December 10, 2023

Health Insurance

Follow Your Health Insurance

Right-wing Texas Politicians Targeting Health Care for Trans Adults Too

During the 2023 legislative session, which begins in January, we’ll be taking a close look at the notable—and, yes, silly—bills that come under the consideration of the august bodies that make up our state government to help you understand what your lawmakers are spending their time on.  

The bill: Senate Bill 1029

Filed by: Bob Hall, Republican, Senate District 2 (Rockwall)

What it would do: Hall’s bill would create liability for health insurance companies and health-care providers if they offer what the legislation defines as “gender modification procedures or treatment” in adult patients. Those treatments include surgeries such as castrations, phalloplasties, and vaginoplasties, as well as much more common procedures such as hysterectomies, mastectomies, and vasectomies—but only when offered to transgender patients seeking gender-affirming care. The bill also includes nonsurgical treatments such as puberty-blocking medications (which are typically given to transgender youths, not adults) and estrogen and testosterone therapies. 

The bill would leave an insurer and/or provider offering such treatments financially responsible for “the patient’s medical, mental health, and pharmaceutical costs, including costs associated with reversing a gender modification procedure or treatment, incurred for the life of the patient as a result of a gender modification procedure or treatment.” It also opens up doctors who offer such treatments to malpractice claims from their patients.

The bill could effectively end gender-affirming care for adults in Texas. While the mechanics of Hall’s bill are different from those of 2021’s anti-abortion law, SB 8, which opened up health-care providers to lawsuits for providing care, it could have similar effects. The threat of potential financial liability has proven a significant-enough deterrent to effectively ban procedures—even in cases in which the letter of the law might not outright preclude such action. In the wake of Texas’s abortion ban, health-care facilities and insurance companies have demonstrated an aversion to risk, and some miscarriage patients have been unable to receive dilation and curettage procedures out of providers’ fears that they may not qualify under the ban’s life-saving or “impairment of a major bodily function” exceptions. If passed, Hall’s bill would create immense financial liability for doctors who perform mastectomies as “gender modification” treatment, for example, and a doctor might shy away from performing a mastectomy on a transgender patient who seeks the operation to eliminate the risk of breast cancer. 

Texas Republicans have filed a wave of bills targeting gender-affirming care for minors in previous legislative sessions and in the current one—including two prefiled by Hall in November—but this is the first attempt to create new laws addressing such interventions for adults. Hall’s bill includes a provision explaining why the senator feels this is necessary: namely, he writes that he watched a 2018 video edited by conservative news outlet the Daily Wire in which a doctor at the Vanderbilt University Medical Center, in Tennessee, discusses how gender-affirming surgical procedures bring in more revenue than outpatient procedures. From that, Hall concludes in his bill, “The medical community has knowledge that many so-called ‘gender affirming’ treatments are not in the best interest of the health of the patient but rather are being promoted for the monetary gain the health care facilities will receive from providing those treatments.” 

Health-care experts have pushed back against the logical leap the bill, and similar ones, make from claims that these procedures bring in revenue and thus “are not in the best interest of the health of the patient.” Last year, an assistant dean of admissions at Brown University’s Alpert School of Medicine told Inside Higher Ed that “anybody who works in a hospital setting knows that there are budgets, there are looks at costs and expenditures, and more resources go to programs that bring in more money,” noting that this is just “the economics of health care.” She compared the scenario Vanderbilt’s administrators spoke of to how a cardiovascular center would make more money from surgical procedures than outpatient ones—which doesn’t mean that heart surgery is not in the best interest of patients, too. 

Does the bill have a chance of passing? It could, but it’s not the most likely bill targeting transgender Texans to become law. Framing opposition to gender-affirming care as “protecting children” is a part of the GOP playbook on the issue this session—“ending child gender modification” is one of Lieutenant Governor Dan Patrick’s legislative priorities—and this bill of Hall’s doesn’t fit within that framework. The senator has also introduced two pieces of legislation that specifically address health care for transgender minors: SB 249, which defines certain procedures as illegal “genital mutilation,” and SB 250, which revokes medical licenses for doctors who offer certain gender-transition treatment for minors (last session, Hall authored a similar bill that passed in the Senate but failed in the House).

Any of these new bills could run into the same opposition that stopped Hall’s previous bill from passing in 2021, when business leaders warned the state that passing such laws could have severe economic costs, as companies and workers might opt to do business in states where they and their children have the freedom to seek medical treatment that is consistent with the American Medical Association’s recommendations. Even if those concerns don’t stop the passage of bills targeting transgender minors and their families, it’s possible that introducing new laws impeding access to the health care sought by consenting adults might be a bridge too far in this session.