Amid tidal wave of anti-trans legislation, Democratic states race to become refuges for gender-affirming care

Democratic state lawmakers are mobilizing against a tidal wave of proposed legislation to heavily restrict access to gender-affirming health care, combating stringent measures that can carry prison sentences as long as a decade with bills that plan to establish sanctuary states to shield doctors, transgender youth and their families in all 50 states from potential legal retribution.

In Minnesota, freshman Rep. Leigh Finke (D) hopes to make the state a safe haven for transgender youth seeking gender-affirming medical care.

Democrats flipped the Minnesota Senate in November’s midterm elections with a string of surprise victories, giving the party control of the legislature for the first time since 2014.

Finke, who is the first openly transgender representative to serve in the state legislature, said she and other Democrats had up until election night expected to spend the next two years in a divided government “playing defense” against Republicans on issues including LGBTQ rights.

But after election day, “everything changed,” Finke said. Taking advantage of a fortuitous opportunity to pass more ambitious legislation, Finke in January introduced House File 146, which seeks to prevent out-of-state laws from interfering with gender-affirming health care offered in Minnesota.

“This became the first priority for me as a legislator to say, you know, there are many things I would like to do for my community, but there is an urgency right now across the country in protecting access to health care,” Finke told The Hill in a recent interview.

Finke said she’s confident in her bill’s ability to pass, and House leadership and Gov. Tim Walz, who is also a Democrat, have supported pro-LGBTQ legislation in the past. 

Last year, Walz signed an executive order cracking down on conversion therapy — a discredited practice that seeks to change a person’s sexual orientation or gender identity — in Minnesota, writing in a signing statement that “our kids deserve to grow up in a state that values them for who they are – not one that tries to change them.”

Finke’s bill has the potential to considerably alter the health care landscape of the Midwest, where state legislators this year have introduced more than two dozen bills to restrict access to gender-affirming medical care for transgender young people, according to the American Civil Liberties Union.

South Dakota, which borders part of western Minnesota, this week became the sixth state in the nation to ban gender-affirming health care for transgender youth. Neighboring North Dakota and Iowa are pursuing similar bans.

In January, nearby Illinois became the first midwestern state to enact a law explicitly protecting access to gender-affirming health care and abortion, promising that “the treatment of gender dysphoria or the affirmation of an individual’s gender identity or gender expression” is lawful health care in Illinois, “whether such activity may constitute a violation of another state’s law.”

A second Illinois bill introduced by Sen. Mike Simmons (D), who in 2021 became the first openly LGBTQ person elected to the state Senate, would build on that law by establishing the Gender-Affirming Health Care Protection Act that would similarly protect doctors and individuals seeking gender-affirming care in Illinois from being charged or subpoenaed based on the laws of another state.

It would also prohibit the governor from complying with extradition requests from other states for individuals in Illinois that have administered, authorized or “otherwise allowed” a child to receive gender-affirming health care, regardless of the state where care was provided.

Simmons in an interview said his bill was largely motivated by reports of individuals and policies targeting transgender youth across the country.

“It seemed to be the right thing to do to move to introduce legislation that would essentially make Illinois a sanctuary state for trans rights; for trans youth that need gender-affirming care, for the parents of trans youth that want to ensure that their youth have access to health care,” he told The Hill.

“We know that trans youth are broadly already facing a number of barriers to health care,” Simmons said. “We know that studies consistently show that access to gender-affirming care for trans kids – when they have access to that gender-affirming care – reduces the risk for depression, psychological distress and suicidal ideation. So this legislation is key in terms of protecting those that are most vulnerable within the LGBTQ+ community.”

Multiple inquiries have found that access to gender-affirming health care can drastically improve transgender youths’ quality of life. In January, a study published in the New England Journal of Medicine found that transgender youth experienced increased life satisfaction and fewer symptoms of depression and anxiety after receiving gender-affirming hormone therapy for two years.

Most major medical organizations including the American Medical Association and the American Academy of Pediatrics recognize gender-affirming health care as safe and medically necessary for transgender youth and adults.

Simmons said he drafted his legislation after conferring with legislators in California and Connecticut, where “safe harbor” laws passed over the summer shield medical professionals and individuals that have provided or received gender-affirming health care from legal action in other states.

California Sen. Scott Wiener (D) led the charge to establish sanctuary states for doctors and transgender youth and their families last year after Texas Gov. Greg Abbott (R) ordered state agencies to investigate the parents of transgender children.

“We were just horrified and deeply concerned about what this meant,” Wiener told The Hill. The state legislature “immediately got to work,” he said.

Wiener’s bill passed both chambers in August and was signed into law by California Gov. Gavin Newsom (D) the following month. The law went into effect on Jan. 1.

Wiener said he hopes the measure sends a clear message to transgender youth across the country that there are elected officials working to protect them and their families.

“Our legislature and our governor see these kids, and we value them and we recognize them as full human beings,” he said.

Similar bills are under consideration in a handful of states nationwide. The Vermont House last week gave final approval to a “shield bill” that would establish protections for patients and providers from prosecutions or investigations by states that have criminalized gender-affirming care and abortion. It now heads to the state House for consideration.

In July, former Massachusetts Gov. Charlie Baker, a Republican, signed legislation that similarly safeguards access to reproductive and gender-affirming health care by shielding doctors and individuals from legal action in other states.