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The GOP’s attack on trans kids’ health care, explained

Arkansas just became to the first state to pass a bill that would cut off trans kids from medical care. More are set to follow.

Rob Melnychuk/Getty Images

It’s become a transgender cliché at this point, but Amanda Dennis, a 41-year-old mom from Northwest Arkansas, always knew her middle child, B, was different.

So when B, now age 8, gravitated toward femininity, Dennis didn’t discourage it. “We have never raised our children in a manner of, ‘You’re a boy, you must do this. You must play with this. You’re a girl, you must do this, play with this,’” she told Vox. “I’ve allowed my children to self-direct and experience the world and life through however they choose to do that.”

That presented some challenges for B in kindergarten and first grade, where she was teased for her femininity by the boys in her class. But then the pandemic hit, and suddenly B was going to remote school, which gave her a chance to breathe and the family an opportunity to help her experiment with her gender in a safe space.

Dennis recalls a moment early in the pandemic when a friend was taking socially distant family pictures in their front yard. “She kept referring to B as ‘she,’ ‘her,’ ‘sweetheart,’ this and that,” said Dennis. “After that was done, I sat down with B and said, ‘How did that make you feel?’ And she said, ‘It doesn’t bother me. I actually prefer that.’”

Over the course of last summer, B started easing into identifying as a girl. Many discussions were held with B about how she’d like to dress, what pronouns she preferred, and trying out a new name. “It was the pandemic and being at home and being together as a family and feeling like we had this moment of safety around us,” said Dennis. It “allowed her to get to that point where she felt like, ‘Oh, I can do this.’”

Though B is much too young to start any kind of medical transition, which wouldn’t begin until after puberty starts around age 11 or 12, her social transition has already paid dividends to her mental health. “It was like a weight lifted off that child’s shoulders,” Dennis said. “It was such a beautiful moment to see her be able to fully embrace who she is as a person.”

Now back in a physical classroom, B seems to be thriving. She’s more relaxed and no longer comes home crying every day. But there’s a threat to B and her family’s newfound peace of mind — in the form of Arkansas’s Republican-led state legislature.

On Monday, state lawmakers passed HB 1570, which bans transition-related health care, like puberty blockers, for trans minors. HB 1570 also encourages, though not requires, health insurance companies to refuse to cover transition-related care for all trans people, even adults. This means if Gov. Asa Hutchinson signs the bill, which he is expected to do, B will not be able to access the care she may eventually need at the only adolescent gender clinic in the state, Arkansas Children’s Hospital in Little Rock.

“The bill in Arkansas is among the most sweeping and egregious anti-trans bills this [legislative] session,” Chase Strangio, an attorney for the American Civil Liberties Union, told Vox.

How the bill works, per Strangio: It would create civil and regulatory penalties for any health care provider who directly provides or even refers a patient for transition-related care to minors. It also bans state funds from being used toward transition-related care for minors, so even if someone goes out of state for care, but is on the state insurance plan or Medicaid, they would not be able to get coverage for that care.

The Arkansas bill is part of a larger, carefully coordinated campaign by the far right and religious conservatives to attack trans people in the wake of their failures to stop marriage equality and pass anti-trans bathroom bills over the past decade. So far, at least 18 states have proposed similar bans on transition-care for trans youth, though Arkansas is the first to pass it. Just last week, Hutchinson signed a sweeping religious exemption law allowing health care providers to refuse to treat LGBTQ people on the basis of religion or moral conscience; he also signed a bill banning trans girls from girls’ sports. Twenty-nine other states have introduced similar trans athlete ban bills this year.

Trans advocates have pointed out that these bills fit comfortably within the larger GOP plan to seize minority power in an effort to force their preferred gender dynamics. “The voting restrictions being passed in these statehouses are the fuel, and the limits on women and trans people are the fire,” Gillian Branstetter, a spokesperson for the National Women’s Law Center, told Vox. “They know their retrograde views on gender are deeply unpopular, and they need to rig the game in order to be able to do it without facing consequences.”

Strangio promised that each and every anti-trans bill passed will be challenged in federal court. “We’re going to challenge the bills and build the public narrative,” he said. “I believe in the harm reduction potential of federal court and state court litigation.”

Branstetter, meanwhile, is looking toward the Biden administration, the president being an early and often vocal supporter of trans rights, to speak out against bills such as the one passed in Arkansas. She noted what a monumental moment it was in 2016 when then-Attorney General Loretta Lynch spoke out against North Carolina’s bathroom bill, which was eventually partially repealed.

“I think an important next step would be for the Biden administration to stand up in support of trans people. I know I’m not alone,” she said.

And trans people really seem to need the support at the moment. The Arkansas bill that passed is so domineering that some families with trans kids are now looking to flee the state, which is not easy to just pick up and do. Dennis, who grew up in Arkansas, doesn’t want to leave her extended family behind.

“None of it is about protecting kids. It’s about removing the ability for parents to make decisions with their medical team and their children, which is private,” Dennis said.

She said she has a window of about two to three years before B’s puberty starts. “I have to make a really difficult decision: Do I stay here in this state or do I try to leave?” she said. “Eventually, if this is not overturned, we will have to leave the state of Arkansas.”

Why are Republicans trying to legislate trans kids’ care?

In late 2019, the anti-trans legislative movement was seemingly on its last legs. It had found early success by passing North Carolina’s bathroom bill, HB 2, which dictated that trans people use government-owned bathrooms according to the sex designated on their original birth certificate, in 2016. But HB 2 ended up a disaster for Republicans. After a massive outcry and resulting boycott (from the NCAA, major corporations, and others) that lost the state an estimated $3.7 billion in state revenue, the bathroom bill was partially repealed, and the state’s Republican governor, Pat McCrory, the bill’s chief cheerleader, was run out of office.

After the North Carolina disaster, bathroom bills in other states failed to pass, effectively ending the bathroom ban effort in state legislatures.

Searching for a new effective line of attack, right-wing media latched onto the case of 8-year-old Luna Younger in Dallas, Texas. Younger was at the center of a bitter custody dispute between a mother who supported her gender identity and social transition and a father who refused to affirm the child.

Even though Luna, like B, is still years away from any potential medical intervention, conservatives took the opportunity to accuse Luna’s mom of wanting to “castrate” an 8-year-old, a completely false claim. After weeks of nonstop coverage and outrage by conservative news outlets like Breitbart and Fox News, several major and local Republican lawmakers rallied around the father, promising to bring the weight of the state against young Luna’s future medical transition.

In addition to Texas Gov. Greg Abbott and Texas Sen. Ted Cruz, who called Luna’s transition “child abuse,” state legislators in several states promised to propose banning transition-related care for minors in their next legislative session in 2020. Ultraconservative, anti-LGBTQ organizations like Alliance Defending Freedom and the Heritage Foundation were quick to capitalize, organizing public events to spread panic over trans kids, fundraise, and write model state legislation for the bans.

While many of these bills were proposed during an election-year legislative session in 2020, none passed — until Arkansas’s this week.

These bills, along with a coordinated distraction of other bills seeking to ban trans girls and women from girls’ and women’s interscholastic and collegiate sports, have taken a serious toll on a trans community that is simply trying to live their lives without conservative lawmakers issuing diktats from their capitols.

“You shouldn’t have to worry that your kid is going to abruptly be cut off from their care because lawmakers want to destroy them,” said Strangio. “There are so many conversations about whether people can leave their jobs, whether people have enough savings, and we’re creating a massive amount displacement within our own country,” he said about the Arkansas bill.

Lawmaker after conservative lawmaker has used the debates over these bills to not-so-coyly push their opinion that trans kids should not legally exist. Earlier this month, Minnesota state Rep. Eric Lucero, who proposed a trans athlete ban in his state, said, “The last several years have been witness to a rise in the number of confused boys and men mistakenly believing themselves to be girls and women when the science says otherwise.” And bills like Lucero’s and the ones banning trans health care would effectively accomplish that — making trans kids’ lives impossible to live.

What is transition-related care for minors?

While many cis people say they’re fine with an adult transitioning their gender, a large number of people feel more squeamish about trans adolescents doing the same. A 2019 PRRI poll reported that 63 percent of Americans would be very or somewhat comfortable if a friend told them they were transgender; however, just 48 percent said the same if their child told them they were.

Trans kids have always existed, and they’ve been studied for at least the past 50 years. Over time, treatment has evolved significantly. Until 2013, being trans as a child was considered a psychological disorder, called gender identity disorder, and early scientists initially recommended “conversion therapy” for gender dysphoric children.

As time went on, however, conversion therapy became less socially accepted (it’s now banned in 20 states and the District of Columbia), and scientists in the early 2010s sometimes sought softer forms of manipulation to dissuade kids from expressing an alternative gender identity — such as isolating kids from opposite-sex friends and banning gender-nonconforming toys or clothes from a household. Overall, none of these “treatments” worked.

“In the past, doctors thought that gender diversity was a pathology, something that needed to be fixed,” said Jack Turban, a fellow in child and adolescent psychiatry at Stanford University School of Medicine, where he researches the mental health of transgender youth, in an email to Vox last year. “They would try to push kids to be cisgender. A recent study from our group found that transgender people exposed to attempts to make them cisgender had greater odds of attempting suicide.”

Nowadays, doctors recommend taking a humane and affirming approach when a child expresses that their gender may not match their assigned sex at birth. This affirmation includes allowing trans kids to socially transition (i.e., use whichever name, pronouns, and clothing make them comfortable). Medical interventions — like puberty suppression or gender-affirming hormones like estrogen or testosterone — are only recommended for adolescents who have been insistent, persistent, and consistent in their gender identity over long periods.

The affirming model has been recommended by nearly every major American medical association, including the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, the Endocrine Society, the World Professional Association for Transgender Health, the American College of Obstetricians and Gynecologists, and many others.

While the affirming model is often willfully misconstrued as instructing parents to accept a child’s gender identity and rush them off into medical interventions, it’s really more about creating a space for trans kids to explore their own gender expression and more thoroughly understand their dysphoria before deciding on whether to transition or not. Allowing a trans adolescent to go on puberty blockers is a decision most parents don’t take lightly. Transitioning is a slow, deliberative process for minors.

Puberty blockers merely act as a pause on an adolescent’s natal puberty, so that adolescents ages 9 to 14 can be more mentally mature before deciding on the course of their permanent treatment when the time comes, according to Safer. Cross-sex hormones, which would be used later in the teen years, would mean testosterone injections for trans boys and a combination of a testosterone blocker in addition to estrogen for trans girls. Safer says it’s a careful and cautious system that also respects the autonomy young trans people should have over their lives and bodies.

However, conservative legislators with their bills to ban transition care have other ideas for trans children’s futures. They appeal to the fallacy that natal puberty is natural and therefore necessary for all kids.

But this approach would force trans girls into male puberty and trans boys into female puberty without their consent, and brings along its own permanent changes, which could only partially be reversed through painful and expensive medical treatments in adulthood. Trans women forced through male puberty would then have to undergo painful and expensive electrolysis to remove facial hair and may be left with a body frame (shoulder and hip width) that would be unchangeable by any surgeries. Trans men would have to have surgery to remove their breasts and, like their trans female counterparts, be forced to live in an unwanted body frame for their entire lives.

B is already experiencing anxiety over her impending puberty as she watches her 13-year-old brother go through it himself. “She came to me the other day and she said, ‘Mom, I’m really worried. Am I going to get an Adam’s apple? Because I don’t want that,’” said Dennis. “I said, ‘Sweetheart, I will do everything in my power. I will go to the ends of this earth to protect you.”

Arkansas trans people are terrified

If any message is clear from the Arkansas state legislature this past week, it’s that trans people are not welcome in the state.

“They’re just not listening to us,” said Rumba Yambu, director of Intransitive, a local trans-led organization that helps provide community and safety for trans people in Arkansas. “We’ve had parents, grandparents, trans people, medical professionals come and testify against these bills.”

Unless Gov. Hutchinson vetoes the bill, it will become law, and what happens after that remains somewhat to be seen. There will be litigation, as Strangio promised, but whether large corporations or the NCAA jump in with an HB 2-style mass boycott is an as-yet-unanswered question. And that may ultimately be what conservative legislatures are hoping for. The NCAA can’t pull events from the entirety of the lucrative Southeastern Conference footprint, which spans from Texas to South Carolina. And large corporations are unlikely to pull business from the whole of the South if each of these states passes discriminatory laws.

So ultimately, it may be up to the Biden administration to take action. The Justice Department could step in and file lawsuits or take regulatory action against these bills, as Lynch did in 2016. Biden could also use his White House platform to speak out against these bills, a move he stopped just short of doing in an International Transgender Day of Visibility statement released Wednesday.

Congress could also end all of this gender madness by simply passing the Equality Act, which passed the House several weeks ago and is awaiting further action in the Senate. (Though given Democrats’ narrow majority and the fact that the bill would need 60 votes to pass, its odds look slim.)

For now, Dennis said the trans families she knows who can afford it are looking to move away from the state. “I see a lot of expressions of fear,” said Dennis.

Even if she were to pack up her own family, which she doesn’t necessarily want to do, there aren’t a lot of potentially safe places nearby for her to move her child. Each state surrounding Arkansas has also proposed similar bills, from Texas to Missouri.

Dennis hopes that progressives from more liberal states won’t write this fight off. Arkansas is “beautiful. It’s full of beauty and we’re the natural state,” she said. “I love it here. I love where I live. I love my community. I love my people. And to think that there are groups of lawmakers in this state that want to rip that away is just very, very disheartening.”