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There are now 25 states with bans on trans health care for minors


Half of all U.S. states now ban gender-affirming care for minors. That became official yesterday when Governor Henry McMaster, a Republican, signed South Carolina's law. NPR's Selena Simmons-Duffin is here to bring us up to speed. Hey, Selena.


CHANG: OK, so tell us about this new law in South Carolina. Like, what's in it, exactly?

SIMMONS-DUFFIN: Well, it prohibits doctors from providing gender-affirming care like puberty blockers, hormones and surgery to transgender people younger than 18, although young people currently in treatment can continue through next January. Also, any doctor who performs surgery - which is extremely, extremely rare for minors in any case - could now face felony charges and up to 20 years in prison.


SIMMONS-DUFFIN: The law also prevents Medicaid from covering gender-affirming care, and it has provisions about parents being notified by schools if their kids are using a different name or pronouns at school.

CHANG: And I know that there are lots of similar bills across the country, right? But what's the backstory on this one?

SIMMONS-DUFFIN: Yeah, South Carolina has been trying to pass a bill like this for a few years now, and this session, lawmakers made it a priority. They framed the issue as protecting children from medical care they consider untested or harmful. And there's also a religious aspect to it. Here's the state's House majority leader, Davey Hiott, speaking to reporters in January.


DAVEY HIOTT: When God created us, he created us male and female, and that's it. There is no other choice. And all these other folks that want to change that from birth or change that through their life, we need to stand up against that.

SIMMONS-DUFFIN: He made those comments on the day of a subcommittee hearing that drew hours of public testimony, including from physicians and family members and trans people who strongly opposed the bill. Here's college student Elizabeth Foster testifying about her brother, who's trans. And she was very emotional.


ELIZABETH FOSTER: Anyone who knew Knox would swear to you that his happiness increased tenfold overnight once he came out. (Crying) He was friendlier, funnier, chattier and so much more confident. This joy is not in any way harmful or dangerous to any of you or any other South Carolinians.

SIMMONS-DUFFIN: Her brother is now in college in Canada, so she came to tell lawmakers about his experience. And now that the bill has passed and the governor has signed it, it takes effect right away.

CHANG: Well, Selena, I mean, the fact that this is the 25th state with some kind of ban on gender-affirming care for minors, I mean, it seems kind of striking. What do you make of this trend?

SIMMONS-DUFFIN: Yeah. You know, I've been asking sources about how this started - you know, just two years ago. And the laws are similar to each other. They use similar language, but they're not carbon copies. Lindsey Dawson directs LGBT policy at the research group KFF. I asked her what she thought kicked this off.

LINDSEY DAWSON: I can't point to a specific external event, but it's almost as if these policies were like wildfire. And once a handful had enacted them, other states followed suit.

SIMMONS-DUFFIN: She also makes an interesting point that one thing all of these laws do have in common is that they have an exception.

DAWSON: There are exceptions for youth who need to access these services, the very same services that are prohibited, for non-gender-affirming care purposes.

SIMMONS-DUFFIN: So these same treatments are legal for kids who are not trans. For example, young people with early puberty or who are intersex. And it's also worth noting that it's not just laws about medical care that have been passing. There have been, also, a lot of new laws about trans young people and school bathrooms and sports.

CHANG: Right. Well, I know some of these laws are facing legal challenges, right? What's happening in the courts?

SIMMONS-DUFFIN: Yeah, that's true. Of the 25 states, Dawson says more than half have been challenged in courts. Some judges have blocked these laws or blocked them in part. Those challenging them argue that they violate the Constitution's equal protection clause and discriminate on the basis of sex. And the Supreme Court has actually been asked to consider the challenges to Tennessee and Kentucky's laws. So we'll see whether the justices decide to weigh in. That decision could come soon.

CHANG: That is NPR's Selena Simmons-Duffin. Thank you so much, Selena.

SIMMONS-DUFFIN: Thank you, Ailsa. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Selena Simmons-Duffin reports on health policy for NPR.