As of this moment, there are 26 states that have banned or limited trans health care for people under 18, a number of which have also restricted care for adults. The Kaiser Family Foundation optimistically reports one state’s ban, Arkansas’s HB 1570, to be permanently blocked. But that injunction is rooted in the federal Constitution, not Arkansas’s state constitution, and with the upcoming case United States v. Skrmetti being argued December 4, the 8th Circuit’s block may not stand long. Together these states cover roughly 40 percent of the US population, teen and adult.

The Tennessee law at issue in Skrmetti is similar enough to other bans that any ruling on the application of equal protection to trans health in this case is likely to apply to current and future health care bans for the next 30 years or more.

But that, unfortunately, is not all. In 2023 Donald Trump promised to “cease all programs that promote the concept of sex and gender transition at any age” and to “[a]sk Congress to permanently stop federal taxpayer dollars from being used to promote or pay for these procedures.” Those promises remained up on his campaign website right through election day and still appear there. Such a federal ban would not merely ban relevant health care for trans youth. It would also make care unaffordable for the vast majority of the 37.2 percent of Americans insured through government sources. We don’t need to look far to see what happens when a government institutes such backdoor bans: the UK already has one, and the consequences have been gruesome.

The US impact is being felt already, and far beyond the borders of states like Texas, where Attorney General Ken Paxton has taken three physicians to court already on charges related to the state’s care ban and alleged fraudulent use of medical billing codes. Trans despair is real, and reaches deep into blue states. The Florida Times-Union reports that last week calls, texts, and web chat requests for support went up 125 percent last week at The Trevor Project — starting around midnight after the election. One third of those contacts identified themselves as Black, indigenous, or people of color. Even before the election 49 percent of trans and non-binary youth surveyed this year by The Trevor Project were unable to access mental health care, with 90 percent saying their mental health was being negatively impacted by politics.

This crisis in care is having broad impacts. Last year the University of Michigan, using data from 2006 to 2018, found that non-binary emergency room patients were much more likely to be admitted to the hospital than cis patients and those admissions were more likely to be related to chronic conditions.

“Transgender people face significant health disparities, including access to primary and preventive care,” said lead author Daphna Stroumsa, M.D., M.P.H., an assistant professor in obstetrics and gynecology at the University of Michigan Medical School. […]

“These barriers — often driven by structural and interpersonal stigma — block trans people from accessing primary care and could lead to heavier reliance on emergency care.”

I can personally vouch for those barriers, having visited a primary care physician for a persistent sore throat and cough only to be questioned about the status of and any plans for my genitals. Seriously, y’all: cis folks are fucking weird.

The article later added:

“The high admission rates, and high proportion of trans people with a chronic condition or with a mental health condition, may represent worse overall health due [to] lack of primary care, or a delay in seeking emergency care,” Stroumsa said. “There is a need for increasing access to affirming primary and mental health care for transgender people.”

And that really is the point. At a time when we desperately need more and better care for many people, but including especially trans and non-binary folks, Republicans are focussed on steadily removing both health care and human support. Much has been made of the federal “global gag rule” on abortion which limits the ability of overseas health non-profits to mention the existence of abortion procedures if an organization accepts US health grants. It has long been assumed that any domestic gag rule would fail due to the protections of the First Amendment. But in the midst of this ongoing health crisis, governments in red states are enacting policies that look very much like gag rules on trans health care, while the incoming Trump administration plans only to make problems worse and more widespread.

In 2019 when Trump proposed similar care bans, hospitals like Mass General responded with statements opposing the effort. This go-round, Oregon Health Sciences University seems first out of the gate with a proactive statement released last Wednesday — one that also voiced resistance to restrictions on reproductive rights, calling out access to abortion and IVF specifically.

Even with powerful, educated, institutional voices of support for trans communities, however, the next four years will be a dangerous and difficult time for anyone and everyone seeking health care.

Trans health care is in the hands of some baleful straights.

PREVIOUSLY IN HEALTH CARE!

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Your friendly neighborhood Crip Dyke also writes other perverted stuff!