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Ban on gender-affirming health care contains exceptions for currently transitioning minors

The Missouri State Capitol on Tuesday, Jan. 3, 2023, in Jefferson City.
Brian Munoz
St. Louis Public Radio
Members of the Missouri Senate gave preliminary approval to bills targeting transgender minors and athletes on the second day back at the state Capitol after a weeklong break.

Updated at 6:05 p.m. March 21 with comments from supporters and opponents of the legislation

After more than 12 hours of filibustering, the Missouri Senate gave initial approval to a pair of bills targeting transgender minors and athletes.

Early Tuesday morning, senators approved SB39, which bars transgender athletes, including both trans girls and boys, from participating in sports that align with their gender identity. They also gave initial approval to SB49, which bars transgender minors from accessing gender-affirming health care.

Katy Erker-Lynch, executive director of PROMO Missouri, an LGBTQ public policy and advocacy organization, said the first call they took after the filibuster ended was from a parent of a transgender child who decided to leave the state.

“She has decided that her family needs to leave and she's losing grandparents, and cousins and schools and community, because she cares that her child has access to care that is gender-affirming, that's responsive and recognizes the human in front of you,” Erker-Lynch said.

Both bills need an additional vote in the Senate before they move to the Missouri House.

The bills would either partly or fully expire four years after they go into effect. The expiration date is Aug. 28, 2027. Additionally, the bill on transition health care includes an exception for minors who are already receiving some gender-affirming health care.

Transgender minors who have been prescribed puberty-blocking drugs or hormone treatments before Aug. 28 of this year would be exempt from the ban.

Surgeries are not included in the exception.

Sen. Mike Moon, R-Ash Grove, who sponsored the bill barring transition-related health care, spoke on that exception Tuesday morning before the legislation received first-round approval.

“We have allowed for those who are already in the process of transitioning the ability to not be pulled immediately from that,” Moon said.

Sen. Lauren Arthur, D-Kansas City, who held the floor for several hours during the Democratic filibuster, said keeping access open for trans kids who are currently receiving gender-affirming care became a priority.

“There were several drafts, and many of them included much worse provisions, if you can imagine,” Arthur said. “At the end of the day, we understood that the kids who are receiving care, particularly puberty blockers and hormone treatment, that they needed to continue being able to receive that.

Erker-Lynch said the exception language shows how these bills are politically motivated.

“The fact that they're allowing you, if you're on a prescription now, to receive gender-affirming care shows that they recognize that these evidence-based practices do save lives,” Erker-Lynch said. “And if they were to interrupt it, they'd be interrupting lifesaving care for kids.”

While that exception ends in four years, the ban on those specific treatments, puberty blockers and hormone treatments also expires in four years. The ban on surgeries does not end.

“We have gotten to a point where we have a four-year protection. That's a start,” Moon said.

Arthur said that in four years, attitudes could change on these bills. This is a losing battle for Republicans, he said.

“I'm hopeful that after losing elections over these issues because voters don't want to see vulnerable kids kicked by the people who are supposed to represent them as leaders … I think that they're going to come around to that,” Arthur said.

Sen. Denny Hoskins, R-Warrensburg, who sponsored his own version of the bill, said that he was not happy with the expiration date on the bills, but that a majority of the bill was good and the best way to move the bill forward.

Unlike Arthur, he expects this issue to persist over the years.

“I think it will continue to be a hot topic, until the majority of states have passed something to ban these procedures,” Hoskins said.

The bill barring transgender athletes from participating in school sports has a wider scope than prior versions.

The legislation would prohibit any transgender athletes, not just transgender girls, from participating in a sport “that is designated for the biological sex opposite to the student's biological sex as correctly stated on the student's official birth certificate.”

The ban would apply to students through the collegiate level. It also would apply to public, charter and private schools.

The Missouri State High School Activities Association already has guidelines on sports participation for transgender athletes. The association did not comment on the bills but said that, based on the applications received, it has approved eight students for participation during the current school year. No more than four students could be currently competing at the junior high level and four at the senior high level.

For college sports, the NCAA also has guidelines.

The entire bill on transgender sports participation would expire on Aug. 28, 2027, not just sections of it. However, the expiration dates on both bills could be extended by lawmakers.

Erker-Lynch said she doesn’t see the expiration date as a compromise.

“We can't compromise on health care, right?” Erker-Lynch said.

While no Democrats spoke against the legislation right before the first-round approval votes, they spent over 12 hours Monday through Tuesday morning filibustering one bill that contained both the health care and sports bans.

Sen. Greg Razer, D-Kansas City, the chamber’s only openly gay member, spoke during his filibuster shift.

“Not everything is about you getting reelected. Not everything is about scaring your base to drive out voters. We're talking about kids here,” Razer told senators.

As to how the House will handle the bill, there are differing opinions.

Erker-Lynch said the conversation could be different from the Senate's.

“I think that there's a real opportunity for some very reasonable, moderate Republicans to take a look at this bill and say: ‘What are you doing to our health care system? What are you doing to our hospitals? And where does this end up?’” Erker-Lynch said.

Meanwhile, Hoskins sees an opportunity to make the bill more agreeable to him.

“We'll see what happens over in the House. Hopefully, the House would consider taking that sunset off,” Hoskins said.

But Arthur said Senate Democrats have made their position known.

“I think we've made it clear that we're not going to accept a worse version of this bill, and that it will face a pretty difficult path if it comes to that,” Arthur said.

Sarah Kellogg has been the Missouri Statehouse and politics reporter for St. Louis Public Radio since 2021.