Texas bill would ban nearly all gender-affirming care, including for trans adults

A bill introduced in the Texas Senate is triggering alarm among LGBTQ+ advocates in the state, who say it would make nearly all gender-affirming health care illegal, including both surgical and nonsurgical treatments — even for trans adults.

“While we’ve seen several bills that would criminalize life-saving health care for trans people, none go as far as this,” Rachel Hill, the government affairs director at the advocacy organization Equality Texas, told CBS News. 

“This bill bans any public funding for trans health care at any age and puts impossible constraints on medical professionals and insurance providers,” Hill added.

The bill, S.B. 1029, which was introduced on Feb. 17 by Republican state Sen. Bob Hall, would ban “public funding for gender modifications and treatments,” bar some health plans from providing “coverage for a gender modification procedure,” and increase legal liability through malpractice suits for medical professionals or health care providers that offer gender-affirming care. 

The bill lists as gender-affirming procedures any surgeries performed on a patient’s genitals, mastectomies, and prescriptions of puberty blockers or hormones “for the purpose of transitioning a patient’s biological sex … or affirming the patient’s perception of the patient’s sex.”

CBS News made multiple attempts to contact Hall’s office, but has yet to hear back.

“This bill would have a chilling effect, halting all best practice medical care for all trans people in this state, regardless of age,” Christopher Hamilton, CEO of Texas Health Action, a nonprofit that works to provide health services to the LGBTQIA+ community, told CBS News. “If this bill passes, insurers will no longer cover gender-affirming care, malpractice insurers will not provide malpractice insurance to providers, and physicians will not assume a personal financial lifetime liability for providing gender affirming care, affecting nearly 100,000 trans people in the state.”

Texas has introduced over 70 anti-LGBTQ+ bills in the 2023 legislative season so far, according to Equality Texas. While legal challenges have prevented most bills from becoming law, critics say the legislative efforts marginalize and stigmatize transgender people. 

S.B. 1029 would likely face legal challenges — and some advocates acknowledge that it might not pass — but its introduction is seen as indicative of a larger agenda to politicize trans issues and access to health care.

“If someone who is trans needs a mastectomy for cancer, they may have to prove that it is for cancer care rather than what the bill calls ‘gender modification,'” said Hamilton. “If a trans person with a uterus needs a hysterectomy for cancer prevention, will this person be denied because of the doctor’s fear?” 

The American Medical Association and the American Academy of Pediatrics have spoken out against what the AMA calls “governmental intrusion into the practice of medicine that is detrimental to the health of transgender and gender-diverse children and adults.”

In 2022, Texas Gov. Greg Abbott made headlines after sending a letter to the state’s health agencies, ordering them to report and investigate gender-affirming treatment to trans youth as potential “child abuse.” A Texas judge blocked the directive after several families sued. 

In the letter, Abbott categorized “reassignment surgeries that can cause sterilization, mastectomies, removals of otherwise healthy body parts, and administration of puberty-blocking drugs or supraphysiologic doses of testosterone or estrogen” as “abusive” — all of which would be banned under the new bill.

“This bill is extremely alarming as it resembles what Texas did with reproductive rights, removing any way for people to get safe, best-practice medical care without having an outright ban,” Hamilton said. 

Texas Lt. Gov. Dan Patrick recently announced his legislative priorities for 2023, including bills to restrict transgender student athlete participation in collegiate sports, and end gender-transition treatment for young people. Patrick said he believed Texans support his proposals because they “largely reflect the policies supported by the conservative majority of Texans.”

According to the U.S. Department of Health and Human Services, “early gender affirming care is crucial to overall health and well-being” for trans and nonbinary youth, “as it allows the child or adolescent to focus on social transitions and can increase their confidence while navigating the healthcare system.”

Experts say that access to gender-affirming care can be a life-or-death issue for trans people. A study published in the journal Pediatrics found that nearly 51% of female-to-male respondents had attempted suicide — far higher than the average youth suicide rate, according to a 2022 study by UCLA.

Access to medical care, participation in sports, and other issues affecting trans youth and adults have become the focus of intense political debate in the U.S. in recent years, with predominantly Republican lawmakers in more than two dozen states attempting to enact measures that would either heavily restrict or completely ban access to gender-affirming care and other resources.

“By filing these bills, lawmakers are playing politics with the very lives of transgender people in our state,” Ash Hall, a policy and advocacy strategist at the ACLU of Texas, told CBS News.

“The mental health toll and harm that even debating this bill would cause is catastrophic,” Hall added.

S.B. 1029 was received by the Secretary of the Texas state Senate on Feb. 17. No further action has been publicly taken at this time.