In Boise, Idaho, a significant decision awaits as lawmakers gear up to vote on a new bill this week. This proposed legislation seeks to prohibit the allocation of public funds for gender-affirming care. This includes barring the use of state employees’ work health insurance and Medicaid for adults from covering such care.
The bill has already made its way through the House and now only requires approval from the Senate, which is predominantly Republican, before reaching Governor Brad Little’s desk. Governor Little has been vocal about his stance against the use of public funds for gender-affirming care, indicating a high likelihood of the bill becoming law.
Should this bill pass, Idaho will join a group of at least nine other states that have already implemented bans on Medicaid funding for gender-affirming care for individuals across all age groups. This move is part of a broader national debate concerning the rights of LGBTQ+ Americans.
Critics of the bill argue that its enactment is almost certain to trigger legal challenges in federal court. Idaho has faced lawsuits in the past over attempts to restrict gender-affirming care for transgender individuals, with limited success in defending these legal battles.
In one notable instance, the state was mandated to provide gender-transition surgery to a transgender inmate, who was subsequently awarded approximately $2.5 million in legal fees. Moreover, a federal judge recently halted Idaho’s enforcement of a ban on gender-affirming medical care for minors pending the outcome of a lawsuit filed by transgender youth and their families. Additionally, a lawsuit by adults in 2022 challenged the state’s denial of Medicaid coverage for medically necessary gender-affirming treatments, leading a federal judge to deny the state’s motion to dismiss the case.
Boise attorney Howard Belodoff, representing the transgender adults in the lawsuit, argued that the bill infringes upon the 14th Amendment’s equal protection clause and the federal Medicaid Act. He emphasized that the legislation unlawfully discriminates based on diagnosis, illness, or condition.
The bill’s proponents, including Republican Rep. Bruce Skaug, argue that the legislation is designed to protect taxpayers from the financial burdens of gender-affirming care, noting that approximately 70% of Idaho’s Medicaid program is funded by the federal government.
However, opponents warn that the bill’s impact could extend beyond its intended scope, potentially affecting privately insured residents in rural areas reliant on state-funded medical centers. Concerns were also raised about the implications for correctional employees, who may face criminal penalties for taking legally prescribed medications, such as hormone therapy, while at work due to the bill’s restrictions on the use of state facilities for medical interventions.
Violations of the proposed law could result in fines ranging from $300 to $10,000 and imprisonment for one to 14 years. Currently, at least 23 states, including Idaho, have enacted laws that prohibit gender-affirming care for minors. Some states are also considering measures that could further restrict access to care for transgender adults, such as limiting telehealth options or imposing additional psychological evaluations.
Despite these legislative efforts, major medical organizations like the American Medical Association and the American Academy of Pediatrics stand against bans on gender-affirming care, supporting its safety and efficacy when properly administered.
While courts have blocked the enforcement of such bans for minors in states like Idaho, Montana, and Arkansas, they have allowed them to proceed in Alabama and Georgia.
This report includes contributions from Associated Press writers Geoff Mulvihill in Cherry Hill, New Jersey, Hannah Schoenbaum in Salt Lake City, and John Hanna in Topeka, Kansas.