Transgender Texans of all ages could lose access to transition-related care under Senate bill

Demonstrators march for Trans Day of Visibility in San Antonio on March 31. Critics of a Texas Senate bill say it could cause transgender people of all ages to lose access to gender-affirming care in the state. (Blaine Young For The Texas Tribune, Blaine Young For The Texas Tribune)

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Transgender Texans of all ages could have their access to transition-related medical treatments severely limited — or effectively ended — under a bill the Texas Senate formally approved Wednesday.

[What transition-related health care is available to transgender kids in Texas? Here’s what you should know.]

Senate Bill 1029 would make physicians and health insurers financially liable for their patients’ lifetime medical, mental health and pharmaceutical costs resulting from complications of gender-affirming medical care even if the providers lack fault or criminal intent. The bill exempts such treatments for kids with “medically verifiable genetic sex disorders.”

According to health groups, the bill would make it highly unlikely for health care providers offering these treatments to be able to get medical liability coverage, leaving them personally on the hook for potential medical, legal and other costs. These financial risks could deter physicians from providing puberty blockers, hormone therapies and gender-affirming surgeries to trans people of all ages in the state.

The Senate voted 19-12 Wednesday to give the bill the final approval, and it now moves to the House. The Senate has also already approved Senate Bill 14, a priority bill that would ban transgender kids from receiving transition-related care, like puberty blockers and hormone therapies. A House committee has also advanced that legislation, and the majority of House members have signed on to support such a ban.

Major medical groups approve of transition-related care and say it lessens higher rates of depression and suicide for trans youth.

[The eyes of LGBTQ Texans are upon Dade Phelan and the House]

SB 1029’s prescriptive liabilities, meanwhile, would also likely prompt health insurers to not cover transition-related treatments for trans Texans, even if they are adults.

“This would just simply say that if you’re going to transition someone, then you’re going to have to assume the responsibility to take care of them,” said Republican Sen. Bob Hall of Edgewood, the bill’s author, on Tuesday.

He pointed to several people who had detransitioned and testified during the committee hearing for both SB 1029 and SB 14 about their difficulties accessing care to help them detransition or getting that care covered.

Marvin Bellows, a Texas counselor whose clients include trans and queer youth, has said the most common reason people detransition is that transition-related treatments don’t provide the social relief a patient sought. Anti-trans discrimination, lack of support from loved ones and a number of other factors can cause that, Bellows said.

LGBTQ and health groups say SB 1029 is a stealthy tactic for decimating trans Texans’ access to treatments that have been supported by leading medical associations — without ever directly banning transition-related care for all ages.

“It really is just an attempt to chill health care for all trans people,” said Christopher Hamilton, CEO of nonprofit Texas Health Action.

On one hand, it’s not guaranteed that health care providers offering these treatments would be sued by their patients. On the other hand, the bill’s lack of a statute of limitations and requirement that lifetime costs be covered could make even a low number of claims extremely costly.

[Transgender Texans and doctors say Republican lawmakers misconstrue what science says about puberty blockers and hormone therapy]

SB 1029 could as a result have a much bigger impact than the Republican Party of Texas’ legislative priority and key legislation for this session like SB 14, which have limited their focus to restricting transition-related medical care only for trans youth.

“This isn’t about kids’ safety. This isn’t about medication safety,” Hamilton added. “It’s specifically targeting transgender people because they’re a small group of people who are easily marginalized.”

And because of the state’s size, this could have an outsized impact on trans Americans. In Texas, there are approximately 93,000 trans adults — less than 0.5% of the state’s adult population — according to a 2022 study from the University of California, Los Angeles’ Williams Institute. But the raw figures indicate that Texas has one of the largest trans communities in the U.S. Around 30,000 Texans aged 13 to 17 are trans, which is about 1.5% of this age group’s population.

During the Tuesday Senate debate, several Democrats sought clarifications on SB 1029 and pushed back against it.

“If a patient comes in and requests a procedure and the physician provides the procedure and does so competently, that physician is nevertheless liable to that patient for anything that follows that procedure. That is the intent of the bill?” Sen. Nathan Johnson, D-Dallas, asked.

“Yes,” Hall said.

“That seems to be contrary to everything in contract law in [the] history of Western civilization, but it’s in the bill,” Johnson responded.

Sen. José Menéndez, D-San Antonio, also unsuccessfully attempted to amend the bill on Tuesday. One proposed change would have allowed trans youth already receiving transition-related care to be exempted so they could continue their care. This would have also addressed a major concern caused by SB 14, the priority legislation that would ban these treatments outright for trans kids.

During SB 14’s Senate debate, Republican Sen. Donna Campbell of New Braunfels — the bill’s author — initially pushed for the same exemption, but she later backtracked and cut it before the legislation was voted out of the upper chamber. As it passed through the House Public Health committee, SB 14 was updated to require those who are already receiving such treatments to be “weaned off” in a “medically appropriate” manner — instead of an abrupt cutoff. This new language, though, has not soothed the worries of medical groups, trans kids and their families.

Menéndez then sought to ban conversion therapy, which aims to change someone’s sexuality and is not supported by science, but failed.

The San Antonio Democrat once again advocated for medical freedom and raised concern that SB 1029 is a civil rights violation as he spoke against the bill and similar efforts on Wednesday.

“These bills embolden hateful individuals to commit violence against [the] LGBTQ+ community, creating a less safe state,” he said. “They push Texans and money out of the state — and not just the transgender or the gay ones that these bills try to erase — but the parents, the business owners, the doctors, the economic opportunities and community members that can afford to take their futures and their economic resources elsewhere. The ones that can’t leave become even more marginalized, more disenfranchised and further pull on available public resources just to stay afloat.”

Hall pushed back against these concerns and said that his bill has “no impact at all on legitimate services.”

“This bill is to protect children who suffer at the hands of greedy hospitals and doctors who are willing to do anything for money, even permanently mutilate young children and then abandon them when they encounter problems,” he said Wednesday.

In addition, Hall’s legislation would prohibit public funding from being used for transition-related care and ban publicly funded health plans from covering such treatments for all trans Texans. The legislation explicitly targets several plans for state and local public employees as well as Medicaid, which provides health care to low-income patients.

In Texas, Medicaid and the Children’s Health Insurance Program already don’t cover transition-related surgeries and prescription drugs like hormone therapies and puberty blockers. Several other states including Florida have also barred Medicaid patients from using the program to access these treatments.

There are also other GOP bills that seek to ban state funding for transition-related care or expand what medical costs health insurers are responsible for.

For instance, House Bill 3502 by Republican state Rep. Jeff Leach of Plano would require health plans that already cover transition-related treatments to also cover “all possible adverse consequences” related to this care as well as “any procedure or treatment necessary” for detransitioning. Critics said this legislation could disincentivize health insurers from covering these treatments for trans Texans, making access to them harder. Leach said during the bill’s committee hearing that he disagreed, adding that the bill doesn’t ban anything. HB 3502 has passed out of committee.

And while SB 1029’s impact could go further than the current GOP’s legislative priority, Campbell and four other Republican senators have signed on as co-authors for Hall’s legislation prior to the floor vote. SB 1029 is also in line with the party’s 2022 platform, which has declared that it “oppose[s] all efforts to validate transgender identity” and wants to ban “taxpayer funding for sex change.”

“This bill abandons all flimsy pretense of safeguarding children,” Jacqueline Murphy, a trans woman, said at a committee hearing on the bill last month, referring to Republicans’ stated motivation for banning such treatments.

Ricardo Martinez, CEO of LGBTQ advocacy group Equality Texas, echoed this sentiment following the Tuesday vote.

“In a state with the second largest LGBTQ+ population, we are sounding the alarm,” he said in a statement to The Texas Tribune. “Make no mistake, the attack on trans people is not about ‘protecting kids,’ it is about making life in Texas unbearable for our trans neighbors.”

William Melhado contributed to this story.

Disclosure: Equality Texas has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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