HB1570 is Malicious Legislation
Arkansas legislators do not respect you.
On Tuesday, April 6, both houses of the Arkansas legislature overrode the governor’s veto and passed HB1570. Among other things, HB1570, the “Save Adolescents From Experimentation (SAFE) Act,” bans providing puberty blockers, hormone replacement therapy, or any surgeries as a treatment for gender dysphoria to anyone below 18. It is opposed by groups such as the American Medical Association, the American Psychiatric Association, and the American Academy of Pediatricians, among many others. The ACLU is currently preparing litigation in response to its passage.
That is the short of it, and is basically what you’ll hear in most news articles covering this story. However, there’s a bit more to be said. HB1570 is worse than commonly presented. That is partly the fault of the media, but more importantly, it’s the fault of the bill’s supporters. Arkansas legislators do not respect you; they do not want you to realize what exactly they’re doing, and would rather you think they’re making a sensible stand to keep children from receiving extreme treatments. In reality, this bill is an extreme overreach by the government, unsupported by reality, aimed towards the purpose of making the lives of the 13,000 transgender residents of Arkansas as difficult as possible.
These are large claims. To justify them, I will make reference to the bill itself (PDF).
First, let me remark on some of the wildly disingenuous arguments used to justify the bill in its opening.
2 (3) For the small percentage of children who are gender
3 nonconforming or experience distress at identifying with their biological
4 sex, studies consistently demonstrate that the majority come to identify with
5 their biological sex in adolescence or adulthood, thereby rendering most
6 physiological interventions unnecessary;
This bill targets anyone under 18. Research indicates that gender dysphoria is typically stable if it exists at adolescence, which begins well prior to 18. The bill is not targeted according to its own justifications. Yet even if it was limited to, say, those younger than 13, it still wouldn’t be justified. The studies consistently look at gender nonconforming and gender dysphoric youth with no clear division between the two. It is extremely rare to the point of nonexistence for interventions to be aimed at merely nonconforming preteens. It is a solution looking for a problem, and in the process merely creates a problem. It bans treatment for youth who need it on the pretext that there are youth who don’t, even though the youth that don’t need it don’t receive it. It is a prime example of Reagan’s remark that the scariest sentence is “I’m from the government, and I’m here to help.”
13 (5) Even among people who have undergone inpatient gender
14 reassignment procedures, suicide rates, psychiatric morbidities, and
15 mortality rates remain markedly elevated above the background population;
If the point of treatment is to align a population completely with the background population, then most treatments are trash. This is an incredibly unreasonable standard. Studies show that treatment does improve outcomes.
20 (B) The prescribing of puberty-blocking drugs is being
21 done despite the lack of any long-term longitudinal studies evaluating the
22 risks and benefits of using these drugs for the treatment of such distress or
23 gender transition;
24 (7) Healthcare providers are also prescribing cross-sex hormones
25 for children who experience distress at identifying with their biological
26 sex, despite the fact that no randomized clinical trials have been conducted
27 on the efficacy or safety of the use of cross-sex hormones in adults or
28 children for the purpose of treating such distress or gender transition;
Demanding a randomized control trial or longitudinal study before using a treatment is insane. Treatments are regularly prescribed off-label. For example, spironolactone is a common diuretic used for the purpose of lowering blood pressure. One side effect of it is that it lowers testosterone levels. In general, however, it’s pretty safe. Because of this, it is sometimes prescribed for women with PCOS — an illness which involves raised testosterone levels — with reasonable success. There is no legislation pending which aims to ban this treatment “despite the fact that no randomized clinical trails have been conducted on the efficacy or safety.”
I also want to point out that it mentions adults as well as children. First they say it’s for “children,” and then they make reference to studies looking at pre-adolescents, and then they apply the rules to anyone under 18… and now they’re mentioning adults. The aim is far wider than the advocates of these types of bills make it out to be, as they make clear here:
34 (13)(A) It is an accepted principle of economics and public
35 policy that when a service or product is subsidized or reimbursed, demand for
36 that service or product is increased.
1 (B) Between 2015 and 2016, gender reassignment surgeries
2 increased by nearly twenty percent (20%) in the United States;
3 (14) It is of grave concern to the General Assembly that the
4 medical community is allowing individuals who experience distress at
5 identifying with their biological sex to be subjects of irreversible and
6 drastic nongenital gender reassignment surgery and irreversible, permanently
7 sterilizing genital gender reassignment surgery, despite the lack of studies
8 showing that the benefits of such extreme interventions outweigh the risks;
10 (15) The risks of gender transition procedures far outweigh any
11 benefit at this stage of clinical study on these procedures.
The legislation explicitly states that it does not support any kind of affirming treatment for anyone, and does not want the government to do anything that might increase access to it. This is inane, as many medical organizations have tried to point out, but it seems Arkansas legislators are not particularly concerned with reality.
20 (1) "Biological sex” means the biological indication of male and
21 female in the context of reproductive potential or capacity, such as sex
22 chromosomes, naturally occurring sex hormones, gonads, and nonambiguous
23 internal and external genitalia present at birth, without regard to an
24 individual’s psychological, chosen, or subjective experience of gender;
I really want to stress that these anti-trans laws are also anti-intersex. I talk about transgender people a lot, but these laws and regulations frequently attempt to erase natural human sexual diversity. They provide specific carve-outs for people with “a medically verifiable disorder of sex development” to ensure that medically unnecessary and risky surgeries can be done on infants to force them into one biological sex category or another.
19 (c) Any amount paid by an individual or an entity during a taxable
20 year for provision of gender transition procedures or as premiums for health
21 care coverage that includes coverage for gender transition procedures is not
This is applicable to anyone, not just legal minors. This law makes it so that if your health insurance plan covers gender transition procedures, that is not tax-deductible. That is done because, as earlier stated, the Arkansas legislature believes that medical gender transition period is experimental and dangerous. Insurance companies are likely to pull their support for gender transition treatments completely in order to allow the majority of their patients which don’t need it to continue getting tax deductions. This provision is likely to make it so that gender transition care has to be paid for entirely out of pocket! And just to ensure this, the very last provision in the bill is as follows:
30 (c) A health benefit plan under an insurance policy or other plan
31 providing healthcare coverage in this state is not required to provide
32 coverage for gender transition procedures.
Let’s recap what we’ve learned.
HB1570 presents an incredibly, unreasonably high bar for what counts as an experimental treatment. It bans treatments that are supported by major medical organizations. It does so under the pretense that studies that look only or primarily at very young people, such as those 13 or younger, apply all the way up to age 18. It misrepresents those studies and ignores the studies which show benefits. It provides carve-outs for medically unnecessary and risky treatments while banning medically necessary and relatively safe treatments. Lastly, it does what they think they can get away with in making the lives of transgender adults harder.
If this doesn’t sound like the bill you’ve been hearing about, you aren’t the only one. The bill’s title and the support around it have all focused on those in their early teens or younger, and much of the support has aimed to be “commonsensical” — who would let children make such huge decisions? But the fact is that children don’t make these decisions. Legal guardians and medical health professionals do, with the youth’s assent. For the government to get in the way of that in this kind of way is almost unprecedented. In the times that it has happened, it has typically been because the treatments were widely regarded as harmful but a few doctors were providing them regardless. The opposite is true here: Gender affirming treatment, including for minors, is supported by every major professional medical and psychological association in the country.
Not only has the Arkansas legislature passed an extremely cruel and harmful bill, but they also don’t respect you. Not at all. They want you to think things that are simply, flatly untrue and mislead you about what they’re doing. It’s a heartless lie.
It’s a heartless lie that has passed into law, and is likely to galvanize those in the other 17 states that are considering similar laws. It’s a disaster.
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