‘Pure Cruelty’: Florida Is Stepping Up Its War on Trans People

Florida Gov. Ron DeSantis launched a full-scale attack on access to transgender healthcare in his state.

The DeSantis administration made twin proposals Thursday to not only to stop minors from accessing gender-affirming care, but also prevent trans adults on Medicaid from doing the same.

The moves would severely limit access to care for transgender youth and adults, which are recommended by major medical groups such as the American Medical Association and American Academy of Pediatrics as key to improving quality of life and mental health for a group already more susceptible to depression and self-harm as a result of discrimination and alienation in society.  

The DeSantis administration released a 46-page report Thursday arguing that transgender healthcare should be banned for Medicaid recipients, saying that existing medical literature “provides insufficient evidence that sex reassignment through medical intervention is a safe and effective treatment for gender dysphoria,” and claiming that such studies which show the opposite are “either low or very low quality and rely on unreliable methods such as surveys and retrospective analyses.” 

The DeSantis administration will “now initiate the rulemaking process regarding the Medicaid program’s coverage treatments for gender dysphoria,” according to a press release announcing the report.  

Despite claims dismissing the quality of the studies, the report references “rapid-onset gender dysphoria,” which was coined in a 2018 study by a Brown University researcher which has been the subject of intense criticism of both its methods and findings ever since. 

Though Medicaid is jointly funded by the federal government and the states, it is administered by the states. Ten states explicitly ban coverage of gender-affirming care for transgender people, though a federal judge struck down a law in Iowa doing so last year. (The Affordable Care Act “prohibits discrimination” on the basis of gender identity.)  

“This is just pure cruelty to low income trans people,” tweeted lawyer and journalist Alejandra Caraballo, a Harvard Law School clinical instructor. 

The American Medical Association and American Academy of Pediatrics have repeatedly defended the use of gender-affirming care to treat transgender patients. 

“In my care of more than 200 transgender youth, I’ve seen the incredible relief and affirmation that these tools can provide,” Dr. Brittany Allen, associate professor of pediatrics at University of Wisconsin School of Medicine and Public Health and co-director of a transgender clinic at American Family Children’s Hospital, said in a statement provided by the AAP earlier this year. 

“Every major medical association in the United States recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people,” the AMA said in a statement last year opposing a law banning gender-affirming care for minors in Arkansas. 

But just hours after release of the report arguing gender-affirming are shouldn’t be covered for transgender adults on Medicaid, Florida Surgeons General Dr. Joseph Ladapo—who has also emerged as a vocal critic of COVID-19 mitigation efforts such as masks and vaccines—wrote in a letter to the Florida Board of Medicine that the science referenced by the AMA “extraordinarily weak” and politically motivated, and asked the board to effectively ban care for transgender youth.

“Florida must do more to protect children from politics-based medicine,” Ladapo wrote, according to a letter obtained by NBC News. 

When Ladapo was appointed by DeSantis last year, an unnamed former supervisor at the University of California, Los Angeles declined to endorse him for the job, saying “the people of Florida would be better served by a surgeon general who grounds his policy decisions and recommendations in the best scientific evidence rather than opinions,” the AP reported in February. (A Florida Department of Health spokesperson dismissed this at the time as a “smear” from a “disgruntled supervisor.”) 

The twin proposals announced Thursday—which are described as aligning the state with “generally accepted professional medical standards,” despite being opposed by major medical groups—come at a time of increasing attacks from Republicans on transgender existence.

The DeSantis administration’s moves, which come at the start of LGBTQ Pride Month and follow the “Don’t Say Gay” law signed by DeSantis prohibiting classroom discussions of LGBTQ identity in schools, were slammed by transgender advocates and medical professionals Thursday.

“It’s unconstitutional for the government to step in and deprive youth—and especially trans youth—of getting the necessary medical care they need,” Tampa psychologist Gary Howell told NBC News. “This interferes with the rights of parents.”

“He’s trying to take the freedom of trans ADULTS to access healthcare and of parents to care for their kids,” Florida state Rep. Carlos G. Smith, a Democrat who is openly gay, said in a Thursday tweet. “There’s no consistent or conservative ideology here. Just cruelty and a willingness to use vulnerable people to advance his presidential dreams.”

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