A Republican-backed budget bill advancing through the Iowa Senate could stop Medicaid and other taxpayer-funded programs from covering gender-affirming care for transgender residents.
The legislation follows years of attempts by Iowa lawmakers to restrict such care, though the latest effort comes amid significant changes to the state’s civil rights protections.
Newsweek has contacted Republican state senator Mark Costello, who chairs the Senate’s health and human services appropriations subcommittee, for comment outside of regular working hours.
Why It Matters
President Donald Trump has taken multiple steps to unravel protections for transgender people since returning to the White House.
Following his inauguration on January 20, Trump issued an executive order stating that it is “the policy of the United States to recognize two sexes, male and female.” He has targeted gender-affirming care for transgender youths, banned trans people from serving in the military, and excluded trans women from competing in female sports.
What To Know
The proposal is part of the Iowa Senate’s Health and Human Services budget bill. The language specifically bars the use of general fund money for “sex reassignment surgery or treatment related to an individual’s gender dysphoria diagnosis.” That could include surgeries, hormone therapy, and mental health services.
If passed, the measure would block transgender Iowans on Medicaid from receiving medically recognized care for gender dysphoria.
Critics argue this could harm some of Iowa’s most vulnerable residents. Democratic state senator Janet Petersen said, according to Des Moines Register: “I believe it’s unconstitutional. Of course, I’m not an attorney so maybe you’d need to ask an attorney, but that would be my opinion.”
The Iowa House introduced its own budget measure on April 30 that does not include restrictions on gender-affirming care.
Republican representative Ann Meyer said House Republicans may favor excluding taxpayer dollars from surgeries and hormones, but said mental health services should remain covered.
The bill comes after a major shift in state law. Earlier this year, Iowa Governor Kim Reynolds signed legislation removing gender identity from the Iowa Civil Rights Act, eliminating specific state protections for transgender people against discrimination.
What People Are Saying
Max Mowitz, executive director of the LGBTQ equality organization One Iowa, told a Senate subcommittee hearing, according to Des Moines Register: “Gender dysphoria, if it goes untreated causes anxiety, depression, suicidal ideation. It would put additional strain on other systems that would need to support these folks that can’t access the care that they need. And I don’t know why we would be removing access to care that is medically necessary that we know folks need to be able to have.”
He added: “You can’t actually access most gender affirming care without mental health care, and a lot of mental health care is used in the treatment of gender dysphoria. So even if you object to the idea of someone accessing surgery or hormones, mental health care is still necessary to provide that care.”
What Happens Next
The bill has passed a Senate subcommittee on a 2-1 vote, and can now progress to review by the Senate Appropriations Committee.
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