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Citing “Dobbs” Ruling, 19 Republican AGs Sign Letter Targeting Trans Adult Care

A new GOP target is emerging: health insurance coverage for transgender adults and their essential medical needs.

A person walks past a transgender flag during the TransFest 2023 in the Queens borough of New York City on July 29, 2023.

Republican attorneys general and legal representatives from 19 states have submitted an amicus brief in a Florida case, Dekker v. Weida, which currently mandates that transgender individuals in Florida continue to be offered coverage under Medicaid. In 2022, the Florida Agency for Healthcare Administration introduced a “standard of care,” declaring that transgender care, irrespective of age, is experimental and thus shouldn’t be covered by the state’s Medicaid program. These guidelines, based on manipulated research by the agency and its contractors, have emerged as a pivotal element in legislative and judicial debates across the United States concerning transgender care. As Republican-led states with supermajorities explore avenues to challenge gender affirming care, a new target is emerging: health insurance coverage for transgender adults and their essential medical needs.

The letter, principally authored by Attorneys General Marshall, Griffin, and Skrmetti from Alabama, Arkansas, and Tennessee respectively, aims to reverse the Dekker decision that permits transgender adults to retain Medicaid coverage for gender-affirming care. The attorneys general reference the Dobbs decision, which overturned abortion rights, eight separate times. They voice concerns that if the district court upholds Medicaid coverage, by imposing heightened scrutiny on laws affecting transgender individuals, it might similarly apply heightened scrutiny to abortion rights.

See this section of the letter:

Page 6 of Amicus brief from 19 state AGs in Dekker.
Page 6 of Amicus brief from 19 state AGs in Dekker.

The letter heavily references the Florida standards of care introduced in June 2022. During court hearings concerning these standards, evidence surfaced indicating that the “research” sanctioned by the Florida agency had been deliberately manipulated to prohibit care. The agency enlisted researchers from the American College of Pediatricians (ACPeds)—a misleadingly named religious conversion therapy association, labeled a hate group by the Southern Poverty Law Center. A document unveiled in April revealed that the agency had pre-ordained a plan leading to “care effectively banned” even before initiating the research. These revelations, coupled with other significant discoveries about the AHCA’s approach, resulted in a judge dismissing the Florida standards of care in the context of Medicaid coverage.

The attorneys general conspicuously avoid mentioning the manipulated nature of the research. Instead, they wholly endorse the AHCA report, which asserts, “The Florida Agency for Healthcare Administration (AHCA) determined that current evidence does not support using puberty blockers, cross-sex hormones, and surgeries to treat gender dysphoria.” Intriguingly, the letter’s authors seem to be not fully confident in the report’s validity, as evidenced by their fervent advocacy for diminished levels of legal scrutiny. When subject to higher scrutiny levels, numerous judges have found the pseudoscientific arguments opposing gender-affirming care to be baseless. This includes judgements in Arkansas, Tennessee, and Florida.

Gender affirming care saves lives. It has been associated with a 73% lower suicidality for those able to access care. Other studies have shown a 40% reduction in actual suicide attempts within the previous year. Over 50 studies have been compiled by Cornell University showing the importance of this care for transgender people. This is why it is supported by every major US medical organization. Yet, those against such care, including Florida’s AHCA and the aforementioned attorneys general, argue that the politically-motivated processes of Florida’s rulemaking under Governor DeSantis should carry more weight than the consensus of major medical institutions.

The letter represents the latest attack on adult trans healthcare. In the last year, several states and organizations have indicated that trans adult healthcare is the next front for anti-trans policies. Florida recently passed a law that has blocked up to 80% of all trans healthcare providers from practicing gender affirming care. Multiple states considered laws banning gender affirming care up to the age of 21 or 26. Furthermore, nationally, anti-trans budget amendments are being considered during the shutdown fight, including a FDA amendment as well as an HHS provision that could target marketplace insurance plans that provide gender affirming care, with potential disastrous consequences for trans people nationwide.

The will of the Republican party to target all trans people appears to be growing. Not long ago, Michael Knowles advocated for transgender “eradication” at a CPAC event. Both Mike Pence and Vivek Ramaswamy have voiced support for national restrictions on gender-affirming care. This letter is one more example that the healthcare of all trans people is being targeted. Given their acknowledgement of transgender rights to all reproductive healthcare rights, it seems likely that they will not stop with transgender people should they prevail.

This piece was republished with permission from Erin In The Morning.

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