to enforce additional anti-transgender laws, including bathroom bans. Moreover, these restrictions are bound to create complications for transgender individuals who have legally updated their federal documents to align with their gender identity, as these documents would conflict with their state-issued ones.
There have been calls for a federal legal response to bills that outlaw gender markers and refuse legal recognition to transgender people. For instance, in Florida, the entire Democratic congressional delegation asked the Biden Administration to use the Real ID act, which mandates “gender” be listed on drivers licenses. There has been no response to that request as of Monday.
Multiple lawsuits are underway trying to reverse the laws in court where they have passed, but the legal outcomes are currently pending.
In an article published in the opinion section of The New York Times, opinion columnist Pamela Paul wrote a 4,500-word article filled with factual errors and unfounded assumptions about transgender care and the lived experiences of transgender people. Although the article is presented as a piece on detransitioners, the interviews serve as vehicles through which Paul packages inaccuracies and disinformation with faulty citations and claims that are not supported by the evidence she presents. The article is the latest in a seriespublished by The New York Times to do so, and a simple fact check of the claims presented easily debunks the article’s central premises as highly misleading.
It is notable that this is not the first time Paul has waded into LGBTQ+ issues with the seeming goal of covering for anti-LGBTQ+ policies. Previously, she wrote an article criticizing LGBTQ+ organizations for the use of the word “queer,” a word that many LGBTQ+ people use to describe themselves. She has written articles accusing transgender people of “erasing women.” However, this article is certainly her longest and most in depth attempt to tackle transgender issues; in doing so, she misses the mark.
Claim: Rapid onset gender dysphoria and transgender social contagion is making people trans.
Fact: Rapid onset gender dysphoria and transgender social contagion is not a validated theory, has been widely debunked as pseudoscience by major medical organizations.
“Most of her patients now, she said, have no history of childhood gender dysphoria. Others refer to this phenomenon, with some controversy, as rapid onset gender dysphoria, in which adolescents, particularly tween and teenage girls, express gender dysphoria despite never having done so when they were younger. Frequently, they have mental health issues unrelated to gender. While professional associations say there is a lack of quality research on rapid onset gender dysphoria, severalresearchershave documented the phenomenon, and many health care providers have seen evidence of it in their practices.”
At the beginning of the article, Paul discusses “Rapid Onset Gender Dysphoria” and “social contagion” as potential reasons for the apparent increase in transgender individuals in recent years, raising concerns that these individuals will detransition. However, her sources clearly contradict her premise. Her first source, used to support “Rapid Onset Gender Dysphoria,” is an article by Lisa Littman that has been retracted. Littman is notably one of the only researchers to argue for the theory, which has been repeatedlydismissed for lacking factual support and for recruiting subjects from anti-trans websites. Recently, unable to validate the theory, she collaborated with Leor Sapir, who lacks a background in transgender mental health care and works at the anti-trans Manhattan Institute, to broaden the definition of “Rapid” so that even a period of two to four years could be considered rapid. She then published it in a journal run by Ken Zucker, an anti-trans “expert” whose clinic was closed following accusations of conversion therapy.
The second set of links, claiming to show “several researchers” documenting the phenomenon, actually refers to only three researchers, not “several.” These “researchers” include Lisa Littman’s personal website, a retracted article by Michael Bailey (Lisa Littman’s treasurer), and another article by Lisa Littman herself. The sources cited for the “documented phenomenon” are the anti-trans website Transgender Trend and a SurveyMonkey poll distributed on Reddit and Twitter.
The only source that correctly represents the consensus is the source showing that professional organizations oppose ROGD as pseudoscientific. In a letter from over 60 psychological organizations, the coalition for the Advancement & Application of Psychological Science calls for the elimination of the term, stating, “There are no sound empirical studies of ROGD” and “there is no evidence that ROGD aligns with the lived experiences of transgender children and adolescents.” Paul, however, simply and misleadingly presents this letter as the organization stating “there is not enough quality research.”
A study in the prestigious journal Pediatrics entirely debunked the concept of ROGD, determining that most transgender people know their gender identity for years before they come out and seek treatment for gender dysphoria. When transgender people finally do come out, many are overjoyed to finally reveal their true self to the world around them – to others, however, the process may seem “rapid.” To ascertain whether transgender identification occurs “rapidly,” researchers directly asked transgender teenagers: “How long have you known you were transgender?” They discovered that on average, transgender people know their gender identity for four years before first coming out and presenting for treatment.
Claim: Stephanie Winn, a “licensed marriage and family therapist,” spoke out in favor of “approach gender dysphoria in a more considered way” but then was “investigated” for conversion therapy.
Fact: Stephanie Winn suggested the treatment of transgender youth with acupuncture to “see if they like having needles put in them” and stating it could “help spark desistance.” She also pushed the idea that transgender men should be estrogen to make them feel more feminine.
“They have good reasons to be wary. Stephanie Winn, a licensed marriage and family therapist in Oregon, was trained in gender-affirming care and treated multiple transgender patients. But in 2020, after coming across detransition videos online, she began to doubt the gender-affirming model. In 2021 she spoke out in favor of approaching gender dysphoria in a more considered way, urging others in the field to pay attention to detransitioners, people who no longer consider themselves transgender after undergoing medical or surgical interventions. She has since been attacked by transgender activists. Some threatened to send complaints to her licensing board saying that she was trying to make trans kids change their minds through conversion therapy. In April 2022, the Oregon Board of Licensed Professional Counselors and Therapists told Winn that she was under investigation. Her case was ultimately dismissed, but Winn no longer treats minors and practices only online, where many of her patients are worried parents of trans-identifying children.”
Paul then attempts to take readers through to other researchers who are, presumably, being “unfairly treated” for their “unorthodox” views on transgender people. One of those people is Stephanie Winn, who she presents as a “licensed marriage and family therapist” in Oregon. She claims that Winn simply spoke out “in favor of approaching gender dysphoria in a more considered way” and was attacked for this. A simple click on Paul’s link, however, shows how this is a highly misleading claim and misrepresents the brutality of what Winn was proposing.
In the thread linked by Paul, Winn muses that transgender men have a “sense of being less feminine” and could be made to feel more feminine by giving them estrogen. There is absolutely no research behind this claim, and in fact, giving transgender people the hormone of their assigned sex at birth has been tried in the past with disastrous effects. In a paper published in 1967 by Harry Benjamin, one of the first major researchers into transgender care, he stated: “I have heard rather frequently in the patient’s history that androgen had been used in the past in an attempt to cure the transsexualism by masculinization. It is the wrong treatment. It aggravates the condition by increasing libido without changing its character or direction. Androgen is contraindicated.”
Winn has also advocated for the treatment of transgender youth with acupuncture, stating, “they can see how they like having needles put in them.”
“So Your Kid Wants To Live As The Opposite Sex” by Stephanie WinnStephanie Winn has not been investigated or attacked simply for “approaching gender dysphoria in a more considered way.” Rather, attacks on Winn are linked to extremely cruel suggestions and musings around how transgender youth should be dealt using cruel, coercive, and painful conversion therapy techniques.
Claim: Transgender people may actually just be gay, and transitioning is a form of “conversion therapy.”
Fact: Gender and sexuality are different, many transgender people identify as gay or bisexual after transition, and gay acceptance is higher than trans acceptance.
Gay men and women often told me they fear that same-sex-attracted kids, especially effeminate boys and tomboy girls who are gender nonconforming, will be transitioned during a normal phase of childhood and before sexual maturation — and that gender ideology can mask and even abet homophobia. … “I transitioned because I didn’t want to be gay,” Kasey Emerick, a 23-year-old woman and detransitioner from Pennsylvania, told me. Raised in a conservative Christian church, she said, “I believed homosexuality was a sin.”
The claim that transgender people are “actually just gay” is one that has been made repeatedly by those opposed to gender affirming care, and one that has been repeatedlydebunked. Paul wades into this claim by featuring Kasey Emerick, who claims that “believing homosexuality was a sin” played into her transition.
Factually, though, attitudes towards transgender people tend to be “significantly more negative” according to an article in the International Journal of Environmental Research and Public Health. This contributes to a much higher rate of violence and discrimination. Many transgender people, such as celebrity Laverne Cox, report that the most common response to coming out is, “couldn’t you have just been gay?”
According to the 2012 National Transgender Discrimination Survey, most transgender people identify as lesbian, gay, bisexual, or queer after transition. If transition was being used to “cure” being gay, it is a startlingly ineffective cure.
Claim: 80% of transgender individuals desist from being transgender if they go through puberty without intervention, and another study suggests that 30% of individuals stop taking hormone therapy medication.
Fact: Detransition rates are estimated to be between 1-4%. The study citing an 80% detransition rate is based on faulty outdated data, using criteria no longer in use. Furthermore, the study indicating a 30% discontinuation rate is based on military families not refilling their prescriptions through Tricare, rather than actual discontinuation of hormone therapy.
The claim that 80% of transgender youth detransition has been widely debunkedand is contradicted by modern research, which indicates regret and detransition rates of 1-4%, according to a review of newer peer-reviewed studies by Cornell University. Recent studies reveal that 97.5% of transgender youth maintain a stable gender identity after five years. The older article Paul references is a journal article in a publication with a very low impact factor; this article does not provide new data, and instead discusses the same two outdated sources commonly associated with the exaggerated “80% detransition rate” claim: Kenneth Zucker’s research from the 1990s on detransition, which uses outdated diagnostic criteria for “gender identity disorder” that misclassified feminine gay men as “disordered,” and Steensma’s studies from 2011/2013, known for similar methodological shortcomings.
Both of these studies share a similar problem that explains why the numbers are so different when compared to modern studies around transgender care: they utilize outdated criteria for “gender identity disorder,” which misclassified tomboys, masculine lesbians, and effeminate gay men as “disordered.” Notably, Zucker advocated for conversion therapy, arguing that “a homosexual lifestyle in a fundamentally unaccepting culture simply creates unnecessary social difficulties.” He also employed techniques aimed at coercing trans kids to conform to their assigned sex at birth, such as withholding cross-gender toys and advising parents “not to give in” to their trans youth’s desires to wear clothing that aligns with their gender identity.
The old criteria noted that to be diagnosed with “gender identity disorder,” you did not need to desire to be “the other sex.” Instead, the disorder was about gendered behavior that was deemed “too masculine” or “too feminine” by society, and purposefully included gay people who didn’t “act man or woman enough.” The new criteria, however, require the transgender youth to desire or insist to be the other sex.
Steensma’s2011 and 2013 studies had similar issues in his research, which in some ways had even worse methodological flaws. Steensma used the old criteria, which is not the way that gender dysphoria is diagnosed today. Worse, the two studies classified every youth who did not return to the clinic as having “desisted” or “detransitioned” with no long term follow-up. Half of the participants in the studies did not return and all were classified as having “desisted.” The sample sizes were tiny at the getgo – only 53 people were in the first study and 127 in the second study. Given the fact that a large portion if not the majority of Steensma’s patients were classified under decades old criteria and assumed permanently detransitioned simply for refusing to follow up, these studies cannot be used to make any reasonable claim of high desistance rates.
The last study that Paul refers to is a study released two years ago on military continuance of care. That study looked at all hormone therapy distributed under the military Tricare health insurance plan and determined that 30% of people stopped receiving their hormones through Tricare. What the study does not do, as Paul claims, is support the idea that “30% of people discontinued hormone therapy.” In fact, there are many reasons why people would no longer fill their hormone therapy through a military Tricare plan, especially towards the end of the study in 2017-2018:
The Trump administration began targeting transgender servicemembers, and many transgender servicemembers likely stopped filling their hormone prescriptions through Tricare for themselves or their family members, fearing being targeted.
Tricare has notoriously poor transgender care coverage, as evidenced by many military members responding to a thread discussing the results of this study, and many transgender servicemembers may opt to get their medication through a low cost alternative such as Planned Parenthood
Hormone therapy can be discontinued for surgery, fertility and pregnancy planning, and many other purposes.
Some nonbinary patients may obtain all the results they wish from hormone therapy before discontinuing, desiring no future results.
Transgender people may simply have not filled the medication through insurance and instead utilized online pharmacies, which have grown increasingly popular.
Transgender patients can easily fill prescriptions through GoodRX plans, which would allow them more privacy.
Transgender people may have been forced off care by military decisions
Even the authors of the article themselves state that they likely overestimate discontinuation:
“We only collected information on medication refills obtained using a single insurance plan. If patients elected to pay out of pocket for hormones, accessed hormones through nonmedical channels, or used a different insurance plan to pay for treatment before and/or after obtaining gender-affirming hormones using TRICARE insurance, we did not capture this information. This means that our findings are likely an underestimate continuation rates among transgender patients.”
There are many more factual errors contained within Paul’s article; it is 4,500 words long and covers virtually every anti-trans claim made in legislative hearings across the United States. Many advocates for transgender people, medical experts, and journalists have weighed in to cover other aspects of Paul’s piece. You can find those here:
A new bill just introduced in Florida aims to expand “Don’t Say Gay Or Trans” provisions to a broad range of workplaces. Targeting government employees, contractors, and nonprofits, the bill sets forth restrictions and bans on policies relating to pronouns, gender identity, and sexuality.
Specifically, it would prohibit state and local government employees as well as any contractors engaged with the government from changing their pronouns or honorifics if they do not match their assigned sex at birth. It would also bar them from instructing on gender identity or sexuality, similar to “Don’t Say Gay Or Trans” laws already active in the state education system. The legislation would establish “biological” pronouns as official state policy.
The bill also would establish protections for what it calls “deeply held biology-based beliefs.” It may even prevent all nonprofits in the state from mandating any “training, instruction, or other activity on sexual orientation, gender identity, or gender expression,” a clause that could destroy LGBTQ+ nonprofits across Florida.
The bill, HB599, was introduced by Representative Ryan Chamberlin, a Republican. The bill is split into two sections, with the first section applying to government employees and contractors, which it defines as “an individual, partnership, corporation, or business entity” that “enters or attempts to enter into a contract for services” with any state, county, municipality, or special district of Florida.
These definitions encompass a huge number of businesses, such as stadiums, convention centers, major hospitals, insurance agencies, and more. For these businesses, as well as for all government workers, the bill would declare that it is the state’s policy that “a person’s sex is an immutable biological trait and that it is false to ascribe to a person a pronoun that does not correspond to such person’s sex.” It then would bar covered employees from sharing pronouns that “do not correspond to that person’s sex,” effectively banning social transition at work for these employees.
See the provisions barring pronouns, honorifics, and more here:
The bill also would enshrine a new phrase into law: protections for employees “deeply held religious or biology-based beliefs.” The phrase “deeply held religious beliefs” has longstanding precedent in constitutional law and is used to overturn laws judged to be violating someone’s freedom of religion.
Deeply held “biology-based” beliefs, however, are not something that has ever been a part of any law. It would appear that this line is meant to provide religious-based protections to people who assert that their misgendering of transgender people and using transgender people’s old names is part of their “biology-based” rights.
The bill is not limited in its application to government employees and contractors, however. A separate section of the bill would apply to “nonprofit organizations or an employer who receives funding from the state.” In the most broad reading of this section, separating “nonprofit organizations” from “employers who receive funding from the state,” it would bar all such organizations from mandating “training, instruction, or other activity on sexual orientation, gender identity, or gender expression.”
Provisions in HB599
This provision is severe in its potential impact. Virtually every LGBTQ+ organization would be radically affected by it and would likely have to shut down. It would be nearly impossible for an LGBTQ+ organization to run without providing instruction, training, and “other activity” around gender identity or sexuality. It would be a blatant power grab by the state targeting organizations critical to the government and would further drive LGBTQ+ activism and organizing underground in the state. If enforced broadly, this section could have a similar impact to laws in Russia designed to shut down LGBTQ+ organizations there.
This section would have impacts far beyond LGBTQ+ organizations as well. The provisions would apply to “any organization that is exempt from taxation” including “s. 501” organizations. This would include, for instance, 501c4s, which are crucial during election cycles and could be used to target left-leaning organizations running election ads. Many of these organizations have LGBTQ+ employees and provide instruction and accommodations for their employees, which would be barred by the state if this gets passed into law.
It could also have impacts on medical organizations that do business with state and local governments. Planned Parenthood, a 501c3, heavily provides care for LGBTQ+ people, and such a law could be used to target the organization statewide. Likewise, many state hospital systems that do business with the government often must educate employees and patients on HIV and AIDs, which is impossible to divorce from LGBTQ+ issues. Community health clinics would, similarly, have to contend with these provisions.
Brandon J. Wolf, the National Press Secretary for the Human Rights Campaign said to the Blade in a statement Tuesday: “This Florida bill is a hateful, anti-LGBTQ+ monstrosity. It is dangerous, unconstitutional, and we know it’s just the start of politicians’ attacks on our community this legislative session. We’re prepared to fight back.”
This legislation represents an early move in what promises to be a challenging year for anti-LGBTQ+ legislation in 2024. Historically, Florida has often been the breeding ground for new laws aimed at the LGBTQ+ community. This bill might well serve as a precursor to the next “model policy” that could be replicated in multiple states, and bears close watching.