Eighteen Republican-led states are backing a Florida federal appeals court argument against government funding of transgender-related treatments, but Wyoming is not one of those states.
U.S. District Court Judge Robert Hinkle of northern Florida delivered a June 21 ruling invalidating a Florida Agency for Health Care Administration (AHCA) rule and a Florida law barring Medicaid coverage of most transgender-related treatments.
Essentially, the ruling compels Florida to give Medicaid money to cover puberty blockers and cross-hormone treatments for qualifying patients.
Cross-sex surgeries were not at issue in this case, titled Dekker v. Weida after its oldest plaintiff, 28-year-old transgender man August Dekker.
Florida authorities appealed Hinkle’s order, and on Friday, 18 states filed an amicus brief in the 11th Circuit Court of Appeals, arguing on Florida’s behalf and for their own interests in regulating Medicaid funding.
Those states are: Alabama, Arkansas, Tennessee, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Mississippi, Missouri, Montana, Nebraska, South Carolina, Texas, Utah, Virginia and West Virginia.
Neither Wyoming Gov. Mark Gordon’s office nor Attorney General Bridget Hill responded by publication time Tuesday to emails requesting comment on Wyoming’s decision not to join the brief.
About Eunuchs
In the brief, the states claim that Hinkle wrongly relied on medical and advocacy organizations that have stifled internal dissent and succumbed to political bias.
They also allege that:
- Hinkle applied a more rigorous standard of review to Florida’s actions than the 11th Circuit dictates for such cases.
- Hinkle wrongly treated Florida’s rule and statute as sex discrimination, when medical treatments depend fundamentally on the sex of patients.
- Hinkle wrongly handed to organizations the rule-making right that Florida’s elected and appointed governance should have.
“Medical interest groups, composed of physicians self-interested in Medicaid coverage, are not neutral arbiters of ‘medical opinion,’” reads the brief, which goes on to tackle such groups as the World Professional Association for Transgender Health (WPATH), the Endocrine Society and the American Academy of Pediatrics, saying the groups have stifled debate within their ranks to impose a false consensus on society.
“WPATH has taken its gender ideology to the extreme and included in its latest Standards an entire chapter on self-identified ‘eunuchs’ (and) deems castration ‘medically necessary gender-affirming care,’” says the brief. “By the district court’s logic, WPATH’s horrifying position means that Florida must now pay for self-identified eunuchs to be castrated.”
‘Pot Called The Kettle Black’
The 18 states’ argument against the alleged false medical consensus roughly mirrors that of Florida’s health agency during the original case in Hinkle’s court.
In his order, Hinkle rebuked that argument as disingenuous, and said it was the Florida health agency and Legislature, rather, that invoked political groupthink in crafting their bans on government funding for transgender-related treatments.
“If ever a pot called a kettle black, it is here,” wrote Hinkle. “The statute and the rule were an exercise in good politics, not good medicine.”
Ideology has driven WPATH and other groups toward embracing transgender-related treatments and government coverage for them because group members are often afraid to speak up and be thought bigots, Hinkle wrote.
But he expressed doubt that the member doctors are embracing these treatments to get government funding or more patients.
“It is fanciful to believe that all the many medical associations who have endorsed gender-affirming care … have so readily sold their patients down the river,” wrote the judge.
Because, Suspicious Terms
Hinkle’s order explains his choice of intermediate scrutiny – a higher standard of review for state laws than the 18 states claim he should have chosen.
Because the bans on Medicaid funding would apply differently to a teenage boy seeking testosterone to remedy low testosterone in his body, and a transgender boy seeking testosterone to transition, the law and rule draw a line based on sex, Hinkle reasoned.
That distinction raises court’s suspicions that a law could be discriminatory, wrote the judge.
The 18 states countered, saying it’s not a line based on sex, but a line based on treatment: remedying low testosterone where testosterone would naturally have occurred would be Medicaid-covered when medically necessary, whereas using testosterone to transition a patient from one gender to another would not, because Florida considers that experimental treatment.
The 11th Circuit has not yet filed a ruling on these issues in the case.
The Plaintiffs
August Dekker has received a double mastectomy but filed a lawsuit to demand continued Medicaid coverage for cross-sex hormones. Brit Rothstein, 20, a transgender man, received a crowd-funded double mastectomy via GoFundMe and sued for Medicaid-funded cross-sex hormones.
Two youths also joined this lawsuit along with their parents. One is a 13-year-old transgender girl who has been on puberty blockers for three years and wants to progress to cross-sex hormones like estrogen. Another is a 13-year-old transgender boy who also wants cross-sex hormones under Medicaid funding.
Not only did Hinkle invalidate the law and rule affecting these plaintiffs, the judge also ordered the Florida health agency specifically to cover their treatments.
The Florida health agency filed its appellant brief Oct. 6, contesting Hinkle’s decision.
A brief on behalf of the two adults and two children in the case is due Dec. 6.
Clair McFarland can be reached at clair@cowboystatedaily.com.
