While the sponsors of H668 are uncertain about the fiscal impacts on the state, I think we can be certain of one expense not documented here and that’s the cost of litigation.
H668 violates Section 1557 of the Affordable Care Act which outlines federal expectations and prohibition of discrimination. While states are given some discretion to set policy, we are also required to cover medically necessary care. We are currently being sued for not covering surgeries for adults because this care is necessary. Everytime we violate federal Medicaid rules, we risk funding for the entire Medicaid program in addition to more court battles.
And we have quite the record in the courts. Every time we have passed a bill denying rights to people who are trans, it’s landed in court:
- The transgender birth certificate ban racked up legal fees of $320,000 for a bill that was enacted even in the face of a 2018 federal decision that found preventing people from changing their birth certificate violated the Equal Protection Clause of the U.S. Constitution.
- Hecox v. Little — The transgender athlete ban (H500a) enacted in 2020 is still being litigated and in August 2023, a federal appeals court upheld an injunction blocking this law. (AG expenses still being racked up)
- M.H. v. Jeppesen – Two trans women on Medicaid sued for denials of gender-affirming care (AG and outside counsel)
- Poe v. Labrador – criminalizes gender affirming care for minors (H71), but a federal judge barred Idaho from enforcing the newly enacted ban until a lawsuit brought by transgender youth and their families is resolved. The judge stated that the bill was likely to be unconstitutional in his ruling. (AG expenses still being racked up).
- Roe v. Critchfield – The infamous bathroom bill (S1100) is stuck in court battles as well. (Racking up more attorney’s fees)
Just like all these laws being challenged in court, H668 clearly violates the 14th Amendment’s equal protections clause.
As one of my colleagues recently stated, “the constitution was made for the minority not the majority.”
And this bill targets a population of people, transgender people in the minority, to be excluded from using a drug treatment plan afforded to cisgender people in the majority. When the state cuts off public funds to a specific group of people because of who they are, that is discrimination. And that is illegal.
As a legislator, I qualify for state health insurance and my health insurance plan covers estradiol hormone therapy for symptoms of menopause. I can verify it’s medically necessary! Just like gender affirming care is medically necessary gender dysphoria. The denial of gender-affirming healthcare goes against the recommendations of leading medical organizations, including the American Medical Association and the American Psychiatric Association.
Denying transgender healthcare to taxpayers, state employees and their children will surely be challenged in costly legal proceedings, which the state cannot defend. On top of that, it’s cruel.
And by the way, it’s estimated that there are fewer than 500 people in our state receiving gender affirming care. I asked Medicaid for figures on costs of hormone therapy and the average annual cost for a prescription of estradiol after applying prescription rebates would be less than 150.00 annually. Now, not all those 500 people are on medicaid or state plans, so conservatively if you look at half that number, you’re looking at about $35,000 per year in costs to the state.
Whereas cutting the funding for these individuals would likely cost the state millions of dollars, and worse, it could cost someone their life without it.
Depression and suicide is very common for people struggling with gender dysphoria; this population suffers from the highest rates of suicide compared to other groups.
By restricting access to these medically necessary treatments, we risk perpetuating health disparities and denying transgender individuals the right to comprehensive healthcare.
The proposed legislation violates the legal and human rights of transgender individuals, infringing upon their right to be who they are and live a full life.
In the spirit of justice and fairness, we must ensure that all members of our community have equal access to the healthcare they need.