The Need to Protect Access to Health Care Grows More Urgent

As part of the wave of anti-LGBTQ+ state legislation, 24 states have passed transgender health care bans. As GLAD and others challenge these bans in court, shielding access to care in non-ban states and protecting the providers who deliver it is becoming more urgent.

Health care professionals who provide care for transgender children and adolescents follow well-established standards that have been developed through decades of clinical study. It is age- and developmentally appropriate treatment requiring informed consent of the young person’s parents and informed assent by the patient, and involves in-depth screening by a multidisciplinary care team.

Every major U.S. professional medical association, representing 1.3 million doctors, recognizes this as safe, best practice, and the only proven effective care for transgender adolescents and teenagers suffering from gender dysphoria.

Parents have testified in statehouses and courthouses around the country about how receiving the doctor-recommended care their children need has enabled their young people to live happier, healthier lives – and about their distress over the harmful impact of taking that care away.

Despite all of this, as of March 2024, 24 states have passed laws banning standard-of-care medical treatment for transgender adolescents. 36% of transgender youth aged 13-17 now live in states where the doctor-recommended health care they need has been made illegal. At least two states – Florida and Ohio – have made moves to restrict how transgender adults can access health care as well.

These bans have been pushed by politicians, not doctors or parents. They do not make health care safer for anyone. They do nothing to support parents as they navigate the best options to aid their children’s physical and mental wellbeing. These are blanket bans that take away parents’ ability to make important decisions about their kids’ health care and deny transgender adolescents treatment that has helped them thrive.

GLAD is directly challenging two of these bans in federal court – in Alabama and Florida – and supporting our partner legal organizations in several other states. When judges have heard the full facts – heard testimony from medical experts, parents, and transgender people – they have ruled against these bans. But as states have pursued appeals into appellate courts that are receptive to backtracking on a range of civil rights protections, including for transgender people, we are starting to see the impact of some of these laws taking effect.

A row of thirteen professionally dressed lawyers.
GLAD Attorneys Jennifer Levi and Chris Erchull, and the rest of the legal team from Southern Legal Counsel, Inc., the Human Rights Campaign, and the National Center for Lesbian Rights representing Florida transgender people and families at Doe v. Ladapo trial in December

The cost to families

Imagine being a parent whose child needs medical care that has been shown to work, is covered by health insurance, and is the widely accepted standard of care. And imagine there is suddenly nowhere in your home state you can get them that care, because some politicians have decided they don’t like it. For many families, the only answer is to travel or in some cases move. 

As a recent report from Campaign for Southern Equality shows, there are huge costs to these options. Families across the South and Midwest where these bans have taken effect may now need to spend up to 18 hours driving, or pay for airfare and hundreds of dollars in related travel costs, in addition to time off work and school, to make one health care appointment for their child. That’s in addition to costs associated with starting at a new health care practice, and the time it may take to find and secure an appointment. Moving incurs its own costs of course, and means uprooting your and your children’s lives – something most families would rather not do, and shouldn’t have to simply to ensure their child can get health care.

Diminishing access to care

Imagine being a healthcare provider, talking with a family, knowing there is treatment that can help their child – treatment you are trained to provide – and being powerless to help. Providers are wrestling with this every day in states with active bans, where hospitals and practice groups have been forced to shut down care, clinics have closed, and some pharmacies have stopped filling prescriptions. 

This is devastating for families and transgender individuals, and the harmful impacts are not limited to states where care has been completely banned. Increased demand in states where care remains available leads to longer wait times, and uncertainty about the reach of bans is also causing a chilling effect for providers and health care institutions. In Florida, where GLAD is challenging restrictions that prohibit well-qualified nurse practitioners from delivering transgender health care for adults but ostensibly allow doctors to continue to do so, one clinic director told the Washington Post recently that he has been unable to hire physicians, because the new law “made most doctors too nervous to commit.”

Some states with bans are also attempting to track the health care residents receive elsewhere. Texas Attorney General Ken Paxton, for instance, has sought the medical records of Texas transgender youth who received care from a Seattle hospital. Such efforts are clearly aimed at intimidating families seeking care for their children, as well as the providers who serve them. 

The good news is that 13 states and DC have now passed laws to shield providers of transgender health care – as well as reproductive health care which is under attack by the same political forces – from the hostile reach of harmful bans. Another 3 states have Executive Orders protecting care, and 6 states have protections for reproductive health care alone.

GLAD has worked alongside providers and state LGBTQ+ community and reproductive equity advocates to pass such laws in Massachusetts and Vermont, including working this session on bills in Rhode Island and Maine.

While the specifics may vary, shield bills are carefully drafted to align with constitutional requirements, federal law, and a given state’s statutory structure. They do several important things to protect access to care:

  • They establish that essential reproductive health care and medical care for transgender people are legally protected in the state. 
  • They ensure a state’s resources are not used to further hostile litigation from other states where essential care is banned.
  • They protect patients from having their medical records about protected health care shared with law enforcement agencies in other states where such care is banned. 
  • They may protect the personal contact information of health care providers – something that can be an important protection as medical care providers have been increasingly personally targeted with harassment and threats. 
  • They may also ensure that insurance plans and health care institutions don’t penalize providers simply for providing medical care that is legal in their state.

These protections are growing more urgent, not only because the number of states banning essential health care is increasing, but because those bans and the disinformation being circulated to support them are designed to have a chilling effect on health care providers and institutions everywhere. At the same time, the tactics being employed by opponents are becoming more and more concerning.

Opponents of the Maine shield bill, LD 227, many of them from outside Maine and spurred on by the anti-LGBTQ extremist group Libs of TikTok, used a campaign of intimidation and disinformation about transgender people to try and stop the bill from moving forward. Bomb threats were called into the state house and the homes of the bill sponsors during the week of the committee hearing. Attorneys General from 16 states with transgender health care bans, led by Tennessee, wrote a letter threatening legal action if Maine passed a law protecting health care within its own borders. 

GLAD partnered with Planned Parenthood of Northern New England, Maine health care associations and providers, and many other organizations and individuals to provide accurate information to legislators and counter the false and at times cruel rhetoric being used against the bill. Maine’s Attorney General responded that the state has every legal authority “to decide what access to health care people in Maine receive, free from interference by out-of-state actors.” In the end, a majority of Maine legislators saw through the fear and falsehoods. LD 227 passed on April 12 and was signed into law by Governor Mills on April 22.

If we want access to quality, science-based health care and the ability for each of us – not the government – to make personal medical decisions for ourselves and our families, we have to protect it – in the courts, in our legislatures, and by making sure providers can practice the medicine they are trained to deliver without hostile, politically-driven interference.

This story was originally published in the Summer 2024 GLAD Briefs newsletter. Read more.