The move, which Oklahoma Gov. Kevin J. Stitt (R) signed into law Tuesday, marks the first time, conservative state lawmakers have successfully tied gender-affirming care to receiving funds from the American Rescue Plan Act (ARPA), the $1.9 trillion effort to restart the economy and harden medical care during the coronavirus pandemic.
Oklahoma Republicans, pushed into action by a campaign led by a pair of conservative podcasters, hailed the move as necessary to limit the type of medical care for young transgender patients that has upset the party’s base this year.
“By signing this bill today, we are taking the first step to protect children from permanent gender reassignment surgeries and therapies,” Stitt said in a statement. “It is wildly inappropriate for taxpayer dollars to be used to condone, promote or perform these types of controversial procedures on healthy children.”
Some advocates worry that recent move in Oklahoma may encourage other legislatures with Republican majorities to add similar restrictions before allocating federal and state money to publicly funded hospitals and clinics. Hundreds of anti-LGBTQ laws have been introduced in state legislatures in recent years. This year, at least 160 measures were considered, with nearly two-thirds of them focusing on transgender rights. Oklahoma was part of this trend, with bills restricting bathroom and sports access for transgender residents.
Covid Money Trail
It was the largest burst of emergency spending in American history: Two years, six laws and more than $5 trillion aimed at breaking the deadly grip of the coronavirus pandemic. The money spared the American economy from ruin and put vaccines in millions of guns, but it also invited unprecedented levels of fraud, abuse and opportunism.
In a year-long investigation, The Washington Post follows the covid money trail to find out what happened to all that money.
However, transgender advocates and medical experts say OU Health’s facilities have followed best practices in its gender-affirming treatment. OU Health officials would not outline what services would end as a result of the legislation. But an Oklahoma pediatrician who treats transgender youth in the region said she believes all hormone therapy and surgery will cease: “To receive this treatment, they will now have to go out of state,” Shauna said Lawlis. About 100 children receive gender-affirming care at the center, Democratic state Sen. Carri Hicks told reporters.
Parents of transgender children receiving care at Oklahoma Children’s Hospital say they may have to travel to Kansas or Colorado. Shane Poindexter, whose 14-year-old transgender son has been treated at the hospital for a year and receives hormone-suppressing medication, said his son had attempted suicide before going to the clinic.
“It’s a place they can go and be who they are and be accepted. Kids are bullies,” Poindexter said. “It was destroying him mentally. The love and affection from that place is amazing. We don’t know what to do now.”
The federal stimulus included about $350 billion to prop up state and local government budgets with virtually no strings attached. At the end of last year, when it became clear that the economy was recovering much faster than lawmakers expected, it paved the way for states to use the aid in unforeseen ways.
In Oklahoma, the legislature opened a public portal last year that allows any citizen to submit a request for the discretionary funds. They received more than 1,400 proposals that a state legislative committee reviewed this summer before sending dozens of them to the full Legislature for a vote.
The state and local funds are part of a larger pool of nearly $5 trillion that Washington sent out in the first two years of the pandemic, creating an unprecedented challenge to account for how the money was spent. With almost no rules on how states used their share, some Republican governors have tried to pay for tax cuts with the aid, for example. In Florida, Gov. Ron DeSantis and other GOP state lawmakers used interest they earned on federal aid to pay for a $12 million fund that covered the cost of flying migrants to Massachusetts last month.
Children’s hospitals around the country have also faced escalating threats of violence over online anti-LGBTQ campaigns targeting gender-affirming care. Some states have taken other steps to block public funds from being used for transgender care; this year, Florida became one of at least 10 states that have blocked Medicaid coverage for the procedures.
“It’s so outrageous and unbelievably vicious,” said Cathryn Oakley, state legislative director and senior counsel at the Human Rights Campaign, which advocates for the LGBTQ community, referring to Oklahoma’s bill. “It’s literally about covid relief. It’s about restarting the economy.”
The push to end OU Health’s transgender care was accelerated by two conservative podcasters who last month began demanding action from lawmakers on their programs and social media.
The target of their ire was the Roy G. Biv Program at Oklahoma Children’s Hospital, which for the past six years has offered mental health counseling and hormone therapy, including puberty blockers. In a handful of cases, it has also referred patients transitioning from female to male to mastectomy surgeons.
Mark Ousley appealed to his 20,000 Twitter followers and listeners to his Oklahoma-based “UnWokable Podcast” in mid-September to urge lawmakers to withhold OU Health’s federal money. He was later joined by Megan Fox, a conservative podcaster who broadcast the calls she made to lawmakers and provided her 23,000 Twitter followers with scripts to do the same.
“I will make it my mission in life to shame every Republican who votes for this,” Ousley wrote in a tweet on September 25.
Transgender advocates and Oklahoma lawmakers said the campaign had a noticeable effect.
“One of them spent the whole day live streaming, calling legislative staff and asking them why they were committing child abuse,” said Cindy Nguyen, policy director for the American Civil Liberties Union of Oklahoma. “There was very inflammatory language; it created momentum.”
Republicans introduced the bill on September 28. In a debate on Thursday, Republican lawmakers argued young patients were taking hormones that could be physically harmful — something the American Medical Association disputes — and said all transition surgeries for Oklahomans under 18 should be banned.
“In order to promote and help ease taxpayer dollars, gender reassignment should not be allowed in this state,” said state Sen. Jake A. Merrick (R). “I think it reflects the majority of the opinions and values that are held in this state.”
Several Democratic lawmakers in the House, meanwhile, gave their time to state Rep. Mauree Turner (D), Oklahoma’s first openly non-binary lawmaker, who appealed to their colleagues not to be swayed by the social media and phone call campaign.
“I hope that one day you might understand a little of what it is like to be born into a body that is not yours. That’s what our youth in Oklahoma are facing,” Turner said, adding that they “came out” to their mother in second grade. “Oklahoma has the money to take care of our people and we don’t have to wage this war on them and we don’t have to use our children, our youth, as pawns. Please vote no.”
The bill passed the House 68-23, after a Senate approval of 31-13. Although the votes were largely along party lines, a few Republicans in both chambers voted against the bill, either because they said the language targeting the OU Health program was not strong enough or because they opposed accepting and handing out the pandemic’s Assistive devices. in general.
OU Health quickly responded to the measure, saying last week that it was already “proactively planning for the discontinuation of certain venereal services.”
But Richard Lofgren, president and CEO of OU Health, sent an email Friday to health system employees saying that while he knew some members of the Legislature might introduce bills targeting the transgender program, he “expected not that it would be tagged to the ARPA request.”
Lofgren also expressed dismay that the legislature required transgender medical care to stop immediately.
“We were not provided with a reasonable timeline for the safe transition of care for our patients,” he wrote in the email, which was obtained by The Washington Post. “For our doctors, not being able to provide a safe transition of care is morally troubling to the guiding principles of our profession and our Hippocratic Oath, but we have to comply with the law.”
A group of Republican lawmakers — and the podcasts — are pushing for more. Last week, a group of senators held a press conference where they said the next step should be a permanent, statewide ban on medical services that help Oklahoma youth transition.
“We should have an immediate statewide ban on these surgeries, on these puberty blockers, on what’s being done to these children,” state Sen. Nathan Dahm (R), who recently appeared on Ousley’s podcast, said at the press conference. Dahm, who has previously introduced legislation on the issue but has so far been unavailable for comment, did not respond to calls seeking comment.
On Saturday, Republican lawmakers continued to push for a statewide ban and appealed to Stitt to call another special session. “We can’t wait for session and then HOPE that we can pass something. This is YOUR moment!,” Merrick said in tweet, tagging both Fox and Ousley. The post came just days after Merrick appeared on Ousley’s podcast. Merrick did not respond to a call seeking comment.
But Stitt said Tuesday he will not call another special session on the matter, instead calling for a permanent ban on the treatments to be passed next year.
“I call on the legislature to ban all irreversible sex reassignment surgeries and hormone treatments on minors when they next convene in February 2023,” he said.
Advocates say the bill Stitt signed Tuesday has already set a dangerous precedent.
“It’s about funding health care for children, and they’re doing it conditional on denying them medically necessary care on the basis of discrimination and gender identity,” Oakley said.
Alice Crites and Tony Romm contributed to this report.