by Tyler O’Neil
Sixteen state attorneys general weighed in on Florida’s rule blocking Medicaid funds from transgender medical interventions on the grounds that they are experimental.
“From the Founding, states have exercised their authority to enact health and safety measures—regulating the medical profession, restricting access to potentially dangerous medicines, banning unsafe or unproven treatments,” the 16 Republican attorneys general write in the brief, a copy of which was provided exclusively to The Daily Signal.
The attorneys general aim to uphold Florida’s right to craft its own health care policy, warning that if the court undermines this right, it will undermine the sovereignty of other states, as well.
Florida’s Agency for Health Care Administration finalized the rule in August, declaring that Medicaid would not cover “puberty blockers,” hormones, “sex reassignment” surgeries, or other procedures that alter primary or secondary sex characteristics.
LGBT and health activist groups led by Lambda Legal represent four young people who say they identify as transgender and filed a lawsuit in September aiming to block Florida’s rule. As part of their lawsuit, the LGBT groups asked the court to block the rule temporarily while it considers the full case. In denying that temporary injunction, the court ruled in October that the case centers on whether Florida’s determination that transgender interventions are “experimental” is “reasonable.”
In arguing against the rule, Lamba Legal cited multiple health care interest groups, including the American Academy of Pediatrics, the World Professional Association for Transgender Health, and the Endocrine Society. The state attorneys general counter that the court should not outsource Florida’s determination to medical interest groups, and they defend Florida’s conclusion that the interventions are experimental.
“After commissioning a systematic review of the literature, the Florida Agency for Health Care Administration determined that current evidence does not support using puberty blockers, cross-sex hormones, and reassignment surgeries to treat gender dysphoria,” their brief reads. “Based on that review, and in consultation with experts, the agency promulgated a rule excluding Medicaid coverage of these procedures.”
The finding by the Florida agency “fits comfortably within the mainstream of medical opinion that has conducted or reviewed systematic assessments of the evidence,” the brief claims. It cites government medical reviews from European countries such as the United Kingdom, Sweden, Finland, and Norway, which “have called for curtailing the availability of transitioning treatments for minors.” It quotes Finland’s health care policy council, which determined that “gender reassignment of minors is an experimental practice.”
The brief also counters the claims of the American Academy of Pediatrics, the World Professional Association for Transgender Health, and the Endocrine Society. “Medical interest groups, composed of physicians self-interested in Medicaid coverage, are not neutral arbiters of ‘medical opinion,’” it notes.
“Moreover, there is particular reason to be suspicious of the interest groups in this case,” the brief adds (emphasis original). “Evidence suggests that the American Academy of Pediatrics, the World Professional Association for Transgender Health, and the Endocrine Society—the three groups that have promulgated guidelines or treatment statements—operate as advocacy groups on this issue, suppressing dissent and rebuffing repeated calls for open, systematic evidence reviews.”
“These groups do not represent ‘medical opinion,’ just an outspoken slice of it,” the attorneys general argue.
The brief notes that AAP’s leadership quashed a resolution aiming to inform the academy’s 67,000 members about the “growing international skepticism of pediatric gender transition.” AAP decried the resolution as transphobic.
One academy member, Dr. Julia Mason, wrote that “AAP has stifled debate on how best to treat youth in distress over their bodies, shut down efforts by critics to present better scientific approaches … and put its thumb on the scale … in favor of shoddy but politically correct research.”
The brief from the 16 state attorneys general also cites Dr. Stephen B. Levine, a psychiatrist and early proponent of transgender medical interventions, who spent decades with the organization that became the World Professional Association for Transgender Health, but has harshly criticized it as “dominated by politics and ideology.” He condemned WPATH’s standards of care as “not an impartial or evidence-based document.”
The brief notes WPATH’s actions to “cancel” and rebuke doctors and leaders who expressed doubt about gender transitions for minors.
Alabama Attorney General Steve Marshall, a Republican, led the brief.
These other Republican state attorneys general signed on: Andrew Bailey of Missouri, Brenna Bird of Iowa, Daniel Cameron of Kentucky, Chris Carr of Georgia, Tim Griffin of Arkansas, Michael Hilgers of Nebraska, Austin Knudsen of Montana, Jeff Landry of Louisiana, Jason Miyares of Virginia, Ken Paxton of Texas, Sean Reyes of Utah, Todd Rokita of Indiana, Jonathan Skrmetti of Tennessee, Alan Wilson of South Carolina, and Drew Wrigley of North Dakota.
Their court brief follows testimony from numerous doctors, including psychiatrists, endocrinologists, and neurologists, who support the AHCA’s determination that transgender medical interventions are experimental and should be excluded from Medicaid coverage.
Walt Heyer, Ted Halley, and Billy Burleigh, men who formerly identified as women and who had their bodies chemically and surgically altered only to regret those interventions later in life, also wrote a brief supporting the rule.
These detransitioners’ “personal experiences with gender dysphoria, gender transition surgery and medical treatments, and de-transition to embrace their biological sex” belie LGBT activists’ claims about a “supposed scientific consensus” on these interventions, their brief argues.
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Tyler O’Neil is managing editor of The Daily Signal and the author of “Making Hate Pay: The Corruption of the Southern Poverty Law Center.”