Republican-led state legislatures are considering a new round of bills restricting medical care for transgender youths -- and in some cases, adults -- returning to the issue the year after a wave of high-profile bills became law and sparked lawsuits.
As legislatures begin their work for the year, lawmakers in several states have proposed enacting or strengthening restrictions on puberty-blocking drugs and hormone treatments for minors. Bills to govern the pronouns kids can use at school, which sports teams students can play on, and the bathrooms they can use are back as well, along with efforts to restrict drag performances and some books and school curriculums.
LGBTQ+ advocates say that most of the states inclined to pass bans on gender-affirming care have done so, and that they now expect them to build on those restrictions and expand them to include adults. With legislatures in most states up for election this year, transgender youths and their families worry about again being targeted by conservatives using them as a wedge issue.
They include Mandy Wong, a mother in Santa Barbara, Calif., who said she's tired of conservative politicians using transgender children as "campaign fuel." While she doesn't expect such a policy to pass in her Democrat-led state, Wong said, her child and his friends feel emotionally drained.
"It was just heartbreaking to tell him ... I don't think this is going away anytime soon," she said. "All the negative attention trans kids, even us as parents, have gotten because of these proposals doesn't seem to be dying down."
In Ohio, House Republicans voted Wednesday to override Republican Gov. Mike DeWine's veto of legislation banning all forms of gender-affirming care for minors. The Senate is expected to follow suit this month. Despite his veto, DeWine signed an order banning the rare occurrence of gender-transition surgeries before adulthood. He also proposed rules mandating a care team for children and adults that critics say could severely restrict access for all patients.
In South Carolina, one of the few Southern states without a ban on gender-affirming care for minors, a House committee voted Wednesday to send a ban to the House floor. The bill, sponsored by the state's Republican House speaker, would also prevent Medicaid from covering such treatments for anyone under age 26. And last week in New Hampshire, the House voted to ban gender-transition surgeries for minors.
At least 22 states have enacted bans on gender-affirming care for children, with most of them approved in the past year. Those who support the bans say they want to protect children and have concerns about the treatments themselves. Major medical groups, including the American Medical Association and the American Academy of Pediatrics, oppose the bans and have endorsed such care, saying it's safe when administered properly.
Last year's limits included a Florida law that has made it nearly impossible for many transgender adults in the state to receive gender-affirming care. Florida Gov. Ron DeSantis has promoted that ban as one of his accomplishments as he seeks the Republican presidential nomination.
"They'll stop at nothing, so we don't know what exactly to anticipate [in 2024]," said Katy Erker-Lynch, executive director of PROMO, an advocacy group in Missouri, where lawmakers have proposed more than 20 bills targeting LGBTQ+ people.
ARKANSAS LAWS
In Arkansas, the 2023 regular session saw numerous laws approved by its Legislature and signed by Gov. Sarah Huckabee Sanders that are similar to those passed in other states, prompting concern from the ACLU of Arkansas and other advocates.
Among them are:
Act 274, which takes aim at gender-affirming care for minors by allowing malpractice claims to be filed at any time up to 15 years after the minor turns 18 years old.
Act 317, which limits transgender people from using the bathroom of their choice at public schools.
Act 619, which makes it illegal for an adult to enter a public restroom designated for the opposite gender from their birth gender "for the purpose of arousing or gratifying a sexual desire."
Act 542 prohibits teachers and other school employees from using transgender students' preferred pronouns or referring to their proclaimed gender identity without written parental consent.
A section in the LEARNS Act, Sanders' education package, bars teachers from providing classroom instruction on sexually explicit materials, sexual reproduction, sexual intercourse, gender identity or sexual orientation before the fifth grade.
Laws aimed at transgender minors are not new to Arkansas, however. In 2021, Gov. Asa Hutchinson signed into law a bill that deters schools from allowing transgender athletes to participate in girls' and women's sports. The same year, he also attempted to veto a bill that banned gender-affirming care for minors but was overridden by a majority of the state Legislature, similar to DeWine's experience this year in Ohio. Arkansas was the first state in the nation to make minors' access to such care illegal, though U.S. District Judge James M. Moody Jr. struck down the law in June.
The full panel of judges from the 8th U.S. Circuit Court of Appeals, at the request of state Attorney General Tim Griffin, have agreed to review the case.
An estimated 1,800 transgender-identifying youths live in Arkansas, according to the UCLA Williams Institute.
Bills filed in Missouri include efforts to remove two provisions that were key in overcoming a Democratic filibuster to that state's ban on gender-affirming care for youths. The new Missouri Freedom Caucus is prioritizing a bill that would make the ban on gender-affirming care for minors permanent, removing a provision that allows it to expire in 2027. Legislation would also remove a clause that allows minors who began care before the law went into effect to continue with it.
Republican state Sen. Mike Moon, who is sponsoring bills both to repeal the expiration date on the medical restrictions and to require schools to tell parents if a student wants to go by a name or pronoun other than the one the parent used to register the child for school, compared transgender medical restrictions for minors to age thresholds in laws for smoking, drinking and driving.
"Children, especially younger children, don't make good decisions, and they're not certain exactly what reality is sometimes," Moon said.
LGBTQ+ activists call laws that require schools to tell parents about a student's desire to change names or pronouns "forced outing," saying schools might be the only safe place for a transgender or nonbinary student to express their gender identify.
Missouri's large number of filed bills has drawn attention from activists, but Republican legislative leaders say they don't think there's much of an appetite for revisiting the restrictions and don't want to prioritize them.
"We passed what I thought was a strong and fairly broad bill last year," said Missouri Senate President Pro Tem Caleb Rowden, referring to the medical ban.
OTHER STATES
In Oklahoma, at least two bills remain active from last year that target gender-affirming care for adults. One proposal would prohibit insurance coverage for the procedures for adults, while another would prohibit public funds from going to any entity that provides such care.
Both measures stalled in the Republican-controlled Legislature last year but could be reconsidered during the legislative session starting in February.
The rules proposed in Ohio by DeWine last week place new limits on adults that advocates say would make treatment difficult, if not impossible, for some people. They include mandating a team for individuals that would consist of at least an endocrinologist, a bioethicist and a psychiatrist. The rules also would require departments to collect data submitted by medical providers on gender dysphoria and subsequent treatment.
Several bills have been filed in Florida, including a measure to require employees at state agencies or at any entity that receives state funding to use the pronouns consistent with their assigned sex at birth.
Legislation introduced Wednesday in West Virginia would ban gender-affirming care up to age 21 and prohibit mental health professionals from supporting what lawmakers call a transgender patient's "delusion" about their gender identity.
In California, which has offered refuge to transgender youths and their families from states with medical bans, conservatives are mounting a longshot effort to put a measure on next year's ballot targeting the rights of transgender minors.
Nebraska state Sen. Kathleen Kauth, who last year sponsored the state's gender-affirming care ban for those under 19, said partisan politics are not behind her push for bills aimed at LGBTQ+ people. This year she is again pushing a bill she introduced last year that would restrict transgender students' participation in sports and limit their access to bathrooms and locker rooms.
Kauth's medical ban led progressive lawmakers to filibuster nearly every bill of last year's session.
"I don't think it's something that is designed to get reelected because, you know, my district is actually half and half -- slightly more are conservative than liberal," Kauth said. "I am about pushing back on federal government overreach, whatever it looks like, and protecting kids."
Nationwide, challenges to laws already in place are moving closer to the U.S. Supreme Court. The American Civil Liberties Union has asked the court to block restrictions on care for youths in Kentucky and Tennessee.
Federal rulings against the bans so far have come from judges appointed by both Democratic and Republican presidents.
Information for this article was contributed by David Lieb, Summer Ballentine, Margery Beck, Sean Murphy and Sophie Austin of The Associated Press; and Josh Snyder of the Arkansas Democrat-Gazette.
Missouri state Sen. Mike Moon speaks to a reporter, Wednesday, Jan. 3, 2024, in his state Capitol office in Jefferson City, Mo. Moon, a Republican, in sponsoring bills to extend restrictions on medical treatments for transgender individuals and to require schools to get parental consent if students want to use pronouns different from what they were assigned at birth. (AP Photo/David A. Lieb)
Missouri state Sen. Mike Moon speaks to a reporter, Wednesday, Jan. 3, 2024, in his state Capitol office in Jefferson City, Mo. Moon, a Republican, in sponsoring bills to extend restrictions on medical treatments for transgender individuals and to require schools to get parental consent if students want to use pronouns different from what they were assigned at birth. (AP Photo/David A. Lieb)