Texas Could Be The Next State To End Most Adult Trans Care

A bill that would target most transition care in Texas was just advanced by the Texas Senate. This bill could make it virtually impossible to get gender affirming care.

In a startling move yesterday, the Texas Senate passed one of the most extreme pieces of legislation aimed at gender-affirming care. While the majority of American bills targeting transgender care have focused on youth, the Texas law takes it a step further, potentially stripping essential care from countless transgender adults. Instead of implementing a direct ban on care like other bills, this legislation insidiously imposes a prohibitively onerous financial disincentive, which could effectively leave physicians unable to provide the necessary treatment. This alarming development marks a significant escalation in anti-trans legislation, as it now targets adults and mirrors a concerning trend recently observed in several other states.

Senate Bill 1029 outlines a series of constraints designed to render gender-affirming care virtually impossible to provide. One such constraint stipulates that health insurance companies covering gender-affirming care would face increased liability to transgender patients. Another limitation bars the use of "public money" for gender-affirming care – a vague restriction that could result in entire hospital systems, which receive any public funding, being unable to offer this care. Most alarming, however, is a provision granting doctors lifetime liability for providing gender-affirming care, even in the absence of malpractice. This provision would mean that doctors would not be able to maintain malpractice insurance that covers their practice and thus would be unable to provide care. Collectively, these restrictions bear a striking resemblance to TRAP Laws (Targeted Restrictions on Abortion Providers), which are often employed to obstruct abortion care within a state.

You can see the doctor liability provisions here:

Doctor liability with no malpractice for gender affirming care.

Taken together, these provisions could effectively bring an end to the majority of gender-affirming care in the state. With a doctors being unable to utilize malpractice insurance and the prohibition of public funds and Medicaid coverage for care, access to treatment may become increasingly limited. The increased risk to private health insurance providers serves as a means of discouraging coverage, while targeting doctors who provide the care further exacerbates the situation. As a result, both transgender adults and providers may encounter insurmountable barriers to accessing necessary treatment. Should it pass, Texas would become the second state to implement such extreme measures against adult care, following Missouri Attorney General Andrew Bailey's order, which essentially prohibits gender-affirming care for most transgender adults in the state.

Local activists and organizations agree. In an interview with the Texas Tribune, Christopher Hamilton of Texas Health Action stated, “It really is just an attempt to chill health care for all trans people.”

Texas is the latest state to target gender-affirming care for transgender adults, but we have witnessed similar actions in other states as well. Missouri recently imposed a series of stringent restrictions on gender-affirming care. In a baffling Catch-22, Missouri's new guidelines necessitate resolving issues like depression and anxiety before initiating gender-affirming care while simultaneously demanding severe dysphoria to qualify for the treatment. Since severe dysphoria often causes anxiety and depression, successfully addressing these mental health concerns might result in dysphoria no longer being classified as "severe," thereby prohibiting treatment. Conversely, if a doctor cannot alleviate the depression and anxiety, the treatment would still be banned due to “unresolved mental health issues.” Ultimately, this leads to a de facto ban on all transgender care. The Missouri policy is being heard in court today in hopes of obtaining a temporary restraining order blocking it from taking effect.

Gender affirming care is proven to save lives. It reduces anxiety and depression, helps give transgender people congruence with their own bodies, and aids in existing as a member of their gender identity in public. One recent study showed a 73% lower suicide rate for people allowed to medically transition, and similar drops in depression and anxiety. Another showed a 40% reduction in attempts over the last year. There are many more studies that have been done on this care - The Center for the Study of Inequality at Cornell University compiled 51 such studies showing the medical and psychological benefits of transitioning for trans people.

In recent years, we have seen an increased targeting of adult gender affirming care by major figures and organizations in the anti-trans movement. Genspect and Transgender Trend, well funded and active organizations campaigning on behalf of anti-trans laws, have lobbied to increase healthcare bans up to age 25. Michael Knowles and Matt Walsh have recently gotten fully behind transgender “eradication,” with Matt Walsh recently stating that gender affirming care should be available to nobody. This is significant given Walsh’s hand in drafting and supporting anti-trans bills.

As legislative sessions continue across the nation, we can expect more of these bills and policies to emerge. Heading into 2024, this issue is likely to become more nationalized as presidential candidates and far-right Republicans attempt to exploit the fear campaign they have instigated against gender-affirming care. Fortunately, there is a glimmer of hope for the transgender community, as anti-trans legislation and candidates who champion these platforms often lack widespread popularity during elections. The outcome of the 2024 election cycle could prove crucial in safeguarding transgender rights for the foreseeable future.