Update on the Fight for Trans Healthcare

On Friday, May 2nd, 2018, Governor Reynolds signed HF766 into law. She made the regrettable choice not to use her line item veto to eliminate the amendment designed to discriminate against transgender Iowans.

The Amendment, tacked onto a Budget bill last minute, was specifically coded directly into the Iowa Civil Rights Act. This is the first anti-trans legislation since HB 1011 in North Carolina that specifically targets the trans and intersex communities for open discrimination. Because it was written into the Iowa Civil Rights Act, this is not at all similar to the original DHS administrative rule that the Iowa Supreme Court ruled unconstitutional.

Yet Governor Reynolds claims:

“This takes it back to the way it’s always been. This has been the state’s position for decades.”

This is in defiance of the Iowa Supreme Court ruling and an attempt to write targeted discrimination into an anti-discrimination act. Just because the State of Iowa had a discriminatory rule does not mean the state’s position should return to that discriminatory rule, and writing it into the Iowa Civil Rights Act is dangerous precedent.

Concerns over the undemocratic coding of discrimination into the Iowa Civil Rights Act has led others to wonder who will be the next target.  Since transgender and intersex individuals are now open to being discriminated against via this amendment, this could open up the conversation of discrimination being written for other demographics if legislators decide their “cost of care” is too high.

The justification of targeting trans people by Iowa Republicans is based in inaccurate estimates of the cost of transgender healthcare; thus, it is possible inaccurate estimates could be used against other marginalized populations as well. If Iowa Republicans succeed in this blatant discriminatory actions, this could serve as a model for anti-trans policies in other states. That makes it imperative that we fight this discriminatory attempt by Iowa Republicans, who sought to undo the Iowa Supreme Court ruling.

In March 2019, Iowa Supreme Court had originally ruled the Department of Health ban on surgeries related to “transsexualism, hermaphroditism, gender identity disorder, or body dysmorphic disorder” was unconstitutional due to the Iowa Civil Rights Act. Gender identity is a protected class under the Iowa Civil Rights Act, or else it was until this amendment watered down what is considered protected.

Mark Stringer, executive director of the ACLU of Iowa, issued a statement to the Des Moines Register stating that gender affirmation surgery is often a life or death matter for many trans Iowans, and that the amendment had “no basis in medicine or science.” He said:

“This amendment is a clear violation of the equal protection under the Iowa Constitution because it would discriminate against people simply because they are transgender.”

After the Iowa Supreme Court ruling in March, many trans Iowans had scheduled appointments in hopes of having their surgeries covered under Medicaid. Now these same people are trapped in limbo. How will this impact our community and the LGBT clinics that serve us? Will some of us be denied coverage for our life-saving procedures? Our access to healthcare that affirms our gender identity is life-saving for many of us, and improves our quality of life. Studies as well as our own life stories show this again and again.

The language used in the Amendment reeks of ignorance. The Amendment reads:

“this section shall not require any state or local government unit or tax-supported district to provide for sex reassignment surgery or any other cosmetic, reconstructive, or plasticsurgery procedure related to transsexualism, hermaphroditism, gender identity disorder, or body dysmorphic disorder. This division of this Act, being deemed of immediate importance, takes effect upon enactment.”

Let’s break this down. The terminology in the Amendment uses harmful and outdated language, which shows a huge disconnect with trans Iowans and the Iowa Legislature. First, transexualism or hermphroditism are harmful and no longer used, even by medical professionals; the correct terms would be transgender and intersex individuals. Also, “sex reassignment surgery” has been called gender affirmation surgery for over a decade. To read more about the more respectful terminology, see the Trans Language primer here.

Second, classifying trans surgeries as “cosmetic” or “plastic surgery” shows a lack of understanding about their medical necessity for many trans and/or intersex Iowans. It also shows a grave disregard for scientific facts and the medical organizations that support these surgeries as necessary and life-affirming.

The American Medical Association, the largest association of physicians and medical students in the United States, articulates in Resolution 122 that an “established body of medical research” shows both the medical effectiveness and necessity of “mental health care, hormone therapy, and sex reassignment surgery” in treating gender dysphoria. The AMA has resolved “[t]hat our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient’s physician.”

Finally, Republicans keep citing “costs” as the reason trans people do not deserve the same access to healthcare as any cisgender person seeking medical treatments. This is simply inaccurate as the costs for covering transgender healthcare are minimal.

As reported by Vox:

When San Francisco began to offer trans-inclusive health coverage to its employees in 2001, the city applied a small surcharge to all employees enrolled in its health plan. But the city ended up using just $386,000 of the $5.6 million raised by the policy — a cost so low that it eventually dropped the additional charge altogether.

”[D]espite actuarial fears of over-utilization and a potentially expensive benefit,” San Francisco’s Human Rights Commission noted, “the Transgender Health Benefit Program has proven to be appropriately accessed and undeniably more affordable than other, often routinely covered, procedures.”

Transgender Iowans have testified to the life-saving access to healthcare. Despite all this evidence, testimony, and statements by medical organizations, Governor Reynolds and Iowa Republicans refused to take any of this into account. They specifically targeted transgender people and wrote it into the Iowa Civil Rights Act to get around the Iowa Supreme Court ruling.

The full impact will not be fully known until the law is implemented and is tested in court.

Statement by Aidan Zingler, co-organizer for the TAGIowa’s Protests:

 “I am angry and disappointed at the Governor choosing to ignore the pleas of her own fellow Iowans in order to pander to right-wing extremists who are targeting the trans community in harmful ways. Trans people will not be erased; we are valid. I ask and invite all transgender Iowans to speak with us, share your stories. We will listen, and we will fight with you to restore our access to healthcare and our right to be treated with the same dignity and respect as any cisgender Iowan.”

Statement from Tobias Gurl, co-organizer for TAGIowa’s Protests:

 “Governor Reynolds has joined the ranks of public officials too cowardly to stand up to her donors. We invite our fellow transgender Iowans and allies to join TAG in reversing this undemocratic amendment.”

Note in regards to who TAGIowa is: The Transgender Action Group is a social justice group from the First Unitarian Church that focuses on supporting the trans community in Iowa, educating the church and the public on transgender people and our lives, and providing events to promote and uplift the trans people within our communities.

AJ+ Video sums up the fight for transgender and intersex healthcare access, and how it’s not just about Iowa. This is a nationwide fight because as of May 2019 only 17 states have coverage for transgender healthcare.


By Aibird

Open the door, step inside. Here you find a forest, teeming with animals and birds, which sweeps up the sides of snow-capped mountains. Here in the small pocket of beauty, one finds the essence of my soul. A writer at heart, I delve deep into the finer details of humanity's spirit, and seek to share with others what gems I uncover. I find life exciting and full of interesting surprises, and despite the great pain that often confronts me, I persevere with the joy in my heart still bubbling, and the light of my soul still aflame. There is a time and a place to introspect one's self, but often enough it is best to not look back in regret, but leap forward in the present toward the achievement of one's deepest dreams. I am a wanderer. An explorer. One place cannot contain me for long, but to my friends and family, I remain loyal, for love is not bound by time nor place. Once cultivated and nourished continuously, it binds people together on a journey through the unknown reaches of life.

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