Texas GOP Wants to Make Gender Surgery So Expensive Doctors Can't Afford It

Republicans are pushing legislation to hold Texas health insurance providers liable for all of the ancillary costs associated with gender-affirming surgeries in the state, a move critics claim could end the practice of gender-affirming care. Sponsored by state Senator Brent Hall, Senate Bill 1029 would, if enacted, make private health benefit plans liable for the costs associated with lifetime care of the patient or any malpractice suits that result as "consequences" of gender modification treatments or procedures covered by the plan, even if there are no medical complications associated with the initial surgery. "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," Hall said Tuesday during debate on the bill. But it also forbids all public insurance plans from covering gender-affirming care, not just for children but for people of all ages, while putting doctors on the hook for all liability tied to their surgeries, creating an environment critics say makes gender-affirming care too risky for doctors to perform.

Critics of the bill say the legislation—part of a wave of anti-trans bills around the country—is nothing more than an effort to price the transgender community out of existence. "So much of what we're hearing from the lawmakers who are filing these bills is that they want to 'protect kids,' but this is because it's not about our kids at all. It's just about erasing trans people," Jonathan Gooch, communications director for the advocacy group Texas Equality, told Newsweek. "I think that's really unique about this one." The bill is part of a larger slate of anti-LGBTQ legislation in the Texas state legislature this session. But it also comes at a time of increasing hostility from Texas conservatives against the LGBTQ+ community. Last summer, The Texas GOP denied Log Cabin Republicans—an LGBTQ+ caucus of the GOP—from having a booth at the state convention. The party went on to define homosexuality as an "abnormal lifestyle choice" in its official party platform, while also opposing "all efforts to validate transgender identity."

Read more

• Transgender lawmaker Zooey Zephyr awaits her fate of censure or expulsion
• Russia wants to ban transgender people changing gender on passport
• Tennessee Republicans vote to make drag shows felonies

Those ideas have begun to gain a foothold in the 2023 legislative session. According to a tracker compiled by Texas Equality, the state's lawmakers have introduced 48 bills this session designed to "limit access to life-saving healthcare for transgender youth," often in opposition to what they say are best-practice medical standards of care. But Senate Bill 1029 is arguably the most extreme measure they've considered this cycle, with Gooch saying that the legislation has inspired more fear from the state's LGBTQ+ community than any other. "This one is causing more panic in the community than any of the other bills," he said. "We hear from people fairly regularly. People will reach out on social media or shoot us an email and say, 'Do I need to have a go bag? Do I need to be prepared to flee if this becomes law?' Which is just so terrifying. What a state of mind to live in." According to a briefing submitted with the bill, many patients in the state seeking gender-affirming care found that ongoing health care concerns associated with their treatments—mental health care, for example—were not covered by health insurance, even as insurance plans would "often" cover the initial treatments. Though he cited no data to back the claim, the costs, Hall argued, could often be shocking to patients whom the bill says are "increasingly" electing to de-transition after seeking care. "The sad reality is that the use of hormone blockers, cross-sex hormone treatments, and gender modification surgeries are not without complications," an analysis of the bill drafted by the bill's author reads. Groups like the Texas Medical Association (TMA), however, oppose the bill on the grounds that it could dissuade doctors from performing surgeries and other treatments widely recognized as being beneficial for their patients. One 40-year study of transgender patients published in October found that gender-affirming surgeries are associated with high levels of patient satisfaction, improved dysphoria, and reduced mental health comorbidities without "any reported patient regret." Other research led by the Harvard T.H. Chan School of Public Health in 2021 found that outcomes of gender-affirming surgeries include lower rates of psychological distress and suicidal thoughts along with other ancillary impacts, like reduced smoking rates. Putting insurers on the hook for other associated costs tied to the procedures, the medical community claimed, could lead some to denying all forms of care. Senate Bill 1029 "very much chips away at Texas' medical liability reform, which has been so critical to Texas patients and physicians and patient care," Dr. Gary Floyd, the TMA's president, was quoted saying by the Dallas Morning News during testimony on the bill Tuesday. Patients generally don't regret receiving the surgery. One recent review of 27 studies involving nearly 8,000 teens and adults worldwide found just 1 percent of patients on average expressed regret about the procedure. Another study of nearly 2,000 patients published in the Journal of the American Society of Plastic Surgeons in January reported an even lower rate of regret among its patients, finding 99.7 percent of transgender people surveyed were satisfied with the results. For comparison, a 2018 study promoted by the AARP found that about 20 percent of knee surgery patients regretted having the procedure. Newsweek reached out to Hall's office and the Texas Medical Association by email for comment.