When Oklahoma lawmakers met last week to distribute more than $108 million in federal pandemic relief funds for one of the state’s largest hospital systems, many expected a routine vote in favor of upgrading its medical records and a cancer-treatment center.
The move, which Oklahoma Gov. Kevin J. Stitt (R) signed into law on Tuesday, marks the first time conservative state lawmakers have successfully tied gender-affirming care to the receipt of funds from the American Rescue Plan Act (ARPA), the $1.9 trillion effort to restart the economy and harden medical care during the coronavirus pandemic.
Oklahoma Republicans, who were pushed into action through a campaign led by a pair of conservative podcasters, hailed the move as necessary to restrict the type of medical care for young transgender patients that has riled the party’s base this year.
“By signing this bill today we are taking the first step to protect children from permanent gender transition surgeries and therapies,” Stitt said in a statement. “It is wildly inappropriate for taxpayer dollars to be used for condoning, promoting, or performing these types of controversial procedures on healthy children.”
Some advocates worry the latest move in Oklahoma might embolden other legislatures with Republican majorities to add similar restrictions before allocating federal and state money to publicly funded hospitals and clinics. Hundreds of anti-LGBTQ bills have been introduced in state legislatures in recent years. This year, at least 160 measures were considered, with nearly two-thirds of them focused on transgender rights. Oklahoma was part of this trend, with bills restricting bathrooms and sports access for transgender residents.
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Transgender advocates and medical experts, though, say OU Health’s facilities had been following best practices in its gender-affirming care. OU Health officials would not outline which services will halt as a result of the legislation. But one Oklahoma pediatrician who treats transgender youth in the region said she believes all hormone therapy and surgeries will cease: “In order to receive this treatment, they will now have to go out-of-state,” Shauna Lawlis said. About 100 children are receiving gender-affirming care at the center, Democratic state Sen. Carri Hicks told reporters.
Parents of transgender children who are receiving care at Oklahoma Children’s Hospital say they may have to travel to Kansas or Colorado. Shane Poindexter, whose 14-year-old transgender son has been treated at the hospital for a year and is receiving hormone suppression drugs, said his son had attempted suicide before going to the clinic.
“It is someplace they can go and be who they are and be accepted. Kids are bullies,” Poindexter said. “It was mentally destroying him. The love and affection from that place is amazing. We don’t know what we are going to do now.”
The federal stimulus included about $350 billion to prop up state and local government budgets with virtually no strings attached. By late last year, as it became clear that the economy was recovering far faster than lawmakers had expected, it paved the way for states to put the aid to use in unanticipated ways.
In Oklahoma, the legislature opened a public portal last year, allowing any state resident to submit a request for the discretionary funds. They received more than 1,400 proposals that a state legislative committee reviewed this summer before sending dozens of them to the full legislature for a vote.
The state and local funds are part of a bigger pool of nearly $5 trillion that Washington sent out in the first two years of the pandemic, creating an unprecedented challenge to account for how the money was spent. With almost no rules on how states used their share, some Republican governors have tried to pay for tax cuts with the aid, for example. In Florida, Gov. Ron DeSantis and other GOP state legislators used interest they earned on federal aid to pay for a $12 million fund that covered the cost of flying migrants to Massachusetts last month.
Children’s hospitals around the country have also faced escalating threats of violence over online anti-LGBTQ campaigns targeting gender-affirming care. Some states have taken other actions to block public funds from being used for transgender care; this year, Florida became one of at least 10 states that have blocked Medicaid coverage for the procedures.
“It’s so outrageous and unbelievably mean-spirited,” said Cathryn Oakley, state legislative director and senior counsel at the Human Rights Campaign, which advocates for the LGBTQ community, in reference to Oklahoma’s bill. “It’s literally about covid relief. It’s about restarting the economy.”
The push to end OU Health’s transgender care was accelerated by two conservative podcasters who last month began demanding action from legislators on their programs and social media.
The target of their ire was the Roy G. Biv Program at Oklahoma Children’s Hospital, which for the last six years has offered mental health counseling and hormone therapy, including puberty blockers. In a handful of cases, it has also referred patients transitioning from female to male to surgeons for mastectomies.
Mark Ousley appealed to his 20,000 Twitter followers and listeners to his Oklahoma-based “UnWokable Podcast” in mid-September to call on lawmakers and demand OU Health’s federal money be withheld. He was later joined by Megan Fox, a conservative podcaster who broadcast the calls she made to lawmakers and provided her 23,000 Twitter followers with scripts to do the same.
“I am going to make it my mission in life to shame any Republican that votes for this,” Ousley wrote in a Sept. 25 tweet.
Transgender advocates and Oklahoma lawmakers said the campaign had a noticeable effect.
“One of them spent the entire day live-streaming, calling legislative staff, asking them why they were committing child abuse,” said Cindy Nguyen, policy director for the American Civil Liberties Union of Oklahoma. “There was a lot of inflammatory language; it built momentum.”
Republicans introduced the bill Sept. 28. In a debate on Thursday, Republican lawmakers argued young patients were taking hormones that could be physically damaging — something that the American Medical Association disputes — and said all transitioning surgeries for Oklahomans under 18 should be outlawed.
“To promote and help facilitate with taxpayer money, the gender reassignment should be disallowed in this state,” state Sen. Jake A. Merrick (R) said. “I think it reflects the majority of the opinions and values held in this state.”
Several Democratic lawmakers in the House, meanwhile, yielded their time to state Rep. Mauree Turner (D), Oklahoma’s first openly nonbinary legislator who appealed to their colleagues to not be influenced by the social media and phone call campaign.
“I hope that one day you understand maybe a little bit of what it’s like to be born into a body that isn’t yours. That’s what our youth across Oklahoma are facing,” Turner said, adding that they “came out” to their mother in the second grade. “Oklahoma has the money to take care of our people, and we do not have to wage this war against them and we don’t have to use our children, our youth, as pawns. Please vote no.”
The bill passed the House 68-23, following a Senate approval at 31-13. Although the votes were largely along party lines, a few Republicans in both chambers voted against the bill, either because they said the language targeting the OU Health program wasn’t strong enough or because they were opposed to accepting and doling out the pandemic relief funds altogether.
OU Health reacted quickly to the measure, saying last week that it was already “proactively planning the ceasing of certain gender medicine services.”
But Richard Lofgren, president and CEO of OU Health, sent an email on Friday to employees of the health-care system, saying that although he knew some members of the legislature might introduce bills targeting the transgender program, he “did not expect it to be tagged to the ARPA request.”
Lofgren also expressed dismay that the legislature required that the transgender medical care stop immediately.
“We were not provided with a reasonable timeline to safely transition the care of our patients,” he wrote in the email that was obtained by The Washington Post. “For our physicians, it is morally distressing to the guiding principles of our profession and our Hippocratic oath to not be able to provide a safe transition of care, but we have to comply with the law.”
A group of Republican lawmakers — and the podcasters — are pushing for more. Last week, a group of senators held a news conference saying the next step should be a permanent, statewide ban on medical services that assist Oklahoma youth with gender transitioning.
“We should have an immediate statewide prohibition on these surgeries, on these puberty blockers, on what is being done to these children,” state Sen. Nathan Dahm (R), who recently appeared on Ousley’s podcast, said at the news conference. Dahm, who has previously introduced legislation on this topic but has so far failed to get a hearing, did not respond to calls seeking comment.
On Saturday, Republican lawmakers continued to push for a statewide ban, appealing to Stitt to call another special session. “We can’t wait until session and then HOPE we can get something passed. This is YOUR moment!,” Merrick said in tweet, tagging both Fox and Ousley. The post came days after Merrick appeared on Ousley’s podcast. Merrick did not respond to a call seeking comment.
But Stitt on Tuesday said he won’t call another special session on the matter, and instead called for a permanent ban on the treatments to be passed next year.
“I am calling for the Legislature to ban all irreversible gender transition surgeries and hormone therapies on minors when they convene next session in February 2023,” he said.
Advocates say the bill Stitt signed on Tuesday has already set a dangerous precedent.
“It’s about funding health care for children, and they are making that contingent on them denying medically necessary care for them on the basis of discrimination and gender identity,” Oakley said.
Alice Crites and Tony Romm contributed to this report.