North Carolina’s LGBTQ+ health care landscape is uncertain as bills affecting their community take shape

By Lucas Thomas

After the recent passage of several bills affecting LGBTQ youth in the North Carolina General Assembly, there isn’t much that people in those communities can do other than strategize for what lies ahead.

After more than 50 minutes of floor debate in the Senate on Tuesday, lawmakers approved House Bill 808, which limits gender-affirming child care and prohibits the use of state funds for such care, with a party vote of 29-16.

The bill is almost certain to become law, considering Republicans have a veto-proof majority in the North Carolina Senate and House of Representatives. However, the future of gender-affirming care in the state is uncertain.

A rally organized by advocacy group Equality NC was held outside the Legislative Building in downtown Raleigh ahead of Tuesday afternoon’s vote. Relatives of transgender youth, a family physician, and representatives from Planned Parenthood South Atlantic and the ACLU of North Carolina were among those who spoke, surrounded by a crowd of several dozen.

When I say access to gender-affirming care is lifesaving, that’s not hyperbole, said Riley Smith, a Durham-based family physician who provides gender-affirming care. These politicians simply have no idea what it’s like to take away that cure.

A woman holding a baby holds up a cardboard sign that reads "Body autonomy for each body."
Catherine Maddox holds up a placard during a rally to protest recent bills coming out of the North Carolina General Assembly on June 27, 2023. Credit: Luca Tomae

After the rally, the group marched in and around the legislative building in silence, making half a dozen circuits of the inner courts. Meanwhile, protesters hoisted signs with messages of support for the LGBTQ+ community.

By 4:00 pm, protesters filled the public gallery overlooking the Senate floor to watch the debate and vote. After the bill passed, chants of protection of trans children rang from the rostrum, prompting Acting Senate Leader Phil Berger (R-Eden) to call order as sergeants at arms and agents of police cleared the space for the rest of the session .

Another fight on the floor

Despite the fact that the fate of House Bill 808 was nearly decided, Senate Democrats made their opposition to the bill heard. Four of them proposed amendments intended to address what they saw as Republican hypocrisy.

Senate Minority Whip Jay Chaudhuri (D-Raleigh) has proposed an amendment that would add a section with separate bills of rights for parents and students.

North Carolina Republicans are currently pushing a Parental Rights Bill that would require parents to be notified if a student changes the name or pronouns they use in school. Opponents of that bill say it would force teachers to introduce LGBTQ students to their parents.

Chaudhuri’s amendment would have enumerated the rights of students to a learning environment where discrimination in all forms is not tolerated and a feeling of safety and comfort at school.

This bill represents another example of letting politicians decide and not letting parents decide, Chaudhuri told his fellow lawmakers.

After Chaudhuri’s amendment was introduced by a party vote, three other Democratic amendments suffered the same fate. One would create a study group on the rise of mental health disorders in children and provide $5 million in funding to the Suicide Prevention Lifeline. Another would have banned licensed medical professionals from engaging in conversion therapy with mentally disabled children and adults, and a third would have raised the legal age of marriage to 18.

Berger challenged the notion that the bill does not adequately address the potential negative mental health effects of LGBTQ+ youth.

I think to the extent that people are out there saying there is an effort to ban anyone from seeking and receiving mental health counseling and assistance, that is not true, Berger told reporters after the Senate session.

Strengthening mental health supports for children has been a priority for lawmakers this legislative session. In April, a bipartisan group of House lawmakers introduced a bill that pledged $1 billion to the state’s mental health system, while the Senate added nearly $1 billion in health spending to the plan. budget they launched in mid-May.

After being sent back to the House for competition on Wednesday, House Bill 808 also passed by that house in a one-party vote. The bill now goes to Gov. Roy Cooper’s desk, where it will almost certainly be vetoed. Both houses of the General Assembly have the numbers to overturn the governor’s vetoes, meaning some form of gender-affirming child care restrictions will likely become law this year.

Looking into an uncertain future

The restrictions on gender-affirming assistance for trans youth are part of a larger group of bills pending that would affect LGBTQ people in the state.

What’s not clear is how these bills will weather a looming wave of litigation. North Carolina Democrats have warned of lawsuits that could result from the enactment of these bills. They pointed to recent cases where similar laws have been blocked and even overturned by federal judges.

A Florida ban on gender-affirming care for transgender minors was temporarily blocked in early June, and a couple of weeks later a similar ban in Arkansas was overturned by a judge who found the law violated the right process and the equal protection clauses of the 14th amendment.

Fear and misinformation about this health care don’t stand up to scrutiny, said Elizabeth Barber, a policy analyst at the NC ACLU. The ACLU has brought challenges to similar laws in other states.

Bills affecting transgender youth at a glance

Senate bill 631: Prohibits public health facilities of the UNC Health System or its affiliates, state institutions, or local health departments from providing children with gender-affirming care, including gender transition surgery, puberty-blocking drugs, or sex hormones cross. No state funds can be used for gender transition procedures.

State: Senate and House approved, returned to the Senate by competition

House law 808: Prohibits all medical professionals from providing gender-affirming care to minors, with some exceptions. This includes carrying out gender transition procedures and providing puberty-blocking drugs and cross-sex hormones, and state funds cannot be used.

Status: Senate committees passed, was sent back to the House which agreed with the Senate changes. Bill has been sent to Gov. Roy Cooper for his signature/veto.

House Bill 574: Prevents transgender women from playing on women’s sports teams at the middle, high school, and college levels.

Status: approved by the House and Senate, returned to the House for competition.

Senate bill 49: Statement of parental rights, would oblige public school staff to inform parents if a child asks to use a different name/pronoun; limits discussion of sexuality issues in K-4 grades; it gives parents the ability to sue school systems.

It hurts trans youth and it has to stop, she said at Tuesday’s rally. Science, medicine, and the law are clear: Gender-affirming assistance is needed to ensure that trans children in Arkansas, North Carolina and elsewhere can thrive and be healthy.

The bills come during Pride Month

Just hours before House Bill 808 was finally passed in the House of Representatives, leaders of the North Carolina Department of Health and Human Services hosted a virtual panel on health disparities for LGBTQ communities in North Carolina.

A department spokesperson told NC Health News the panel was planned in recognition of Pride Month and was not a response to any bill coming from the legislature.

Health and Human Services Secretary Kody Kinsley, who has spoken candidly about his experiences as a gay man, was joined by representatives from several advocacy organizations, including Equality NC, during the discussion. When asked what could be done to depoliticize public health, Kinsley replied that he is concerned that we have a science-based, fact-based literacy in our country that is very low.

A screenshot of a man in glasses and a blue shirt speaking during an online panel
North Carolina Department of Health and Human Services Secretary Kody Kinsley speaks during an online panel discussing health care disparities for LGBTQ communities in North Carolina on June 28, 2023. Credit: Screenshot from NC DHHS Zoom Facebook live event

One of the great shortcomings encountered during the COVID-19 pandemic was the inability of public health communities to translate their knowledge into information that the public could easily understand.

Waving an academic journal and pointing to a fact isn’t enough to educate the public, Kinsley said.

Another fundamental principle of public health is about interfering in people’s lives as little as possible for the most valuable outcome, Kinsley said.

During the debate on House Bill 808, Republicans and Democrats had been opposing each other with references to several research studies on gender-affirming treatment. Neither side has reached consensus on the efficacy and appropriateness of such treatment.

Kinsley never mentioned any specific policies during the discussion, although Artie Hartsell, director of strategic initiatives at Equality NC, did refer to gender-affirming care bills toward the panel’s conclusion.

We are in a time where rhetoric and misinformation are so rampant that we are seeing treatments withdrawn and treatments stigmatized that have been around for a long time, Hartsell said.

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