Never one to miss a chance to claim the crown as America's reigning culture warrior, Florida Gov. Ron DeSantis has unveiled yet another in his long line of antitransgender policies. This time he's proposing to deprive his transgender citizens — minors and adults alike — of fundamental medical care.
The policy proposal came in a report and statement issued Thursday by Florida's Medicaid agency, aimed at stripping coverage for gender-affirming care from transgender Medicaid enrollees. The documents indicate that a final determination of coverage eligibility will be issued following a further review.
This isn't DeSantis' first attack on the transgender community.
He has mocked transgender people in public, including University of Pennsylvania swimmer Lia Thomas, signed legislation requiring Florida K-12 and college sports teams must be designated male or female based on "biological" sex, and of course earlier this year signed a measure limiting gender discussions in Florida schools — the notorious bill nicknamed "Don't Say Gay" by critics.
The "Don't Say Gay" bill is at the center of DeSantis' campaign against the Walt Disney Co. After Disney publicly criticized the measure, DeSantis moved to strip the company of its quasi-governmental authority over the vast tract of land in central Florida occupied by Walt Disney World and its related resorts.
That move, ironically, may result in saddling local residents with billions of dollars in tax bills while giving Disney a big tax break.
The DeSantis administration's Medicaid initiative seemed timed for maximum crassness, issued at the very start of June — LGBTQ Pride Month, celebrated each year in honor of the effective launch of the gay liberation movement with the Stonewall Uprising in New York in June 1969.
In Medicaid, which is funded jointly by the federal government and the states, coverage for transgender care is left up to the states. Currently, the District of Columbia and 24 states, including California, explicitly cover transgender treatment and care.
Ten others exclude that care from Medicaid coverage, and 16 have no clear policy. Thus far, Florida has been in the last category; the latest initiative seems designed to move the state into the exclusion group.
The DeSantis administration's effort to narrow healthcare coverage for transgender residents is yet another manifestation of the Republican Party's drift toward abject soullessness and moral bankruptcy.
Republican officeholders like DeSantis and Texas Gov. Greg Abbott will spare no one in their quest to score points against Democrats and progressives — "own the libs," as it's known: The more powerless and vulnerable the victims, the better.
Texas' healthcare policy disadvantages its neediest residents. The state has not expanded Medicaid under the Affordable Care Act, leaving an estimated 770,000 low-income residents who might be eligible for Medicaid under the ACA rules without health coverage at all.
That's especially pertinent in light of the massacre of 19 schoolchildren by a gunman in Uvalde, Texas, on May 24: Abbott says the event points to the need for better mental health treatment — but the majority of mental health services in the U.S. is provided by Medicaid. Abbott, moreover, has refused to back away from his own loosening of gun regulations in Texas.
As for DeSantis, through his COVID policies, which amount to shunning masks and social distancing and undermining confidence in vaccines, he has sacrificed the lives of thousands of his own constituents.
Florida has reported more than 74,500 COVID deaths, a rate of 347 deaths per 100,000 population, according to the Centers for Disease Control and Prevention. Had the state's rate even matched the national rate of 302 deaths per 100,000, more than 9,500 Floridians would have been spared death from COVID. Had Florida matched the rate in California (229), one of DeSantis' favorite targets, 25,000 Floridians would have been spared.
DeSantis and his claque assert that Florida's statistics are skewed by its older demographics, and that he should be praised for focusing on keeping Florida's seniors safe. That won't wash. Florida's record on booster vaccinations among its older residents, as well as statewide generally, is poorer than the national average and much worse than California's.
How has DeSantis responded to this record? By highlighting his hostility to anti-COVID measures as though that's a badge of honor and appointing an established "COVID crank," Joseph Ladapo, as his state surgeon general.
Ladapo has touted the antimalarial drug hydroxychloroquine and the anti-parasitic drug ivermectin as treatments for COVID-19, despite the absence of any evidence that they serve that purpose.
He has questioned the efficacy of COVID vaccination for children; under his leadership Florida officially recommended against vaccinating children for COVID, a stance that flatly contradicted guidance from the federal government and medical consensus.
Ladapo supervised the issuance of the transgender proposal. The federal guidelines endorsing gender-affirming care for young people, Ladapo said in April, are "about injecting political ideology into the health of our children."
The roots of DeSantis' hostility to transgender people are murky. It's possible he believes that targeting a vulnerable community will place him in better stead with GOP voters, as he tries to position himself as a credible Republican candidate for president in 2024.
Culture warriors of the DeSantis ilk may consider transgender people to be among the last in America who can be openly disrespected. They have not yet acquired the numbers or the level of social acceptance that has brought the gay and lesbian community a political voice. The treatment and care of transgender people can be costly and physically challenging
The core of Florida's Medicaid determination is that several treatments of gender dysphoria are "experimental" and inconsistent with "generally accepted professional medical standards." Therefore, they shouldn't be eligible for Medicaid coverage.
That's disputed by the medical profession. Existing guidelines published by the American Academy of Pediatrics, the Endocrine Society, the American Academy of Child and Adolescent Psychiatry and the World Professional Assn. for Transgender Health all support the treatments being challenged by Florida authorities. That's according to a letter signed by 300 Florida healthcare professionals involved in treating transgender and gender diverse youths, issued in April in response to a preliminary version of the state's findings.
The state's preliminary guidance by the Florida Department of Health, which is almost identical to the version published Thursday, "misrepresents the weight of the evidence, does not allow for personalized patient and family-centered care, and would, if followed, lead to higher rates of youth depression and suicidality," the professionals wrote.
One feature of Florida's Medicaid determination that gives away its essential shoddiness is the roster of researchers it cites. Of the five, three have made public reputations by writing and campaigning critically against transgender treatments; none is a transgender treatment advocate.
Among the sources is James Cantor, a Canadian researcher who has written that advocacy of some transgender treatments privileges "sociopolitical opinion over science." Cantor was hired by the state of Alabama as an expert witness in its defense of a state law criminalizing the provision of gender-affirming treatment to gender dysphoric minors.
As a federal judge observed last month in his ruling temporarily blocking parts of the law, "Dr. Cantor admitted that: (1) his patients are, on average, thirty years old; (2) he had never provided care to a transgender minor under the age of sixteen; (3) he had never diagnosed a child or adolescent with gender dysphoria; (4) he had never treated a child or adolescent for gender dysphoria; (5) he had no personal experience monitoring patients receiving transitioning medications; and (6) he had no personal knowledge of the assessments or treatment methodologies used at any Alabama gender clinic."
As a result, the judge said, he gave Cantor's testimony about the treatment of gender dysphoria in minors "very little weight."
Another of Florida's sources is Quentin Van Meter, a Georgia pediatric endocrinologist who advocates the discredited practice of "conversion therapy," which aims to change its subjects' sexual orientation or gender identity by psychological means. Conversion therapy is effectively outlawed in 18 states and the District of Columbia, including California.
A third source is Patrick Lappert, a surgeon and Catholic deacon who speaks regularly to Christian audiences, where he promotes his argument that "utilitarian ideas about the human person and sexuality are driving the confusion over gender."
In short, nothing factual in Florida's published rationalization justifies taking healthcare away from its transgender population, just as nothing factual justifies DeSantis' other legal attacks on the community or his denigration of anti-COVID safety measures. He's playing a political game. For his victims, however, the consequences can be deadly serious.
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