"This Will Get Ripped Up By Courts" - TN Bill Bans Adult Trans Coverage In Any State If Contracting With TennCare

Tennessee's Insurance Committee passed HB1215, a bill that would ban insurers from contracting as a TennCare MCO if they covered gender affirming care anywhere in the nation.

In recent months, numerous bills have been introduced that negatively affect transgender individuals. Most of these bills focus on transgender youth and include provisions such as forcing medical detransition, imposing bathroom restrictions in schools, and prohibiting teachers from using preferred pronouns and names. However, there has been a recent surge in bills that target transgender adults. One such bill is HB1215 in Tennessee. The proposed legislation not only prohibits health insurance companies from contracting with TennCare in Tennessee but also prevents them from receiving TennCare contracts if they cover gender-affirming care for any age in any state. On Tuesday, the House Insurance Committee in Tennessee debated the measure, ultimately passing it out of committee on a voice vote.

The bill in its original form stated that any managed care organization that contracts with TennCare, Tennessee’s Medicaid program covering 1.7 million people, from covering gender affirming care. This restriction applied to transgender adults as well. People quickly pointed out that this bill could target insurance companies like Blue Cross Blue Shield and United Healthcare, both of whom administer TennCare programs, from providing gender affirming care coverage for transgender adults. Others pointed out that the bill could even ban companies for providing such care out of state.

On Tuesday, the bill’s sponsor, Representative Tim Rudd (R), put forward an amendment to clarify that the bill’s intent to target insurance companies for any transgender healthcare coverage nationwide. The amendment goes further than what even most activists feared. It bans:

• Insurance companies from providing care for trans people nationwide.

• Insurance companies with similar trademarks or names from providing that care nationwide.

• Insurance companies acting as subsidiaries from providing that care nationwide.

• Insurance companies acting under another company’s license from providing that care nationwide.

See the relevant amendment here:

Amendment to HB1215 banning adult trans healthcare coverage in other states.

This is a major escalation against transgender adults . Should this bill pass, Tennessee will have to drop companies like United Healthcare and Blue Cross Blue Shield, as they provide gender affirming care coverage in many states (and are mandated to by state and federal law). The only way these organizations could contract with Tennessee is if they dropped their gender affirming care coverage for transgender adults in all US states. They are unlikely to do this as Tennessee’s share of the health insurance market is not very large. However, if larger states pass similar legislation, red states could attempt to force insurance coverage to drop gender affirming care coverage for trans adults nationwide.

This bill contradicts US federal law and is flatly unconstitutional. That is what Representative Bo Mitchell (D) stated about the bill. After Democrats argued over the bill’s violations of the commerce clause, ERISA protections, and the Affordable Care Act, he questioned the sponsor about the mechanics of the bill. The bill’s sponsor confirmed that the intent was to target out of state provision of care, to which Rep Mitchell stated, “Your values are great as long as they don’t conflict with the United States constitution. It’s not worth my time sitting here arguing. You’re going to pass it through committee, you’re going to pass it through the floor, and the first moment it passes through the courthouse doors, it’s getting ripped up.”

See Rep. Mitchell’s committee argument:

This bill is part of a trio of new bills that target insurance providers and companies for gender affirming care coverage. Just yesterday, Florida released the “Reverse Woke Act” which would make companies liable in perpetuity if their healthcare coverage includes gender affirming care. Texas SB1029 would similarly target insurance coverage for trans adults and would target doctors for “gender affirming care damages.” We have already seen Ron DeSantis weaponize state contracts with the College Board to remove queer material from AP African American Studies. Red states are increasingly turning to putting pressure on companies in order to curtail gender affirming care nationally for any age groups.

The immediate impact of bills like this passing is unclear. Tennessee would lose coverage for 1.7 million Tennesseans, and the state would have to drop several managed care organizations from the rolls. Representative Caleb Hemmer (D) stated that there would not be an insurance company that could fulfill this requirement due to ERISA and federal regulations. Even if Tennessee could fund such a provider, a bill like this could result in a loss of healthcare choices for millions of Tennesseans. If more states pass similar legislation, the loss of health insurance choices could affect people nationwide. This new front in anti-trans legislation harms more than just transgender people; it harms all who rely on politicians to not play political games with their healthcare options.