Two new bills target transgender rights, health care

Two new bills filed this week target transgender North Carolinians, part of a wave of anti-trans legislation filed by Republicans across the country.

Senate Bill 514 would prohibit transgender people under the age of 21 from receiving medical care related to gender transition, even if judged medically necessary by their parents and doctors.

The bill closely mirrors a similar legislation filed across the country, including in Arkansas this week where a similar bill was passed into law this week. To enact the law, that state’s legislature overturned the veto of Republican governor Asa Hutchinson, who condemned it as “government overreach.”

But in several respects SB 514 goes beyond the law passed in Arkansas.

The bill would also require state employees, including teachers and counselors, to inform parents in writing if they have knowledge of a minor who exhibits “gender dysphoria, gender nonconformity, or otherwise demonstrates a desire to be treated in a manner incongruent with the minor’s sex.”

Gender non-conformity can include anything from young men who paint their nails and young women who prefer to dress in clothes traditionally considered masculine to non-binary and gender-fluid people who do not identify strongly as male or female. The bill would require those children’s teachers and counselors to report them to their parents if they “exhibit symptoms” of gender non-conformity, even if they do not consider themselves transgender.

The bill also seeks to legally protect so-called  “conversion therapy,”  a scientifically discredited practice  that attempts to “cure” lesbian, gay, bisexual and transgender people. The practice, which research has repeatedly found causes depression, anxiety and suicidal thoughts, has been banned in 20 states. In 2019 Gov. Roy Cooper issued an executive order forbidding taxpayer money to be used to pay for its use on minors in North Carolina. Polling shows overwhelming support for banning the practice in North Carolina, but multiple bills to do so have gone without a hearing or a vote.

Taken together, these provisions of the bill establish a legal mandate to identify and report children who may be transgender, prevent their parents and doctors from making medical decisions about their care and legally protect methods of “curing” them that have been established to be harmful.

“It’s heartbreaking – though not unexpected – to see these direct, repeated attacks on trans and gender-nonconforming youth in North Carolina and across the country,” said Kendra Johnson, Executive Director of Equality NC, in a statement Wednesday. “These attempts to control the bodies and medical decisions of parents and their transgender children are invasive, inappropriate, and outright dangerous.”

“Decisions about a child’s medical welfare should be made between that child, their doctor, and their parents or guardians – not lawmakers.,” Johnson said. “We cannot legislate the transgender community out of existence. It is the job of all lawmakers to understand the entirety of their constituency and mitigate challenges instead of creating barriers.”

At the heart of the bill are arguments about whether transgender identity exists and whether certain of their rights are protected by law. These are disputes that have already been largely resolved by the scientific community, federal policy and the U.S. Supreme Court.

Significantly, gender dysphoria is mischaracterized throughout the bill. The American Psychiatric Association makes clear it is not a mental illness, instead defining it as “a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify.”

More than 40 years of research into and treatment of transgender people experiencing dysphoria has led psychiatric and medical professionals to conclude the most effective course of treatment is gender transition — aligning one’s life socially and sometimes physically to better match their gender identity. Not all transgender people choose to medically transition, but for those for whom it is judged necessary, medical experts agree that it can be life-saving.

The bill would also legally prohibit any state government health plan or state provided insurance from paying for that care.

Blue Cross/Blue Shield of North Carolina, which administers the State Employee Health Plan, recognizes the necessity of transition care. It has, since 2011, recognized dysphoria as a serious medical issue and covered treatments related to transition, including hormone therapy and gender confirmation surgery. But as Policy Watch has reported, the trustees of the state health care plan cut off that coverage to state employees.

The board of trustees of the state health care plan voted to begin covering treatments for gender dysphoria at the end of 2016, near the end of Janet Cowell’s term as State Treasurer. The change was necessary to comply with the Affordable Care Act. When Republican Dale Folwell came into office in 2017, he opposed the move, calling care related to gender dysphoria elective and unnecessary. The plan’s trustees allowed the coverage to expire at the first opportunity and have never reinstated it. Transgender state employees and employees with transgender family members cut off from their coverage sued the state over the change.

Ignoring scientific consensus and federal law that recognizes transgender peoples’ identities and upholds their rights, the bill seeks to legally conflate gender identity and biological sex. It describes sex as “the biological state of being female or male, based on sex organs, chromosomes, and endogenous hormone profiles, and is genetically encoded into a person at the moment of conception, and it cannot be changed.”

Making no distinction between biological sex , gender and gender identity, the bill characterizes transgender people as confused and says that if they are not encouraged to transition, any gender dysphoria they experience will naturally dissipate.

That judgement is opposed by every major legitimate medical and psychiatric association that has examined the issue.

A second bill, Senate Bill 515, would allow any medical provider  to refuse to perform any form of care or service “on the basis of conscience, whether such conscience is informed by religious, moral, ethical, or philosophical beliefs or principles.” That would including providing referrals to others who may provide the care or service. LGBTQ advocates call it a “license to discriminate” against lesbian, gay, bisexual and transgender people among, among others, for religious reasons.

“This is the latest in a series of coordinated attacks on healthcare access for trans and gender-nonconforming youth across the country, the true aim of which is to push trans and non-binary people out of public life,” said Chantal Stevens, Executive Director of the ACLU of North Carolina, in a statement Wednesday.

“Not only are these bills rooted in falsehoods, hate, and fear-mongering, but they also invade the private interactions between each of us and our medical providers,” Stevens said. “Just as North Carolina is recovering from the damage wrought by HB2 on our reputation and economy, let’s move forward together to build equitable communities rather than doubling down on being a state that legislates hate.”

These two bills follow the filing last month of House Bill 358, which would bar transgender women from competing against other women in sports at schools and universities in North Carolina.

Rev. Jasmine Beach-Ferrara, Executive Director of the Campaign for Southern Equality, warned the current wave of ant-trans legislation could lead to the sort of division and harmful backlash that accompanied HB2, the law that excluded LGBTQ people from non-discrimination protections five years ago.

“Our state learned a lesson all too painfully with HB2,” Beach-Ferrara said in a statement Wednesday. “Extreme bills that target LGBTQ people harm individuals, communities, and the fabric of our state itself.”

“We’re working toward building communities across North Carolina where every LGBTQ person can thrive,” Beach-Ferrara said. “That means being treated with dignity and respect, it means living free from discrimination, and it means being able to access the health care you need and deserve in your hometown.”