Attorney General Bonta Leads Coalition Urging Court to Protect Access to Healthcare for Transgender Teenagers

OAKLAND – California Attorney General Rob Bonta today led a coalition of state attorneys general in support of a challenge to an unconstitutional Arkansas law that prohibits healthcare professionals from providing transgender teenagers with medically necessary care. The coalition of 21 attorneys general filed an amicus brief in the U.S. Court of Appeals for the Eighth Circuit urging the court to affirm a district court judgment that blocked enforcement of Arkansas Act 626, the “Save Adolescents from Experimentation” or SAFE Act. Despite medical consensus that gender-affirming care has a positive impact on adolescents with gender dysphoria, the law seeks to prohibit physicians and other healthcare providers from referring or providing this treatment to minors.

“There are rights in this country that are inalienable and true for all, and the right to live with dignity, free from discrimination is one of them,” said Attorney General Rob Bonta. “Prohibiting young people from accessing healthcare that has been deemed medically necessary is irresponsible and not based in science or reason. In California, our laws seek to promote access to healthcare, not restrict it. My office will work to ensure Californians and all Americans are able to receive gender-affirming care in any state in this country.”

"It's unconscionable that anti-LGBTQ+ politicians in Arkansas have chosen to attack transgender children instead of loving, supporting and empowering them," said Equality California Executive Director Tony Hoang. "Every child deserves access to quality, affirming healthcare, no matter who they are or where they live. Attorney General Bonta has been a powerful champion for the trans community, and we are so grateful to him for his leadership in this fight."

“The pandemic has made plain that fair and equal access to health care must be a critical part of everyone’s lives across our nation, especially for our most vulnerable,” said California State Insurance Commissioner Ricardo Lara, who has spearheaded efforts for transgender youth to have access to gender-affirming medical care. “For years, I have fought to combat discrimination, push for equitable access to care, and advocate for health care for all, including for our LGBTQ+ community and transgender youth. I am proud to support Attorney General Bonta in this legal challenge to ensure that there are no barriers for our transgender youth to receive the necessary medical care they need to be their authentic selves.”

At Commissioner Lara's direction, the Department of Insurance issued a General Counsel Opinion Letter in December 2020 clarifying that, under existing California law, health insurance companies may not deny gender-affirming care based solely on a patient’s age.

On April 6, 2021, the Arkansas General Assembly passed Act 626, which bans healthcare providers from providing gender-affirming treatment to transgender teenagers and even providing referrals for such treatment. Under the law, healthcare providers who failed to comply could lose their professional license and be at risk of professional discipline.

On July 21, 2021, a district court granted a motion for a preliminary injunction blocking the law, and in August, the court enjoined the Arkansas Attorney General’s Office from enforcing any provision of Act 626 during litigation of the case.

Arkansas is the only state with a law banning medical treatments prescribed for gender transition. In today’s amicus brief, Attorney General Bonta explains that the law violates the Equal Protection Clause of the Fourteenth Amendment to the U.S. Constitution.

Transgender people with gender dysphoria often suffer from severe distress due to the stigma associated with their gender identity. Among transgender people, there are higher rates of having serious thoughts of suicide and actual attempts at suicide than the overall U.S. population. Those risks are even higher among transgender youth. According to research cited in today’s brief, including information from the California Department of Insurance, U.S. Centers for Disease Control and Prevention (CDC), and the UCLA Williams Institute, unaddressed gender dysphoria can impact quality of life, cause fatigue, and trigger decreased social functioning, including reliance on drugs and alcohol to cope with the impacts of discrimination, and lead to increased risk of HIV and AIDS due to inadequate access to care.

A survey in the Journal of Adolescent Health found that for youth under the age of 18, the use of gender-affirming hormone therapy was associated with 39% lower odds of recent depression and 38% lower odds of attempting suicide in the past year compared to youth who wanted but did not receive such therapy.

The CDC found that transgender students were more likely to report being threatened or injured with a weapon at school, experiencing sexual dating violence, physical dating violence, bullying at school, electronic bullying, and feel unsafe at or traveling to or from school.

In today’s brief, the attorneys general argue that access to gender-affirming healthcare must be protected, as it adheres to well-accepted medical standards.

In California, longstanding laws and regulations have ensured that transgender patients are not denied or limited coverage for ordinarily available healthcare. California’s Medi-Cal program has prohibited exclusions for gender-affirming care since 2001. Private insurance plans are also prohibited from excluding gender-affirming care under a 2012 rule.

The attorneys general also argue that decisions made between children, their families, and their doctors that are based on widely-accepted medical practices should be protected. Analysis has shown that while removing medical exclusions for transgender patients has had little impact on premium costs, the benefits have had a major impact on transgender people – including reduced suicide risk and lower rates of substance use.

In filing today’s amicus brief, Attorney General Bonta was joined by the attorneys general of Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, Washington, and the District of Columbia.

A copy of the amicus brief is available here.