BATTLE LINES — It’s a presidential election first: the issue of gender-affirming care, especially for those under 18, is front and center in the 2024 Republican primary. The bulk of candidates have taken hardline stances against gender-affirming care for minors, matching Republican state lawmakers across the country who have targeted legislative efforts toward restricting it. Yet there also are a few voices of moderation in the GOP field, including former New Jersey Gov. Chris Christie and former Arkansas Gov. Asa Hutchinson, raising the likelihood that the issue surfaces at the Aug. 23 presidential debate. Hutchinson vetoed a ban on gender-affirming care for minors as governor in 2021, and has continued to oppose similar bans, citing concerns about government involvement in family life. Christie has made similar arguments , walking the line between the party's widespread opposition to transgender healthcare and traditional conservative wariness of government overreach. “Parents should be the ones who work with their children to work through some of these difficult problems,” Christie said Sunday on Face the Nation . “You're talking about over the last three years, less than a thousand minors who have been involved in this in terms of transitioning in — in a country of 330 million people. That's what I'm talking about in terms of small, it's not that the issues don't matter. It's that they don't matter to the great, vast number of people in this country who want to be helped.” At least 20 states have laws limiting access on gender-affirming care for minors, including gender-affirming surgery, as well as puberty blockers and other hormonal treatments. In response, Democrats in largely blue states have passed “shield” laws protecting access to care in the state, accommodating those who travel to receive care and the doctors that treat them. But given the financial burden of relocation and the long waitlists to receive care in states where it is available, lawmakers and activists alike are hoping that Congress will take larger-scale action on the issue. In March, Representatives Pramila Jayapal (D-Wash.) and Ed Markey (D-Mass.) introduced a Transgender Bill of Rights, a series of protections for transgender people which includes “recognizing the right to bodily autonomy and ethical healthcare by expanding access to gender-affirming medical care” and “protecting transgender people from discrimination in healthcare.” A ruling out of Tennessee’s 6th Circuit last week marked the first time a federal court permitted a ban on gender-affirming care for minors to take effect. Now, Democratic state lawmakers are scrambling to secure protection against similar bans — and pushing Congress for more action on the issue. “I would love to see, across the nation, standards that are set by our Congress, leveling the playing field from a legislative perspective,” said Vermont state Rep. Taylor Small. “ I think one way that we can get progress going on the national scale is when we see individual states stepping up, and affirming these rights and values that we share and hold. That only puts further legislative pressure to have this be a nationwide policy rather than piecemeal.” Defenders of transgender medical care for minors cite the approval it has received by medical associations like the American Medical Association and the American Academy of Pediatrics as a potentially life saving treatment. Opponents have argued that youth lack the maturity to make life-altering medical decisions and have cast doubt on the long-term medical outcomes of gender-affirming surgery in particular. Gender-affirming surgery is uncommon among minors; according to one estimate , in 2021, about 42,000 children and teens across the United States received a diagnosis of gender dysphoria. Bans on gender-affirming care have been challenged — and resoundingly blocked — in federal courts, including in Arkansas , Alabama , Florida , Indiana and Kentucky . The Tennessee decision allowing a ban on gender-affirming care to take effect marked a “radical departure” from precedent, said Beth Littrell, a senior supervising attorney at the Southern Poverty Law Center. With the ban in place, Tennessee medical providers will be prohibited from providing gender-affirming care to minors. Youth who leave Tennessee to seek care would be protected under shield laws like the ones passed in several blue states, which largely exempt recipients and providers of gender-affirming care in that state against criminal charges originating in states where it is banned. In Colorado, Democratic state Rep. Brianna Titone sponsored such a bill adding protections for patients seeking gender-affirming care in the state, as well as Colorado providers who treat them. Transgender youth and their families increasingly find themselves forced to travel across state lines to receive care . State Rep. Leigh Finke (D-Minn.) said that people enter Minnesota frequently to receive care now that the state is a “gender-affirming care island in the upper Midwest,” surrounded by states where care has been restricted. Many also choose to make those relocations permanent, she said. “People don't want to go to a state to receive health care and then return to a state where their children or their own identities are being targeted,” Finke said. “So there’s more relocation now than we expected when we started this at the beginning of the session and I think that is a trend that will continue.” Welcome to POLITICO Nightly. Reach out with news, tips and ideas at nightly@politico.com . Or contact tonight’s author at lhodgman@politico.com or on Twitter at @lucyehodgman .
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