Photo: Giorgio Viera/AFP via Getty Images
The Republican-led Florida House last week passed some of the most extreme anti-trans legislation to move through the far-right chamber to date. Media attention focused on a measure that would ban trans people from carrying accurate driver’s licenses by requiring state IDs to list only the gender assigned to a person at birth. The proposal has been dubbed the “trans erasure bill.”
That same piece of legislation, House Bill 1639, would also mandate a series of pernicious measures relating to private health insurance coverage. These aspects of the proposed law have garnered fewer headlines, but the impact could be far-reaching: They risk raising the cost of health insurance for everyone in the state.
Cisgender people are not the key concern here. The anti-trans legislation is most vile, of course, for its explicit intent to render public life and necessary health care ever more inaccessible for trans people.
Control over gender-nonconforming people requires control over everyone.
Yet the fact that a Republican agenda for trans erasure means doing damage to the wider health care system is a reminder that control over gender-nonconforming people requires control over everyone.
The trans erasure bill mandates that all private health insurance plans, for every Floridian, cover what is commonly described as “conversion therapy” — a dangerous pseudoscientific approach to changing someone’s sexual preferences or gender identity. The bill doesn’t call it that, of course, but with a little translation of the obfuscating language and poor grammar, it’s easy to show what Florida Republicans are trying to do.
The bill “forbids health insurers and HMOs from prohibiting coverage of mental health and therapeutic services to treat a person’s perception that his or her sex is inconsistent with sex at birth by affirming the person’s sex at birth.” That is, health insurers must cover therapy that insists that a gender assigned at birth is correct, and that a person suffering from gender dysphoria should be made to accept this.
Conversion therapy is a debunked practice, banned in 2020 states and rejected by the American Medical Association. Yet, should the trans erasure bill become law, Florida residents under private health insurance plans will have to pay for it to be covered.
[pullqutote pull=left]“For every anti-LGBTQ bill we see pass in Florida, we’ll see it taken up elsewhere.”[/pullquote]
Florida has been ground zero for introducing a spate of anti-trans legislation aiming at health insurance and medical liability as a means to bring about de facto health care bans for trans adults, alongside explicit bans on care for trans youth.
“It’s so important we stop these bills in Florida,” Carlos Guillermo Smith, a senior policy adviser for Equality Florida who is running for state Senate, told me. “For every anti-LGBTQ bill we see pass in Florida, we’ll see it taken up elsewhere.”
It’s not clear, and has not been calculated, what the exact cost of the “conversion therapy” mandate would be for privately insured Floridians. No research was carried out by Republicans on the financial consequences of the measure, despite such analysis being required by state law before any mandate on health insurance is enacted. Florida Republicans, though, might not know that: They’re usually fighting tooth and nail against enacting these mandates, which in most cases have been proposed to expand access to health care, not restrict it.
This grim irony — that the Florida GOP usually opposes government mandates on health care coverage provisions but is in this case seeking to impose its own in the name of conversion therapy — is not lost on LGBTQ+ and health care advocates in the state.
“They’ve taken their culture-war attacks against trans people so far that it’s costing everyone,” said Smith. “If the human price wasn’t bad enough — and it should be — it’s hitting all our pockets,” he told me, noting that Florida is one of “a handful of remaining states” that has refused to expand Medicaid, in turn denying coverage to 800,000 uninsured Floridians.
In a series of tweets, Smith cited Florida’s own law, which states that the legislature “recognizes that most mandated benefits contribute to the increasing cost of health insurance premiums.” Nonetheless, he noted, “HB 1639 mandates anti-trans ‘conversion therapy’ on all health care plans no matter what the cost on Floridians.”
“If the human price wasn’t bad enough — and it should be — it’s hitting all our pockets.”
There’s no real contradiction here. Republicans have long combined costly totalitarian bureaucracy and law enforcement with vicious austerity measures in service of their ultimate goals: white supremacy, Christo-nationalism, and property protection.
The answer to the conversion therapy mandate is not to call upon Republicans to remain consistent in their austerity logics and resist all government mandated health care. Rather, it’s to fight for a robust system of free health care for all, less vulnerable to the compulsions of conservative minority rule.
Other measures in the trans erasure bill take specific aim at insurance plans that cover gender-affirming care and require that coverage for “de-transition” medical treatment be offered for any such plan.
“De-transition” care should already be covered as gender affirming health care — to transition again is still to transition — but the legislation is an invitation for private insurers to treat trans people as a site of risk and raise premiums accordingly or drop gender-affirming care coverage altogether.
The bill explicitly states that plans that cover trans health care can charge “an appropriate additional premium,” singling out trans people for higher premiums to cover the care they need. Meanwhile, all Floridians would have to pay more for the inclusion of conversion therapy in their coverage.
Having passed the House last week, the Florida Senate now has until the end of the week — the close of the legislative session — to take up the trans erasure bill and other anti-trans legislation passed by the House. If the Senate responds to rightful public concern about the legislation and does not pick it up in the coming days, the bill dies.
It would be a small but necessary victory against the Republican war on trans existence.
