Texas youth trans directive ignites battle over health coverage – Washington Examiner
A Texas directive regarding healthcare access for transgender youth has sparked an ideological battle over gender identity and the new role that Obamacare could play in making procedures and medications such as hormone therapy, surgery, and puberty blockers more accessible.
The Biden administration has taken steps to reverse Trump-era policies limiting transgender people’s legal recourse for fighting discriminatory treatment. The administration also aims to include healthcare, which includes things such as medically necessary mental healthcare and surgical treatments, as
essential health benefits
in Obamacare plans.
“This is absolutely going to set up a major fight over medical conscience and religious conscience,” said Jay Richards from the DeVos Center for Religion and Civil Society at the Heritage Foundation. “It’s one thing to say if you remove tonsils that are infected for boys, you have to do it for girls. It’s another thing to say if you do double mastectomies for women who have some serious breast cancer, you have to do it for 15-year-old healthy girls for gender dysphoria.”
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Transgender youth are the subjects of a growing body of state-level actions to limit access to the healthcare they and their parents agree would benefit them. For instance, the majority-Republican Arizona State Legislature voted to back bills on Thursday that would prohibit gender surgery for minors. In 2021, Arkansas enacted a
now-contested ban
on gender confirmation procedures for minors. Meanwhile, in 2021, 10 states passed
bans
on trans youths competing in school-sponsored sports.
The most recent and high-profile example of a state effort to impede access to certain health services for transgender youth is the February
directive
out of Texas that recharacterized giving “gender transitioning” procedures to minors as child abuse.
The order, which was partially
blocked
by a Texas judge earlier this month, stipulated that healthcare providers and educators are legally required to report parents who allow their trans children to be treated for their gender dysphoria, a state of distress due to a person’s sex assigned at birth not aligning with one’s gender identity.
The campaign team for Texas Gov. Greg Abbott, who is up for reelection in November,
called
the directive “a 75-80% winner,” but it has ignited fury from many parents of trans children, activists, and
medical professional organizations
such as the American Academy of Pediatrics.
“When supported by families and recommended by doctors, politicians should not intervene in these intensely personal medical decisions. Lawmakers should be expanding mental health services for trans youth, not adding to the existing isolation and stigma that fuels suicide risk among this marginalized group of young people,” said Sam Ames, the director of advocacy and government affairs for The Trevor Project.
Hormone treatments such as feminizing hormone therapy or masculinizing hormone therapy are not typically used in young children. Doctors generally wait until the child is 16 to begin hormone therapies, but they can administer drugs that forestall puberty in the meantime.
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Many conservatives argue that starting these treatments in children so young puts them at risk for long-term health effects, such as fertility problems. It also raises the risk that the child will grow up to regret the choice to transition and
then try to detransition
.
“These are highly controversial — a lot of us don’t even think this is legitimate healthcare. We think this is actually destructive,” Jay Richards told the Washington Examiner. “And it’s going to run directly counter to a lot of physicians’ moral intuitions or medical intuitions and in many cases religious beliefs.”
The issue of gender identity, Richards
argued
in February, is an affront to evolutionary basics such as sexual dimorphism, or the systematic differences between two people of different biological sexes.
“Behind ‘gender-affirming care’ is the hope of aligning the recipient’s body with his or her gender identity. Such ‘care,’ however, is at best cosmetic. It cannot achieve the impossible: to change someone’s sex with chemicals or scalpels,” Richards wrote.
Faith-based insurers and physicians who object to providing such procedures could fight it on religious freedom grounds in the courts, using prior cases as precedent, such as Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania. In that
2020 decision
, the Supreme Court determined that the religious order was exempt from an Obama-era mandate to provide contraception in its healthcare plans, an outcome regarded as a major victory by religious liberty advocates.
While the Obamacare coverage rule has not been finalized yet, it is currently under review by the White House Office of Management and Budget, which will push it through the finish line.
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But the coverage change would solidify and strengthen an already-existing requirement with which Obamacare plans must comply. The anti-discrimination statute in the sweeping healthcare law known as Section 1557, which has been in place since 2016, had already required state plans on the Obamacare exchanges to cover treatments for gender dysphoria.
“I don’t read it as a mandate for gender-affirming care,” said Katie Keith, a healthcare policy expert at Georgetown University’s Center on Health Insurance Reforms. “It doesn’t say this is what you have to cover and when and all these things. What it really says is, if you were just automatically excluding the same type of care that you cover for nontransgender people, for transgender people, that is presumptively discriminatory.”
In fact, the vast majority of marketplace insurance plans in 2021 did not include transgender-specific exclusions in their silver-level plans,
according
to research from Out2Enroll, a national initiative to connect LGBT people with health coverage options under Obamacare. Keith, who works with Out2Enroll, added that trans-specific exclusions began to fall when the 1557 statute went into effect in 2017.
