Missouri this month became the first state in the nation to severely restrict gender-based treatment for people of all ages, following a series of quieter steps across the country that limited transgender adults’ access to health care.

Last year, Florida joined six other states in banning Medicaid from covering some forms of gender-based care for transgender people of all ages. These prohibitions apply approximately 38,000 beneficiaries public insurance programs, according to the Williams Institute, a research center at UCLA Law School.

And in at least five states, Republican lawmakers have proposed bills that would remove gender-based care for minors as well as young people. Some are trying to ban it for those under 21, while others are trying to ban it for those under 26.

Missouri’s new radical politics took a different approach. Citing consumer protection laws designed to regulate fraud, State Attorney General Andrew Bailey issued an emergency rule barring physicians from providing gender-based treatment to patients of any age unless they comply with a number of significant restrictions, including an 18-month psychological evaluation. . The rule also stated that patients should not receive gender-based treatment until any mental health issues were “resolved”.

Onerous restrictions amount to a “de facto prohibition,” said Jillian Branstetter, a communications specialist for the American Civil Liberties Union, whose Missouri chapter announced his intention to file a legal challenge to the rule.

“The political situation regarding health care for transgender people has always been in this direction,” Ms Branstetter said.

The rule excludes people who are currently undergoing treatment if they and their physicians “promptly” comply with psychological assessments and other restrictions.

Aro Royston, a 35-year-old transgender man from St. Louis, said he was shocked. under the new policy. He said he took testosterone for eight years with monthly supplements prescribed by his doctor. If he no longer had access to treatment, he said, he would be “devastated” and travel out of state to get help.

“I think what upsets me the most is that I am an active member of this society,” said Mr. Royston, program manager for an American defense contractor. “I worked on defense programs to protect my nation. And my nation can’t protect me?”

Missouri’s new policy goes into effect on April 27 and expires in February 2024, when the state legislature resumes its session. (Two bills which would ban childcare — and prevent Medicaid from covering it for all ages — didn’t move forward in this year’s session.)

While Mr. Bailey’s order applies to all ages, his public comments have focused on children, echoing the rhetoric of Republican politicians across the country and in Missouri. “As Attorney General, I will always fight for the protection of children because gender reassignment measures are experimental,” Mr. Bailey tweeted.

In February, his office launched an investigation into the Washington University Youth Gender Clinic in St. Louis after a former employee filed a whistleblowing report. complaint arguing that the patients were sent for treatment in a hurry and did not undergo an adequate psychological examination. (Clinic said that he followed accepted standards of care.)

Asked why his order includes adults, Madeleine Siren, a spokeswoman for Mr Bailey, said: “We have serious concerns about how children are treated in the state, but we believe everyone has a right to evidence-based medicine. and adequate mental health. take care.”

Fourteen other states — Alabama, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, South Dakota, Tennessee, Utah, and West Virginia, and as of Wednesday, North Dakota — have passed laws restricting gendered care for minors.

Although there are disputes between them. medical workers about which children would benefit from gender-confirming care and when they should start treatment, several major medical groups in the United States, including American Academy of Pediatricsdenounced the statute.

For transgender adults, many studies have shown that transitional care Maybe improve psychological well-being and quality of life.

Terry Schilling, president of the US-based advocacy group American Principles, which advocates limiting the rights of transgender people, said in an interview earlier this year that the focus on minors was a short-term political calculation. He said his organization’s long-term goal is to phase out transition aid altogether.

“I feel about this whole issue the same way I feel about lobotomy or eugenics — it’s a bad medical fad,” he said.

Mr Schilling said the policy could include outright bans for people of all ages or bills to make it easier for people to sue health care providers if they regret making the switch. He also mentioned the possibility of classifying transitional care as “consumer fraud” – the same approach suggested by Mr. Bailey – because he claims that gender reassignment is impossible.

for many years, seven states Arizona, Florida, Missouri, Nebraska, South Carolina, Tennessee, and Texas have adopted policies that prevent Medicaid from covering certain types of gender-affirming care. (The federal insurance program for low-income people is partially funded by the states, which also have wide discretion in determining eligibility.)

The Medicaid bans are based “on a shaky legal foundation,” said Christie Mallory, legal director of the Williams Institute. Courts in Wisconsin and West Virginia have ruled that such bans violate the Affordable Care Act, which prohibits sex discrimination, as well as other federal regulations.

But some lawmakers are introducing broader bills that would ban gender-related care from public or managed health centers or those that receive public funding.

In Oklahoma, for example, a bill introduced this year by state senator Nathan Dam would withhold Medicaid reimbursement — for any procedure or treatment — at any health center that offers gender-based care or works with a provider that offers it.

In a January interview, Mr. Dam said his only goal was to prevent taxpayer money from covering the transition. “If an adult wants to make this decision and pay for it himself, he can do it,” he said. However, he also acknowledged that the policy may encourage some health care providers to stop offering care to adults.

Over the past few decades, physicians increasingly removed Obstacles, such as psychological assessments, for adults to receive hormonal treatment, shifting decision making to the patients themselves.

“There is a very, very broad consensus that gender-affirming adult care is appropriate and beneficial,” said Erica Anderson, a clinical psychologist and former president of the U.S. Professional Association for Transgender Health.

Dr. Anderson, a transgender woman, in public expressed concern about the growing number of adolescents, especially those with complex psychiatric problems, seeking help for gender reasons. She also supported the policies of some European countries, including Sweden another Britanniawhich have recently restricted when children can have certain medical procedures.

But last month Dr. Anderson joined hundreds of doctors in signing a letter emphasizing that gender-affirming care is beneficial and important for many transgender children and condemning legal prohibitions in the United States. Efforts to extend such restrictions to adults would cause significant harm, she said.

“The blur between youth and adult care is ominous,” she said. “This is an ominous sign of excess on the part of people who think the state should decide people’s privacy.”

Missouri’s rule also met with opposition from some conservatives in the state. This was stated by Secretary of State Jay Ashcroft, a Republican who recently announced that he was running for governor. St. Louis Public Radio that while he supported child bans, he did not believe the state should restrict adult care.

“I don’t think people should be doing this,” Mr. Ashcroft said, referring to adult gender treatment. “But there is a difference between what I think and where I think the government should be involved.”

Maggie Astor made a report.