The state Senate approved a bill Tuesday that includes multiple controversial LGBTQ policies. Democrats objected to a GOP move to add the proposals to a popular House bill, prompting a heated fight over the Senate’s rules.
The original version of House Bill 805 added new consent requirements for pornographic websites, and it got unanimous support from Democrats and Republicans. It would allow people who appear in sexually explicit photos and videos online the option to have them removed.
The Senate added a lot more. Its bill would allow lawsuits against medical providers over gender transitions, and change the definition of biological sex in state law to exclude gender identity. The new definitions would say that gender identity is “a subjective internal sense” that “shall not be treated as legally or biologically equivalent to sex.” The change could affect transgender people seeking to change their birth certificate.
Sen. Buck Newton, R-Wilson, is the bill’s sponsor. “We cannot ignore the biological realities, and we believe our state laws should reflect that,” he said. “Women are being systemically erased from our language, whether it’s changing words from pregnant women to pregnant person, or mother to a birthing parent.”
The bill would also require schools to provide parents with a list of school library books and allow the parents to ban their children from checking out specific titles.
But Senate Minority Leader Sydney Batch says the new provisions are harmful, and it means the original pornography bill likely won’t make it to the governor’s desk.
“When my Republican colleagues loaded this bill with culture war amendments, they didn’t just distract from the problem, they made it impossible to solve,” she said.
The bill put Democrats in the difficult position of voting against legislation titled “Prevent Sexual Exploitation.” Instead of voting no, they took an unusual approach. Asked to vote yes or no, most responded “I vote present.”
Sen. Ralph Hise, R-Mitchell, that’s not an option in the state Senate.
“Notice, you have a green button and a red button, not an extra ‘whatever I came up with today’ button,” he said. “Those are the options under the Senate rules.”
The dispute put a lengthy delay on the vote as senators paged through their rulebooks. Batch said the only law she could find requiring legislators to vote yes or no dates to the 1700s.
“What it does say, if we don’t actually move and we don’t discharge our duty, which I assume that my colleagues are saying today, it’s a $10 fine,” she said, brandishing a stack of cash on the Senate floor. “I have $10 for every single one of the members in my caucus who voted present.”
But Republicans decided to count the present votes as excused absences, so on paper, Tuesday’s vote looks nearly unanimous in support of the controversial bill. It’s unclear if House Republicans will approve the Senate’s version of the bill.
Even if the House doesn’t take it up, Wednesday’s vote could wind up in campaign ads next year. “This was about elections and mailers and things like that,” said Sen. Lisa Grafstein, D-Wake. “You can already see, somebody didn’t get the memo, and they’ve been attacking members on voting no, when we did not vote no. That’s absolutely what it’s about.”
A Tennessee state law banning gender-affirming care for minors can stand, the US supreme court has ruled, a devastating loss for trans rights supporters in a case that could set a precedent for dozens of other lawsuits involving the rights of transgender children.
The case, United States v Skrmetti, was filed last year by three families of trans children and a provider of gender-affirming care. In oral arguments, the plaintiffs – as well as the US government, then helmed by Joe Biden – argued that Tennessee’s law constituted sex-based discrimination and thus violated the equal protection clause of the 14th amendment. Under Tennessee’s law, someone assigned female at birth could not be prescribed testosterone, but someone assigned male at birth could receive those drugs.
Tennessee, meanwhile, has argued that the ban is necessary to protect children from what it termed “experimental” medical treatment. During arguments, the conservative justices seemed sympathetic to that concern, although every major medical and mental health organization in the US has found that gender-affirming care can be evidence-based and medically necessary. These groups also oppose political bans on such care.
All six of the supreme court’s conservative justices joined in at least part of the decision to uphold the law, although several also wrote their own concurring opinions. In his majority decision, Chief Justice John Roberts emphasized that the ruling primarily rested on the justices’ finding that the law did not violate the equal protection clause, rather than on an ideological opposition to trans rights.
“This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy and propriety of medical treatments in an evolving field. The voices in these debates raise sincere concerns; the implications for all are profound,” Roberts wrote. He added: “We leave questions regarding its policy to the people, their elected representatives, and the democratic process.”
In recent years, the question of transgender children and their rights has consumed an outsized amount of rightwing political discourse. Since 2021,26 states have passed bans on gender-affirming care for minors, affecting nearly 40% of trans youth in the US. Twenty-six states have also outlawed trans kids from playing on sports teams that correspond with their gender identity.
Many of these restrictions have been paused by court challenges, but the supreme court’s decision could have vast implications for those lawsuits’ futures. A study by the Trevor Project, a mental health non-profit that aims to help LGBTQ+ kids, found that anti-trans laws are linked to a 72% increase of suicide attempts among trans and nonbinary youth.
Justice Sonia Sotomayor dissented from the majority opinion, alongside Justices Ketanji Brown Jackson and Elena Kagan. Because the law discriminates on the basis of sex, Sotomayor argued in her dissent, it should face higher legal scrutiny than the majority decided to give it.
“Male (but not female) adolescents can receive medicines that help them look like boys, and female (but not male) adolescents can receive medicines that help them look like girls,” Sotomayor wrote. “By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims. In sadness, I dissent.”
While largely avoiding the same level of heated pushback of years’ past, Texas lawmakers passed several bills that give LGBTQ+ people in Texas, specifically transgender residents, less opportunity to receive care and maintain their identities in state records.
Texas legislators filed over 100 anti-trans bills through the session, some containing provisions that have been shot down in years’ prior while others proposed new restrictions. Less than 10 were ultimately approved by lawmakers.
The new bills that are likely to be signed by Gov. Greg Abbott represent a yearslong movement from state conservatives to find new ways to restrict the presence of trans and LGBTQ+ Texans, advocates say. The bills that failed may also be resurrected by lawmakers in future sessions. Here’s what to know.
State definitions of man and woman
Several bills filed in the Legislature aimed to craft legal definitions of sex and gender in addition to their target goals — but House Bill 229 makes that goal its sole purpose, establishing state definitions for male and female and applying those definitions across statute.
HB 229 defines a woman as “an individual whose biological reproductive system is developed to produce ova,” and a man as “an individual whose biological reproductive system is developed to fertilize the ova of a female.”
Most immediately, the bill will bolster an already existing block from stateagencies on changes to gender markers on state documents, which was backed by a nonbinding opinion from Attorney General Ken Paxton in March. The bill may also force those who have already switched their documents to match their identified gender to have changes reverted when they are renewed.
The longer-term effects of HB 229 are still not immediately apparent, as references to man and woman are used hundreds of times in statute and may ripple into other laws affecting people’s lives. Texas joins 13 other states that have also crafted their own definitions, and several other bills that also passed in the state have individual definitions for related terms like “biological sex.”
President Donald Trump issued an executive order named “Defending Women From Gender Ideology Extremism” in January providing federal definitions of male and female. Similarly, HB 229 has been dubbed the “Women’s Bill of Rights” by supporters, claiming it protects women in the state from men invading their spaces.
Abbott released an executive order of his own shortly after Trump’s affirming the president’s directive, but did not provide his own definitions. In a May post on social media, the governor said he would immediately sign HB 229 into law.
New requirements for medical records and insurance coverage
Tightening the ability to change the gender on state records like drivers’ licenses has been a key issue for conservative lawmakers for years, and while HB 229 sets a precedent in disallowing new changes, another bill creates new requirements entirely. Senate Bill 1188 creates a new section on all state medical records listing patients’ assigned sex at birth and any physical sexual development disorders. It also bans changes to those gender markers for any reason other than clerical errors, and creates civil penalties for medical professionals who do change them.
House Democrats opposing the measure during floor discussion worried that SB 1188 may scare medical providers into inputting vague or inaccurate health information out of fear of fiscal or legal retribution. The bill does allow the new section to include information on a patients’ gender identity, however health care services must opt-in to provide it.
The bill also creates restrictions on where health care providers can store patient data and the physical servers they use to store them, and new regulations on how artificial intelligence can be used to create diagnoses.
SB 1188 is not the only bill opponents have said will create a chilling effect on the LGBTQ+ community. Some bills may be more immediate in blocking options people have to do things like change their state records, but others like SB 1188 and Senate Bill 1257 may reduce what resources are available. SB 1257 was signed by Abbott in May and mandates that insurance companies provide coverage for gender detransitioning care if they already cover gender transition care.
Proponents of the law claim it enforces responsibility onto insurance companies. The law is not a ban on gender-affirming care, however opponents worry it may act as one by incentivizing insurance companies to pull coverage altogether rather than take on potential new costs.
SB 1257 is the first legal mandate for detransition care in the United States, making Texas a testing ground for insurance companies’ appetite to keep or pull coverage. Similar bills in Arizona, Florida and Tennessee did not pass out of their respective state legislatures in 2024.
Less protections and resources for LGBTQ+ youth
Medical gender transition care for minors was banned in Texas by the Legislature in 2023, a restriction that was upheld by the state Supreme Court in 2024. House Bill 18, primarily an overhaul of rural health care including a rural pediatric mental health care program, bans minors from accessing its resources for gender-affirming mental health counseling “inconsistent with the child’s biological sex.”
The current gender transition care ban for minors does not include mental health services, only puberty blockers, hormone therapy and surgery, which is rare for those under 18. Another proposal headed to Abbott’s desk, House Bill 1106, asserts that parents who do not recognize or affirm their child’s gender identity cannot be held liable for abuse or neglect because of that lack of recognition.
More restrictions on LGBTQ+ presence in schools
Access to materials and resources related to LGBTQ+ subjects are also being restricted by legislators through two key bills primarily aimed at schools. Senate Bill 12 bans Texas schools from teaching about sexual orientation or gender identity and forbids student clubs “based on” those subjects.
The bill would prevent clubs like Gay-Straight Alliances and pride clubs, which are often tailored toward anti-bullying initiatives in schools. Opponents of the bill claim a ban on those clubs would cut off LGBTQ+ students from communities and resources that can save lives.
“One of the deadliest things that our youth go through is experiencing the perception at least of isolation, and GSAs are a powerful way that we can combat that and make sure that our youth are getting support,” said Ash Hall, ACLU Texas’ policy and advocacy strategist for LGBTQIA+ rights.
While SB 12 restricts instruction and student groups, Senate Bill 13 gives school boards and new advisory councils greater oversight to remove books from school libraries that go against “local community values.” Some lawmakers and advocates worry school boards and advisory councils would be able to restrict books containing LGBTQ+ material.
A third bill, Senate Bill 18, would have banned “drag-time story hours” at municipal libraries and cut funding to those who host them, however that bill was unintentionally killed by Lt. Gov. Dan Patrick after a procedural error at the end of the Senate’s deadline to pass bills.
Bills that failed to pass
The small set of bills passed by legislators shift the state’s treatment of LGBTQ+ Texans significantly, but still represent a fraction of what lawmakers proposed. House Bill 239, this session’s bathroom ban bill, was one of the over 100 bills that did not survive and was never heard by lawmakers despite half of the House signing on as coauthors. House Bill 2704 sought a similar ban through private lawsuits rather than criminal charges, but was never picked up by lawmakers.
Also left unheard was House Bill 3817, filed by Rep. Tom Oliverson, R-Cypress, which would have created a new felony charge for “gender identity fraud” if a person represented themselves as a gender besides the one they were assigned at birth to state agencies or employers.
Advocates like Johnathan Gooch, communications director for Equality Texas, say that the Legislature has kept its course on anti-trans legislation for the last few sessions, and that bills that didn’t get picked up by legislators may be at the forefront of future sessions.
“We’re hearing rhetoric that we’ve heard for a very long time and just more, more bills, a variety of new ways to narrow the rights of trans people,” Gooch said. “It just doesn’t come as a mistake that the number of bills is escalating.”
The military has been ordered to identify troops who either have or may have gender dysphoria, the psychological term for the distress caused by one’s gender identity and sex assigned at birth not being the same. The goal is to get started on forcing transgender people out of the military ahead of the June 6 date set by Defense Secretary Pete Hegseth to start the purge.
Earlier this month, the Supreme Court ruled that the administration could start forcing transgender people out of the military, while several legal challenges to the trans military ban are being heard by lower courts. Hegseth then said that transgender service members would have until June 6 (or July 7 for those in the reserves) to voluntarily leave the military and have a chance to keep some of the benefits they accrued in their time in the armed services.
Orders issued yesterday, Advocate reports, will have each branch of the military start identifying transgender people to kick out after June 6. It tells each branch to identify people who have a diagnosis of gender dysphoria or “symptoms consistent with gender dysphoria” and review their medical records.
“Commanders who are aware of service members in their units with gender dysphoria, a history of gender dysphoria, or symptoms consistent with gender dysphoria will direct individualized medical record reviews,” the directive says. It also reaffirms that gender-affirming care is banned for transgender active-duty members of the military.
Stars and Stripes reports that an unnamed senior Defense Department official explained that commanders can now start medical screenings for servicemembers who don’t identify as transgender but who they suspect may have gender dysphoria.
“[This] is also consistent with what we expect and require of commanders generally, to ensure that their service members are fit and capable for duty — whether it’s under this policy or any other qualification where they may have concern that that service member requires medical intervention or is not able to perform their duties,” they said.
“The implementation requires some steps to ensure that those who go forward in service remain eligible to meet the high standards of the department. The department requires high standards to ensure that the force is ready to fight and win the nation’s wars as called upon.”
On May 8, Hegseth issued a memo saying that transgender servicemembers would have until June 6 to voluntarily start the process of leaving the military and get an honorable discharge, which would make them eligible for voluntary separation pay, as well as some health care and employment assistance benefits.
“There’s no guarantee to access to your pension or severance or an honorable discharge,” said Rae Timberlake of the trans service member organization Sparta Pride. They are one of the estimated 1000 transgender service members choosing to leave the military voluntarily now in order to get some of the benefits they have been earning throughout their career that might not be available if the military forces them out for being transgender after June 6.
“This is not voluntary,” they said. “This is a decision that folks are coming to under duress.”
National Center for Lesbian Rights attorney Shannon Minter told Advocate that the May 15 memo is “disturbing.”
“From the beginning this policy has been implemented in a rushed and chaotic manner that is completely unnecessary and deeply disrespectful to these service members, who deserve at the very least clear information and an orderly process so that they can make informed decisions that will have such a profound effect on their lives and their families,” he said.
“It is also deeply concerning that the separation codes that this guidance indicates will appear on the records of officers who are involuntarily separated will create the false impression that they are some sort of risk to national security. This is grossly untrue and will needlessly limit their civilian employment opportunities.”
The purge stems from an executive order issued in January that said that trans people can’t lead “an honorable, truthful, and disciplined lifestyle and that not using pronouns associated with a person’s sex assigned at birth violates the military’s “high standards for troop readiness, lethality, cohesion, honesty, humility, uniformity, and integrity.” This runs counter to actual studies of transgender people in the military that have found that they can serve without issue.
The executive order led to several lawsuits challenging it, including a lawsuit filed in Washington state brought by seven transgender servicemembers and one trans person who wants to join the military. A federal judge in that case issued a temporary injunction, blocking the Department of Defense from implementing the ban while the court heard the case.
Trump’s Department of Justice (DOJ) appealed the injunction, but the U.S. Court of Appeals for the Ninth Circuit refused to lift it. So, the DOJ appealed to the Supreme Court, which lifted the injunction earlier this month.
Stars and Stripes reports that there are around 4200 service members with a diagnosis of gender dysphoria.
Today, a Montana Court struck down SB 99, a 2023 Montana law that categorically bans often life-saving health care for transgender youth. The Court granted Plaintiffs’ motion for summary judgment in Cross v. Montana, holding that SB 99 violates the constitutional rights of transgender youth who are seeking gender-affirming care and the healthcare professionals who are providing that care.
The lawsuit challenging SB 99 was brought by Lambda Legal, the American Civil Liberties Union (ACLU), and the ACLU of Montana. This ruling removes completely the threat hanging over Montana transgender youth and their families that their access to critical medical care would be terminated.
“I will never understand why my representatives worked so hard to strip me of my rights and the rights of other transgender kids,” said Phoebe Cross, a 17-year-old transgender boy. “It’s great that the courts, including the Montana Supreme Court, have seen this law for what it was, discriminatory, and today have thrown it out for good. Just living as a trans teenager is difficult enough, the last thing me and my peers need is to have our rights taken away.”
“Today, the court saw through the state’s vitriol and hollow justifications and put the final nail in the coffin of this cruel, and discriminatory, law,” said Lambda Legal Staff Attorney Nora Huppert. “No parent should ever be forced to deny their child access to the safe and effective care that could relieve their suffering and provide them a future. Because Montana’s Constitution protects their right to privacy, transgender youth in Montana can sleep easier tonight knowing that they can continue to thrive.”
“We are very pleased that the Court saw through the State’s unfounded arguments about why gender-affirming medical care should be treated differently from other forms of care,” said ACLU staff attorney Malita Picasso. “The Court recognizes SB 99 for what it truly is, an effort by the State to legislate transgender Montanans out of existence.”
“The Montana Constitution protects the privacy and dignity of all Montanans,” said Akilah Deernose, ACLU-MT Executive Director. “In the face of those protections, cruel and inhumane laws like SB 99 will always fail. Today’s decision should be a powerful message to those that seek to marginalize and harass transgender Montanans.”
In its ruling, the court stated:
“[t]he Court is forced to conclude that the State’s interest is actually a political and ideological one: ensuring minors in Montana are never provided treatment to address their “perception that [their] gender or sex” is something other than their sex assigned at birth. In other words, the State’s interest is actually blocking transgender expression.”
Plaintiffs in the case include Molly and Paul Cross and their 17-year-old transgender son Phoebe; Jane and John Doe joining on behalf of their 16-year-old transgender daughter; and two providers of gender affirming care who bring claims on their own behalf and on behalf of their Montana patients.
On December 11, 2024, the Montana Supreme Court upheld a preliminary injunction that SB 99 was likely unconstitutional under the Montana state constitution’s privacy clause, which prohibits government intrusion on private medical decisions. The ruling rested entirely on State constitutional grounds, insulating transgender adolescents, their families and health care providers from any potential negative outcome at the United States Supreme Court.
The U.S. Supreme Court will soon rule in U.S. v. Skrmetti, the landmark case brought by Lambda Legal, the ACLU, and the ACLU of Tennessee, Lambda Legal on behalf of three families and a medical provider challenging a Tennessee ban on gender-affirming hormonal therapies for transgender youth on the grounds the ban violates the Equal Protection Clause of the U.S. Constitution.
More information about the case is available here.
The news out of the #txlege is heavy, but we will continue to fight back against anti-LGBTQIA+ legislation at the Capitol and across Texas.
These bills will have a massive impact on trans Texans. This week is a time of grief and a source of pain for many. During this time of uncertainty and confusion, please hold on to each other and know that you are not alone. Hundreds of thousands of Texans are in your corner.
This past Monday, we passed a key landmark. All House bills that had not been referred out of committee are no longer eligible to become law. That means that 139 of the 200+ bad bills have died—bills that would have criminalized being trans or sought to ban trans care for adults outright.
“Despite some of the worst bills dying, the news of HB 229 and HB 778 passing the House weighs heavy on all of us. No matter where the fight takes us, we will survive, and we will do it together.” -Brad Pritchett, Interim CEO of Equality Texas
If you are struggling right now, please consider reaching out to:
Attorney General Pam Bondi, who has a long history of opposing LGBTQ+ rights, issued a memo to the Department of Justice (DOJ) telling employees to investigate and prosecute cases of minors accessing gender-affirming care as female genital mutilation (FGM).
“The Department of Justice will not sit idly by while doctors, motivated by ideology, profits, or both, exploit and mutilate our children,” the memo states. “Under my watch, the Department will act decisively to protect our children and hold accountable those who mutilate them under the guise of care.”
“I am putting medical practitioners, hospitals, and clinics on notice: In the United States, it is a felony to perform, attempt to perform, or conspire to perform female genital mutilation on any person under the age of 18. That crime carries a maximum prison sentence of 10 years per count. I am directing all U.S. Attorneys to investigate all suspected cases of FGM—under the banner of so-called “gender-affirming care” or otherwise—and to prosecute all FGM offenses to the fullest extent possible.”
It’s unclear what that part of the memo will do, since gender-affirming genital surgery isn’t performed on minors in the U.S. Under federal law, FGM is defined as “partial or total removal of the external female genitalia or other injuries to the female genital organs for non-medical reasons.” The only case of gender-affirming care cited in the memo involved a mastectomy.
The memo goes on to say that the DOJ will go after “on- or off-label use of puberty blockers, sex hormones, or any other drug used to facilitate a child’s so-called ‘gender transition’” as a violation of consumer protection laws. Bondi directed the Civil Division’s Fraud Section to investigate the use of puberty blockers as a violation of the False Claims Act and accused hospitals of performing gender-affirming genital surgery on minors “while billing Medicaid for an entirely different procedure.”
The memo tells the department to ignore the medical recommendations of the World Professional Association for Transgender Health (WPATH), the medical organization that sets standards of care for the treatment of gender dysphoria, saying that the group “muzzled dissenting members,” a common accusation against scientific organizations that produce recommendations that the right doesn’t like.
The memo does not discuss circumcision or genital surgeries often performed on intersex children in order to make their bodies conform to stereotypes of what male or female genitalia should look like.
Gender-affirming care is supported by all major medical associations in the U.S., including the American Medical Association, the Endocrine Society, and the American Academy of Pediatrics, as safe and life-saving for young people with gender dysphoria.
Williamette University Constitutional Law professor Robin Maril said that Bondi’s memo doesn’t create any new laws, and the parts about fraud are already part of how the DOJ handles the law.
“The bulk of this is just showing how they’re going to use resources and investigate,” she told NBC News. “That’s not a law change. It’s meant to have a chilling effect on physicians providing access to necessary care, fearing that it will be characterized as chemical and surgical mutilation of children.”
The memo comes after the president signed an executive order in January to ban gender-affirming care, even though the president doesn’t have the authority to do so. The executive order told federal departments to look for ways to fight against gender-affirming care, even though Congress has not banned the practice despite bills to ban it being introduced several times over the past few years.
Also this week, Bondi convened the first meeting of the administration’s “anti-Christian bias” task force. She started the meeting by saying that President Joe Biden – a devout Catholic – had “abused and targeted Christians,” citing a 2023 FBI memo about threats posed by anti-choice protestors.
The Trump administration has opened a new “snitch line” to report what it calls violations of Trump’s executive order “Protecting Children From Chemical and Surgical Mutilation.”
In twin actions this week, the Department of Health and Human Services (HHS) continued its efforts to end gender-affirming care for trans youth with the new whistleblower portal and the launch of an investigation of “a major pediatric teaching hospital” over the alleged firing of a nurse because she sought a religious exemption to avoid administering puberty blockers and hormones to minor patients.
Though unnamed, the nurse is likely whistleblower Vanessa Sivadge, who worked at Texas Children’s Hospital and provided testimony to Congress this week about her alleged termination.
The “snitch line” was shared publicly on Monday with guidance for potential whistleblowers published on the HHS website.
“You have three options to report a tip or complaint related to the chemical and surgical mutilation of children or whistleblower retaliation,” the guidance states, with instructions to provide identifying information of those involved in the alleged order violation.
“Please reference EO 14187 in your complaint,” the guidance states, referring to Trump’s “Chemical and Surgical Mutilation” order.
That order has been blocked by multiple federal judges with temporary restraining orders, but the Trump administration continues to invoke it in its crackdown on doctors and hospitals.
One ruling, by U.S. District Judge Lauren King in the Western District of Washington, termed the order a violation of constitutional protections by “treating people differently based on sex or transgender status.” Those cases continue to make their way through the courts.
The concurrent hospital investigation is designed to showcase the administration’s weaponization of 50-year-old federal anti-abortion provisions known as the Church Amendments to protect anti-trans whistleblowers. Those allow religious accommodation to anti-abortion healthcare providers based on “religious beliefs or moral convictions respecting sterilization procedures.”
Trump’s order characterizes gender-affirming care as “maiming and sterilizing.”
In January, the Justice Department dropped charges against Dr. Eithan Haim, a Texas surgeon accused of leaking private medical information about minors who received gender-affirming care at the same Texas hospital where Sivadge worked. He shared that information with rightwing media outlets.
The DOJ had previously charged Haim with violating HIPAA laws with “intent to cause malicious harm.” He called himself a whistleblower.
The Trump administration continues to characterize evidence-based trans healthcare as “mutilation”, despite every major medical association, including the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society, supporting the practice.
Mehmet Oz, the newly confirmed administrator of the Centers for Medicare & Medicaid Services (CMS), is telling state Medicaid officials to stop covering gender-affirming care for transgender youth. Medicaid is the joint state-federal program that covers health care for people with low incomes, including 40% of minors in the U.S.
A letter sent from the CMS to state Medicaid directors said that the program should stop reimbursing gender-affirming care for minors, including puberty blockers, hormone therapy, and surgical interventions. The letter says that there is an “underdeveloped body of evidence” supporting gender-affirming care despite the research showing that it’s a safe and effective treatment for gender dysphoria, which is supported by all major medical organizations in the U.S. The letter also cites the U.K.’s “Cass review,” a report on gender-affirming care that has been criticized for its bias against transgender people.
In a statement, Oz – who was confirmed by the Senate earlier this month – said that gender-affirming care can lead to sterilization, and that’s why the CMS is cracking down on it.
“Medicaid dollars are not to be used for gender reassignment surgeries or hormone treatments in minors – procedures that can cause permanent, irreversible harm, including sterilization. CMS will not support services that violate this standard or place vulnerable children at risk.”
Republicans in the Senate at first balked at Oz’s nomination, not due to his lack of qualifications for leading the agency but because he had, on television, expressed more liberal views when it came to acknowledging that trans kids exist and supporting reproductive freedom. The White House assured Senate Republicans that Oz is now transphobic.
Taking away health care from trans minors in low-income families just a week into his tenure at the CMS may reassure Republicans of Oz’s conservative credentials.
In January, the president signed an executive order targeting gender-affirming care for trans minors and some young adults. The order told the Department of Health and Human Services (HHS) – under which the CMS is organized – to “take all appropriate actions to end the chemical and surgical mutilation of children,” including by changing “Medicare or Medicaid conditions of participation or conditions for coverage.” Referring to gender-affirming care as “mutilation” is a tactic used by anti-transgender activists to sway public opinion against the care that has been shown to save lives.
Former HHS official Adrian Shanker, who worked at the department under former President Joe Biden, said that the CMS letter misuses regulations to limit gender-affirming care coverage.
“I don’t think this letter is using those regulations in good faith,” Shanker told Advocate. “This letter is using highly politicized language that is not grounded in the mountain of evidence that supports the underlying health and well-being of trans youth.”
“It frankly looks like a campaign document,” he continued. “It looks like a document written by anti-trans activists rather than by public health professionals and health care leaders.”
Shanker pointed out that the letter itself is not legally binding but that it will lead states to cut off coverage for gender-affirming care.
“The significant fear here is that this ‘Dear State Medicaid Director’ letter will be utilized to preclude access to care even further in some states,” he said. “And the risk of that is actually very significant because we have incredible amounts of data that confirms the health impacts of denying access to care for trans youth.”
In 2015, trans reality TV personality and author Jazz Jennings appeared on Oz’s talk show, and he complimented her mother for being supportive.
“I love the support you’ve given your daughter,” Oz said. “It’s wonderful. And you can see the beautiful young woman she’s becoming because of it.”
This was before Oz entered the political realm. The exchange, though, led to Sen. Josh Hawley (R-MO) sending a letter demanding the administration explain the ten-year-old episode.
“Have your views on this issue changed since you hosted your television show?” Hawley’s letter demanded, asking if Oz supports the administration’s position that “gender transition procedures for minors should be banned.”
In a statement, a spokesperson for the White House said that Oz would follow the president’s views on the matter, saying that everyone in the administration will follow his “playbook.”
Five days after President Donald Trumpdeclared “gender ideology” to be “one of the most prevalent forms of child abuse,” Montana’s Republican-controlled House of Representatives killed a bill that would have enshrined much the same idea into state law by criminalizing parents and medical providers.
Montana Senate Bill 164 would have made it a felony for any adult to help transgender children under 16 to gain access to gender-affirming medical care—including hormones, puberty blockers, and surgeries—classifying such help as child endangerment. On Tuesday, House lawmakers voted 58-40 to reject the proposed law, with 17 Republicans joining Democrats to block it from advancing to its final reading.
“I think it’s overly broad,” the lone Republican to speak against the bill, Rep. Brad Barker, said Tuesday. Barker said that while he generally opposes gender-affirming care for trans youth, SB164 was “the wrong approach.”
“I don’t like the thought of criminalizing parents,” Barker added, entreating fellow Republicans to “vote with your conscience.”
The bill carried penalties of up to five years in prison and $10,000 in fines for any adults, including parents and doctors, who provided children with surgery, puberty blockers, or hormone replacement therapy for the purpose of “altering the appearance” of the child or affirming the child’s gender. If “serious bodily injury” occurred, the maximum punishment was 10 years imprisonment and $25,000 in fines.
“Turning parents and doctors into felons is absolutely not the approach that best serves this state,” Democratic Rep. SJ Howell, the first non-binary person to be elected to the Montana legislature, said on the House floor.
The bill cleared the Senate in February, 30-20, with two Republicans voting against it. In that floor debate, the legislation’s sponsor, Republican Sen. John Fuller, called it a “simple bill” to protect Montana’s children. “The state does have a compelling interest, a very compelling interest, to avoid the sterilization and sexual mutilation of children,” he said. In 2023, Fuller sponsored a law that threatened medical providers’ licensing if they offered gender-affirming care to minors, a law that courtshave blocked while litigation proceeds.
“This bill is not about politics, it’s about safeguarding the health and innocence of Montana youth,” one of SB164’s House supporters, Republican Rep. Braxton Mitchell, said Tuesday. But more than a quarter of members of his own party disagreed, suggesting a potential turning point for the Montana legislature, at least on trans issues.
Tuesday’s vote was the second time this year a large swath of Republicans crossed party lines to block an anti-trans bill. Last year, Montana’s first openly transgender lawmaker, Rep. Zooey Zephyr, said her Republican colleagues often privately bemoan the transphobic culture wars and apologize to her for their votes on anti-LGBTQ legislation.
Even so, Republican Gov. Greg Gianforte signed two anti-trans bills into law last month—a bathroom ban and a law prohibiting trans girls and women from playing on women’s sports teams from kindergarten through college. The bathroom ban has been temporarily blocked. A state law that prohibited trans women from participating in female collegiate sports was ruled unconstitutional in 2022.
The right to privacy is enshrined in the Montana constitution, and state courts have strongly affirmed its application to healthcare laws. Last December, the Montana Supreme Court upheld a lower court’s preliminary injunction on a law that would have made gender-affirming medical care providers vulnerable to licensing board disciplinary proceedings. And last summer, it ruled that a parental consent law for minors seeking abortion was unconstitutional. (In January, Montana Attorney General Austin Knudsen asked the U.S. Supreme Court to declare that ruling an unconstitutional infringement on parental rights. The Supreme Court has not decided whether to hear the case.)
If it had passed, SB164 would have become the first law in the country defining gender-affirming care as a form of felony child endangerment. (Child endangerment and abuse fall under different statutes, but both evoke the same myth that gender-affirming care is dangerous for youth.)
Montana, however, wouldn’t have been the first state to direct child welfare workers to investigate families of trans children. In 2022, Texas Republican Gov. Greg Abbott ordered the state’s Department of Family and Protective Services to open child abuse investigations into parents who seek gender-affirming care for their children. That directive remains partially blocked after families of trans children and the LGBTQ advocacy group PFLAG sued.
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