Idaho ban on public funds for gender-affirming care heads to House floor

The state flag hangs in the rotunda at the Idaho State Capitol building in Boise on Jan. 23, 2024. (Otto Kitsinger for Idaho Capital Sun)

A bill to ban Idaho public funds from covering gender-affirming medications and surgeries for Idaho adults and children is headed to the Idaho House floor.

House Bill 668 would ban public funds from paying for gender-affirming medications and surgeries. The bill references definitions for that care from Idaho’s 2023 ban on providing gender-affirming medications and surgeries to children. 

The ban on using public dollars for gender-affirming care would explicitly apply to Idaho Medicaid — which largely covers low-income and disabled people and insures around 300,000 Idahoans.

But it’s unclear how the bill would impact health insurance provided to Idaho state employees and their family members. About 62,000 Idahoans are insured through those policies, which are set to switch to a new insurer this summer. 

In this file photo, Rep. Julianne Young, R- Blackfoot, listens to debate on the House floor at the Idaho Capitol on Jan. 17, 2022. (Otto Kitsinger for Idaho Capital Sun)

“This bill does not speak specifically to the issue of state insurance. It speaks to the use of public funds. And so there are some things there that would remain unanswered questions,” Rep. Julianne Young, R-Blackfoot, told the committee. 

Young and Rep. Bruce Skaug, R-Nampa, co-sponsored the legislation. The Idaho House Judiciary and Rules Committee voted on Thursday to advance the bill to the House floor. Only the committee’s three Democrats opposed. 

“We simply recognize that there is a burden on those providing the services to make determinations about what is and is not medically necessary. We’ve included the language specific to these procedures because we do believe that at best these procedures are controversial,” Young said.

The bill says:

• Idaho Medicaid can’t reimburse or cover gender-affirming medications or surgeries banned under an existing Idaho law. That law banned those treatments for any child in Idaho, but not all gender-affirming care, the Idaho Capital Sun previously reported. But, the law’s implementation is temporarily blocked as a lawsuit challenging the legislation makes its way through the courts.

• State property, facilities or buildings can’t be used “to provide the surgical operations or medical interventions” in that previous law.

• Doctors or health care professionals employed by state, county or local governments can’t provide those services “in the course and scope of (public) employment.”

The bill would ban any gender-affirming care medications and surgeries “for purposes of altering the appearance of an individual in order to affirm the individual’s perception of the individual’s sex in a way that is inconsistent with the individual’s biological sex.”

A study published last month found that gender non-conforming people were at a higher risk for being in a lower socio-economic status. About 7,000 Idaho adults and 1,000 Idahoans age 13 and up are transgender, according to estimates from the University of California-Los Angeles.

Most people testifying opposed the bill, including three Idaho health professionals

Major medical groups say gender-affirming care is medically necessary and safe.

Gender-affirming surgeries were not performed on minors in Idaho before last year’s ban on the care for children  bill was passed, the Idaho Capital Sun previously reported. 

Around a dozen people — including three Idaho health professionals and several people who receive gender-affirming care — testified against the bill. Five people testified in support of the bill, some of whom opposed state tax funds supporting gender-affirming care on religious grounds. Some also called gender-affirming care harmful or questioned its effectiveness.

“What is the evidence that allows clinicians to make such recommendations? To be honest, it is amazingly weak,” South Carolina urologist Dr. Julius Teague, who was called on as an expert witness, told lawmakers.

Dr. Marvin Alviso, a Boise doctor, said none of the over 400 patients he’s provided gender-affirming care to over seven years have regretted hormone treatments. 

After his testimony, Rep. Barbara Ehardt, R-Idaho Falls, who sponsored Idaho’s ban on transgender athletes in schools, said she was “distraught” to hear Alviso say not one of his patients regretted the care. 

Rep. Barbara Ehardt, R-Idaho Falls, speaks from the House floor at the Statehouse in Boise on Nov. 15, 2021. (Otto Kitsinger for Idaho Capital Sun)

“Something’s wrong there. Either we’re not asking the questions or we’re not actually helping our patients, if not one. Statistically, I think that is almost impossible,” Ehardt said. 

AlexaLynne Fill, who is transgender, told the committee that Idaho became her home when she moved here in 2004. 

“I vehemently oppose this bill and its hateful intent. This bill seeks to discriminate further against trans …” she said. Skaug soon interjected.

“We talk about the bill, not the motives,” he said.

She apologized. 

“This bill seeks to discriminate further against my trans and non-binary siblings, compromising our health and wellbeing. Further vilification and marginalization of a vulnerable population is nothing more than a cruel and vicious attack. Stop the hate, do better and serve the entire citizenry of Idaho,” Fill said.

Merrick Collins, a transgender man, said being on hormones has not only helped him feel at home in his body, deeping his voice and helping grow more facial hair, but it’s also helped him become “more physically healthy than I’ve ever been.”

He said he used to have bad asthma. But it’s dissipated so much that he said he doesn’t even need an inhaler. 

“Repealing Medicare and Medicaid coverage for (hormone replacement therapy) limits my access to medication that I need to function properly in society, lowering my quality of life while I live here in Idaho,” Collins said.

Public employees or officers who intentionally violate the bill could face misuse of public funds charges.

The bill would still allow surgical procedures and medications used in gender-affirming care to use public funds in certain cases, like when it’s necessary for health. But the bill excludes it for the purpose “to affirm the individual’s perception” of their sex, the legislation states.

“Surgical operation or medical intervention is never necessary to the health of the minor or adult on whom it is performed if it is for the purpose of altering the appearance of an individual in order to affirm the individual’s perception of the individual’s sex in a way that is inconsistent with the individual’s biological sex,” the bill says. 

Seven states bar Medicaid from covering gender-affirming care, according to a 2022 report by UCLA. 

House Bill 668 relies on definition for gender-affirming medication and surgeries created in Idaho law through last year’s House Bill 71. That law’s implementation has been blocked during litigation that’s been appealed to the U.S. Supreme Court. 

Exceptions outlined in the legislation

The bill allows the following exceptions to the ban:

• When a surgical operation or medical intervention is “necessary to the health of the person on whom it is performed.”

• To treat infections, injuries or disorders “caused or exacerbated by … gender transition procedures.” 

• And when “performed in accordance with the good faith medical decision of a parent or guardian of a child or an adult born with a medically verifiable genetic disorder of sex development.”

If passed, the bill would take effect July 1, 2024. 

Idaho Gov. Brad Little in May 2023 directed the Idaho Department of Health and Welfare to develop a policy to ban gender-affirming care treatments for both adults and children. 

The health department’s spokesperson AJ McWhorter told the Idaho Capital Sun in early January a policy was being developed. He said the agency “has not covered any surgeries for gender dysphoria for adults or youth.” The agency “will not be implementing new changes to coverage pending legal guidance to ensure compliance with Governor Little’s directive that any policy changes comply with state and federal law,” McWhorter said.

A federal district court judge in June blocked Florida’s ban on Medicaid covering gender-affirming care treatments, saying policymakers adopted the ban for “political reasons,” the Washington Post reported.

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