Missouri rules part of rapid push to limit trans health care

The push to restrict health care for transgender people has expanded beyond children, with Missouri placing new limits on gender-affirming care for both adults and minors.

The restrictions highlight how rapidly states' efforts targeting the rights of transgender people have grown this year, despite new obstacles from the courts and the Biden administration.

Here's what's happening:

WHAT'S THE STATUS OF BILLS TARGETING TRANSGENDER PEOPLE?

More than 450 bills have been introduced in statehouses around the country this year targeting transgender people, which LGBTQ+ advocates say is a record number.

They include bans on gender-affirming medical care for minors and restrictions on the types of restrooms transgender people can use. Lawmakers have also been advancing measures restricting classroom instruction on sexual orientation and gender identity, and bills that would out transgender students who want teachers to address them by the pronouns they use.

WHAT RESTRICTIONS ARE IN PLACE?

The rules announced Thursday by Missouri's Republican attorney general place several new restrictions on when someone could receive gender-affirming care. They include 18 months of therapy and would require any mental health issues such as depression or anxiety be resolved before anyone could receive care. It also requires documentation of three years of “persistent and intense” gender dysphoria before treatment can begin.

The rules, which are set to take effect April 27, are believed to be the first limits placed by a state on gender-affirming care for adults. LGBTQ+ advocates have condemned the move and have vowed legal action.

Missouri is one of three states that has banned or restricted gender-affirming care via regulations or administrative orders. Two Florida boards have banned the care for minors. Texas' governor has ordered child welfare officials to investigate reports of children receiving such care as child abuse, though a judge has blocked those investigations.

At least 13 states have now enacted laws restricting or banning gender-affirming care for minors: Alabama, Arkansas, Arizona, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Tennessee, Utah, South Dakota and West Virginia. Bills await action from governors in Kansas, Montana and North Dakota. All but three of the laws were enacted this year.

Federal judges have blocked enforcement of bans in Alabama and Arkansas, and nearly two dozen states are considering bills this year to restrict or ban care. A new law signed last month by Republican Gov. Sarah Huckabee Sanders aims to effectively reinstate Arkansas' ban by making it easier to sue providers of such care for minors.

Republican states like Oklahoma have also threatened some funding for hospitals that offer gender-affirming care.

In North Dakota, Republican Gov. Doug Burgum this week on Tuesday signed new laws that effectively prohibit transgender girls and women from joining female sports teams in K-12 and college. At least 21 states have enacted such laws.

There's also been a resurgence this year of bills prohibiting transgender people from using restrooms that align with their gender identity, six years after North Carolina repealed its bathroom law. Republican lawmakers in Kansas last week sent Democratic Gov. Laura Kelly a bill that would impose some of the broadest bathroom restrictions, and appear to have enough votes to override an expected veto.

Sanders this week signed a bathroom bill that was scaled back following complaints from transgender people and their families. The law makes it a crime for a transgender person to use a restroom that aligns with their gender identity, but only if a minor of the opposite sex is present and if they're in the bathroom for sexual purposes.

Sanders has already signed a law prohibiting transgender people at public schools from using the bathroom that aligns with their gender identity.

WHAT'S HAPPENING IN COURT?

There have been two major court victories recently protecting the rights of transgender people, even as the flood of legislation continues.

The U.S. Supreme Court last week allowed a 12-year-old transgender girl in West Virginia to continue competing on her middle school’s girls sports teams while a lawsuit over a state ban continues. Also last week, a federal judge ruled that an Indiana school district didn't violate a former music teacher’s rights by pushing him to resign after the man refused to use transgender students’ names and gender pronouns.

Lawsuits have also been filed in recent weeks challenging bans on gender-affirming care for minors in Indiana and Florida.

More action could be on the way soon. A federal judge who blocked Arkansas' gender-affirming care ban for minors is considering whether to strike down the prohibition as unconstitutional.

WHAT HAS HAPPENED WITH RESTRICTIONS ON TRANSGENDER ATHLETES?

A proposed rule released last week by the Biden administration would forbid schools and colleges from enacting outright bans on transgender athletes but still allows teams to create limits in certain cases.

The plan has sparked outrage from conservatives but also has drawn criticism from some trans rights activists who note it could still prevent transgender athletes from competing on teams that align with their gender identity.

The proposed rule, which still faces a lengthy approval process, establishes that blanket bans would violate Title IX, the landmark gender-equity legislation enacted in 1972.

Schools that receive federal funding could still adopt policies that limit transgender students’ participation, particularly in more competitive high school and college sports.